8 December 2021 – Daily Current Affairs

HYDOGEN SULPHIDE SUPPRESSES HIV

Finding could lead to more comprehensive antiretroviral therapy against disease

Researchers at the Indian Institute of Science (IISc) and their collaborators have identified a key role played by hydrogen
sulfide (H2S) gas in suppressing the human immunodeficiency virus (HIV). Increased H2S was found to have a direct effect
on reducing the rate at which the virus multiplies in HIV-infected human immune cells. The finding paves the way for
developing a more comprehensive antiretroviral therapy against HIV.

The team included researchers from the Department of Microbiology and Cell Biology (MCB) and the Centre for Infectious
Disease Research (CIDR) at IISc, along with collaborators from the Bangalore Medical College and Research Institute. The
results are published in the journal eLife.

Current state-of-the-art combined antiretroviral therapy (cART) is not a cure for HIV. It can only suppress the virus—cause
it to become latent. Unfortunately, in some cases, cART is known to fail even when patients fully follow their drug regimen.
Certain negative effects are also associated with cART, such as the build-up of toxic molecules, leading to oxidative
stress and loss of function in the mitochondria, the cell’s powerhouse. These effects can contribute to inflammation and
organ damage. Stopping cART is also not an option because the virus can reactivate—emerge from its latent state—in the
absence of therapy.

Scientists have recently begun exploring the beneficial effects of the presence of H2S in HIV-infected cells on both oxidative
stress and mitochondrial dysfunction, according to Amit Singh, Associate Professor in MCB/CIDR and corresponding
author of this study.

In a previous study, Singh’s lab developed a tool to measure oxidative stress in cells infected with HIV. “In that work, we
showed that the chemical agent N-acetylcysteine was able to suppress HIV reactivation from latently infected cells,” he
explains. “A German study later showed that N-acetylcysteine partly acts by releasing H2S molecules, which is when we
began examining its role.” Previous work from Singh’s lab has also looked at the effects of counteracting oxidative stress
by an antioxidant nanozyme during HIV infection. “Since H2S also functions as an antioxidant molecule, we wished to see
whether our prior insights on oxidative stress and HIV could be translated to show the contribution of H2S on HIV infection.”

Singh adds, “This opens the door to supplementing cART with chemical donors of H2S to lock HIV in a state of deep
latency, potentially improving the lives of millions infected with the virus. Since H2S donors are already undergoing clinical
trials for other diseases, they can quickly be repurposed for HIV treatment.”

ABOUT HYDROGEN SULFIDE

Hydrogen sulfide (also known as H2S, sewer gas, swamp gas, stink damp, and sour damp) is a colorless gas known for its pungent
“rotten egg” odor at low concentrations. It is extremely flammable and highly toxic.

Hydrogen sulfide is used or produced in a number of industries, such as

 Oil and gas refining
 Mining
 Tanning
 Pulp and paper processing
 Rayon manufacturing
 Hydrogen sulfide also occurs naturally in sewers, manure pits, well water, oil and gas wells, and volcanoes. Because it is
heavier than air, hydrogen sulfide can collect in low-lying and enclosed spaces, such as manholes, sewers, and underground
telephone vaults. Its presence makes work in confined spaces potentially very dangerous.
 The health effects of hydrogen sulfide depend on how much H2S a worker breathes and for how long. However, many effects
are seen even at low concentrations. Effects range from mild, headaches or eye irritation, to very serious, unconsciousness
and death.

THE INDIA-RUSSIA MILITARY ALLIANCE

What is the status of the defence sales between Russia and India? Apart from sales, what other forms of military cooperation have the two countries agreed to?

The story so far: At the 20th meeting of the India-Russia Inter-Governmental Commission on Military & Military Technical
Cooperation on Monday, the two sides concluded four agreements, contracts and a protocol. While three documents were
signed by the ofcials of the two sides, the protocol was signed by the two Defence Ministers. This includes an agreement
for manufacture of over 6 lakh AK-203 assault rifes in India and the renewal of the agreement on military cooperation till
2031. The two sides have reafrmed their long-standing and deep-rooted defence and strategic cooperation through the visit.

WHAT IS THE STATUS OF THE DEFENCE TRADE BETWEEN THE TWO COUNTRIES?

Russia continues to be among India’s biggest defence suppliers and the two sides are now looking to move from licence
manufacture to joint research and co-development of defence equipment. Monday’s agreement will see the manufacture of
6,01,427 AK-203 7.63X39mm assault rifes by a Joint Venture, Indo-Russian Rifes Private Ltd, at Korwa, Amethi, in U.P.
This is among a series of defence agreements signed between the two sides in the last few years. Russia has started deliveries
of the S-400 Triumf long-range air defence systems to India. The frst division will be delivered by the end of 2021, Dmitry
Shugaev, Director of Federal Service for Military-Technical Cooperation (FSMTC), said recently. With the $5.43 billion
S-400 as well as other big ticket deals, the defence trade between India and Russia since 2018 has crossed $15 billion. Mr.
Shugaev added that Russia’s sales with India is about 25% of the total arms exports.

There are several other big-ticket deals currently under negotiation and expected to be concluded in the near future. These
include procurement of 21 Mig-29s and 12 Su-30MKI fghters, Igla-S short-range air defence systems and the long-delayed
deal for manufacture of 200 K-226T utility helicopters in India for which ofcials say the issues surrounding the
indigenisation plan are yet to be resolved. In addition to the S-400, other major contracts currently under implementation
are construction of additional stealth frigates in Russia and India, licensed production of the Mango Armour-piercing
discarding sabot (APFSDS) rounds for the T-90S tanks as also additional T-90S tanks. Some of the largest deliveries by
Russia to India since 2000, include supply and licensed production of T-90S tanks, aircraft carrier INS Vikramaditya, Krivak
class stealth frigates, licence production of Su-30MKI fghter aircraft, Smerch multiple rocket launchers and Mi-17V-5
helicopters among others.

WHAT ARE THE OTHER AVENUES OF COOPERATION OTHER THAN DEFENCE SALES?

On a broader military cooperation, a bilateral logistics support agreement, Reciprocal Exchange of Logistics Agreement
(RELOS), as well as a Navy to Navy cooperation MoU are at advanced stages of conclusion. The RELOS, which has seen
several delays, gives India access to Russian facilities in the Arctic region which is seeing increased global activity as new
shipping routes open up and in the backdrop, India’s own investments in the Russian Far East. Underscoring the deep
military to military partnership, the two countries have held a series of exercises both bilateral and multilateral, even during
the COVID pandemic.

The two sides are now looking at expanding format of exercises to make them more complex, more sophisticated for
exchange of experiences with regard to real time combat situations, including mobilisation of forces and their transportation
across long distances, instant exercises, the impact of cyber, and the huge impact of drone technology on modern warfare,
ofcials said. In addition, the two countries are also looking at ideas for expanding India-Russia cooperation in Central Asia
and “possibility of supplementing bilateral exercises with trilateral and multilateral ones – we are in discussion with the
Russian side”, the outgoing Indian Envoy in Russia D.B. Venkatesh Varma, told The Hindu in August.

WHAT IS THE FUTURE TRAJECTORY OF THE DEFENCE COOPERATION?

Timely supply of spares and support to the large inventory of Russian hardware in service with Indian military has been a
major issue from India. To address this, Russia has made legislative changes allowing its companies to set up joint ventures
in India to address it following an Inter-Governmental Agreement signed in 2019. This is in the process of being
implemented. With increased competition from the U.S., France, Israel and others who have bagged major deals in recent
years, Russia is also focusing on timely deliveries and lifetime support. Russia will remain a key defence partner for India
for decades to come, Mr. Varma had said. In line with India’s quest for self sufciency, the partnership is reorienting
presently to joint research and development, co-development and joint production of advanced defence technology and
systems, the joint statement issued at the end of the visit of Russian President Vladimir Putin said. In line with this, the two
countries have been discussing how they can cooperate in using India as a production base for exporting to third countries
Russian-origin equipment and services. “Today we are conducting joint research work on more than 100 promising topics,
laying the huge groundwork for the development of high-tech industry in both countries in the future,” said Alexander
Mikheev, Director General of Rosoboronexport on Monday.

AFSPA: WHO RULES INDIA

The problems in troubled areas such as Jammu and Kashmir and parts of the Northeast should be solved through a political
process and not through a law that violates people’s right to life and dignity

Following the botched Army operation in Nagaland that resulted in the tragic death of 14 civilians, demands for the repeal
of the Armed Forces (Special Powers) Act (AFSPA) have gained momentum. In this piece dated February 12, 2013, Walter
Fernandes argues that AFSPA has not only provided blanket impunity to the armed forces in disturbed areas but also failed
from the security point of view, with militant groups continuing to grow. He argues that the problems in troubled areas
such as Jammu and Kashmir and parts of the Northeast should be solved through a political process and not through a law
that violates people’s right to life and dignity.

Edited excerpts: Finally a senior Union Minister has made ofcial what many knew already. The Government cannot even
make the Armed Forces Special Powers Act (AFSPA) more human because the army does not want it diluted, leave alone
repealed. In his K. Subramanyam Memorial Lecture on February 6, 2013 at the Institute of Defence Studies Mr P.
Chidambaram said “We can’t move forward because there is no consensus. The present and former Army Chiefs have
taken a strong position that the Act should not be amended (and) do not want the government notifcation … to be taken
back. How does the government … make the AFSPA a more humanitarian law?”

WHOSE COUNTRY IS IT?

The first question it raises is: “Who rules India: The elected representatives or the army?” The second is “Why does the
army oppose even dilution of the Act to make it more human?” The Justice Verma Commission has said in unequivocal
terms that security persons who rape women should be judged under the same act that applies to the civilians. A similar
stand has been taken by others. In 2005 the Jeevan Reddy Commission said that AFSPA should be repealed and the clauses
that are required should be included in other Acts. Mr R. N. Ravi, former head of the Intelligence Bureau for the North East
is on record that AFSPA is the biggest obstacle to peace in the region. Former Home Secretary Mr G. K. Pillai has come
out openly against the Act.

These statements are not emotional outbursts. They come from persons who have worked in the system and know the
dynamics of the Act and of running the Government. But the army is opposing even this change. What is their rationale for
thinking that security persons who rape innocent women should enjoy impunity in the name of national security? For whose
security was the law enacted, for that of the country or of the criminals in uniform? Whenever some change is suggested
in the Act the army seems to oppose it and the civilian government buckles under its pressure. For example, when the
Jeevan Commission appointed to inquire into the alleged rape and murder of 30-year old Manorama Devi of Imphal in
Manipur arrested by the Assam Rifes suggested that the law should be repealed and the clauses that are required should be
integrated with other All India laws the Government did not even publish the report. The Hindu procured it “illegally” and
uploaded it on its website.

IMPUNITY UNDER AFSPA

After the Verma Commission Report said that security persons who rape women should be tried under the civilian law, the
Union Law Minister said in an interview on NDTV that there are problems in implementing these suggestions.

FOR WHOSE SECURITY WAS THE LAW ENACTED, FOR THAT OF THE COUNTRY OR OF THE CRIMINALS IN
UNIFORM

During a TV discussion another Union minister said that because of its slow legal process the public does not know the
punishment meted out by the army. They did not specify the constraints or the legal action taken. A search of the records
shows very few cases of trial leave alone of punishment. For example, no action has been taken in the Manorama Devi
case. On December 23, 2005 a group of university students entered a railway compartment at Kokrajhar in Assam, not
knowing that armed security persons from Haryana were travelling in it. The jawans closed the doors of the compartment
and tried to molest the students. Alerted by their shouts the Bodo student union stopped the train and tried to take action on
the jawans. The police opened fire on them and four students died. No action has been taken till today. One can give many
more such instances that have gone unreported or have been hushed up. In a recent case in Assam the local people caught
the jawan so the army promised action against him. He was jailed for three months. People in Jammu and Kashmir speak
of a large number of women who have been violated but the armed forces have gone unpunished. So the women live with a sense of shame. Some of them testifed before the Verma Commission and its recommendation stems from their testimony.
One is also told that the honour of the army is involved and national security requires the law. In what way does lack of
action against rape protect the honour of the army?
PROLIFERATION OF MILITANT GROUPS

One can question AFSPA even from the security point of view. It was enacted in 1958 on an experimental basis for six
months as a measure against “terrorist” groups in the North East. It was applied first in Nagaland, in 1980 in Manipur, later
in Jammu and Kashmir and over the decades in more areas of the North East. What was enacted for six months has remained
for more than fve decades. In 1958 there was one “terrorist” group in the North East. Manipur had two groups when the
State was brought under the Act.

Today, Manipur has more than twenty such groups, Assam has not less than ffteen, Meghalaya has five of them and other
States have more groups. How does the army explain this proliferation of militant groups in spite of the Act? Has it served
its purpose? One is also told that the armed forces will not be able to remain in the North East or Jammu and Kashmir if
the law is repealed. That is a lie. The army is deployed all over India without such a law. Those who demand its repeal do
not ask the army to leave any region. They only want the armed forces to serve the country under the Constitution without
a law that allows abuses with impunity.

There is no reason why a rapist or murderer should have a separate law only because he belongs to the armed forces. Take
for granted for a moment that all the women whom they rape are terrorists. Why should they be raped? Why can they not
be dealt with under the law of the land? These actions do not add to the honour of the armed forces or to the security of
India. They only violate people’s right to a life with dignity and cannot be justified in a democratic country. Civilians have
been elected to rule the country. They have a duty to ensure that the security forces work under the Constitution. The
problems in the North East and in Kashmir should be solved through a political process and not through a law that violates
people’s right to life and dignity with impunity. They need confdence building measures (CBM) in order to move towards
peace with justice. What better CBM can one suggest than repealing the AFSPA?

HEALTH ACCOUNT NUMBERS THAT REQUIRE CLOSER SCRUTINY

The reduction of out-of-pocket expenditure that the NHA highlights is essentially due to a decline in utilisation of care

low public spending on health in India has meant that people depend heavily on their own means to access health care. It
causes rich-poor, rural-urban, gender and castebased divides in access to health care, pushes people to poverty, and forces
them to incur debt or sell assets. As a result, our health outcomes are worse than in many neighbouring countries.

In this context, the National Health Accounts (NHA) report for 2017-18 is being celebrated widely as it shows that total
public spending on health as a percentage of GDP has increased to a historic high of 1.35% of GDP, fnally breaking through
the 1%-1.2% mark of GDP. Out-of-pocket expenditure as a share of total health expenditure has come down to less than
50%. An increase in public spending and decline in out-of-pocket expenditure, if actually realised, are welcome steps
forward to achieve greater fnancial protection.

However, the NHA numbers need to be carefully scrutinised before jumping to conclusions. The NHA capture spending on
health by various sources, and track the schemes through which these funds are channelised to various providers in a given
time period for a given geography. Multiple data sources are combined to produce the estimates. Out-ofpocket expenditure,
the biggest part of NHA estimates is captured using “Household Social Consumption in India: Health” survey of National
Sample Survey Organisation. Public spending on health by various departments of the Union and State governments, major
urban local bodies, and social security schemes are captured from Budgets.

urban local bodies, and social security schemes are captured from Budgets.
 Various sources are also used to capture insurance premiums, expenditure estimates from frms, non-governmental
organisations and foreign entities.

SPENDING IS ONE OF THE LOWEST

India’s total public spending on health as a percentage of GDP or in per capita terms has been one of the lowest in the world.
There has been a policy consensus for more than a decade now that public spending has to increase to at least 2.5% of GDP.
However, there has not been any signifcant increase so far. Despite several pronouncements, it has continued to hover
around 1%-1.2% of GDP. The Union government traditionally spends around a third of the total government spending
whereas the majority is borne by the States.

The increase shown in NHA 2017-18 is largely due to increase in Union government expenditure. For 2017-18, the Centre’s
share in total public spending on health has jumped to 40.8%. However, if we study the spending pattern of the Ministry of
Health and Family Welfare and the Ministry of AYUSH, we see that expenditure increased to 0.32% of GDP from 0.27%
in 2016-17 — insuffcient to explain the overall jump. Much of this increase has actually happened on account of a tripling
of expenditure of the Defence Medical Services (DMS). Compared to an expenditure of ₹10,485 in 2016-17, it increased to
₹32,118 crore. During this period,expenditure on the National Health Mission increased only by 16% to ₹25,465 crore.
Though the increasing spending for the health of defence personnel is a good thing, such spending does not beneft the
general population. Clearly, the health of women in the reproductive age-group and children below five years, who
constitute a third of our population, have been accorded lesser priority compared to the around 64 lakh families covered
under the DMS. The other thing to note is that the share of current health expenditure has gone down to 88% of THE
compared to 92.8% in 2016-17. Within government expenditure, the share of current health expenditure has come down to
71.9% compared to 77.9% a year ago. This essentially means, capital expenditure has increased, and specifcally in defence.

CAPITAL EXPENDITURE

There is a problem in accounting capital expenditure within the NHA framework. Equipment brought or a hospital that is
built serves people for many years, so the expenditure incurred is used for the lifetime of the capital created and use does
not get limited to that particular year in which expenditure is incurred. Counting the capital expenditure for a specifc year
leads to severe overcounting. Considering this, the World Health Organization proposes to leave out capital expenditure
from health accounts estimates, instead focus on current health expenditure. However, in NHA estimates in India, in order
to show higher public investment, capital expenditure is included; thus, Indian estimates become incomparable to other
countries. If we take out the capital expenditure, current health expenditure comes down to only 0.97% of GDP. This is
only a marginal increase from 0.93% in the previous year.

MORE A SIGN OF DISTRESS

The NHA estimate also shows that out-of-pocket expenditure as a share of GDP has reduced to less than half of the total
health expenditure. Over the last few years, the share of out-of-pocket expenditure has been declining. For the year 2017-18,
out-of-pocket expenditure has declined not only as a share of total health expenditure but also in nominal and real terms. Is
it a welcome development? Does it mean improved fnancial protection? Has it declined because public spending has
increased? NSSO 2017-18 data suggest that during this time period, utilisation of hospitalisation care has declined compared
to 2014 NSSO estimates for almost all States and for various sections of society.

The decline in out-of-pocket expenditure is essentially due to a decline in utilisation of care rather than greater fnancial
protection. The experience of various developing countries suggests that as public spending on health increases, utilisation
of care increases because there is always a lot of latent demand for health care which was hitherto unrealised as people could
not aford health care. With increased public investment as health care becomes cheaper, people tend to access care more.
Since it is very unlikely that peoples’ need for health care has declined, and current government health expenditure has not
increased much, a decline in out-ofpocket expenditure could be due to lower utilisation of care a sign of distress rather than
a cause of celebration.

Actually, the NSSO survey happened just after six months of demonetisation and almost at the same time when the Goods
and Services Tax was introduced. The disastrous consequences of the dual blow of demonetisation and GST on the
purchasing power of people are quite well documented. As purchasing power declined, health care would have become more
unafordable, forcing people to forgo care. Though more people have moved towards subsidised public services to some
extent, this has not been enough to ofset the decline in utilisation. Another plausible explanation is linked to limitations in
NSSO estimates. The NSSO fails to capture the spending pattern of the richest 5% of the population (who incur a large part
of the health expenditure). Thus, out-of-pocket expenditure measured from the NSSO could be an under-estimate as it fails
to take into account the expenditure of the richest sections. To sum up, one may argue that much of the increased public
spending is not going to beneft the common people as it is mostly a one-time investment for defence personnel. The reduction
of outof-pocket expenditure is a sign of distress and a result of methodological limitations of the NSSO, rather than a sign of
increased fnancial protection.







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