Re: Questions on enhancing access to care and antiretroviral treatment

[Guest guest]

--- Bitra <sharanindia@...> wrote:

> Date: Mon, 12 Mar 2001 20:40:54 +0530

> From: Bitra <sharanindia@...>

> -owner

> Subject: Re: [] Questions on enhancing

> access to care and antiretroviral treatment

>

> Dear All,

> This is in response to the questions on the

> discussion on Access to Care

> & ARV therapy.

>

> (1) Advocacy should start with giving all possible

> information

> regarding ARV to NGOs/CBOs, Govt officials, doctors

> & Health care

> workers at all levels (Tertiary, Secondary &

> Primary) and networks of

> PLHA groups. There is a desperate lack of quality

> information available

> & disseminated. Only after that can we start

> thinking of a campaign -

> letters etc.

>

> (2) Friends from abroad should advocate with NACO &

> Health Ministry

> officials to first provide drugs for opportunistic

> infections in all

> Govt hospitals(lacking even now in most hospitals)

> and then talk about

> benefits of ARV.

>

> (3) Lack of access to care in India has largely to

> do with lack of

> access to information for most PLHAs - starting with

> Voluntary

> counselling & testing centres where HIV testing can

> be done with proper

> counselling, provision of ongoing counselling,

> referral services,

> psychosocial support, home & community based care,

> peer support groups -

> the whole Continuum of care and just not the medical

> aspects of care.

> Care & treatment issues needs to be demystified and

> people should be

> empowered to ask questions on quality treatment

> rather than depending on

> doctors. Stigma & discrimination in health care

> settings still remains

> an important issue and is an important barrier for

> PLHAs accessing

> medical care in India.

>

> (4) Decentralizing of care is the only solution -

> home based care rather

> than hospital/institution based care, involvement of

> communities in

> providing care and empowering PLHAs to demand

> quality care at all levels

> of health care. Training of health care workers in

> providing care to

> PLHAs keeping in mind local resource constraint

> settings is also

> important which also includes addressing attitudes

> of the medical

> fratenity. Building linkages between health care

> systems and the

> community through NGOs/CBOs is equally important.

>

> Regards,

> Dr Bitra

> Dermatovenereologist &

> Consultant, Sharan & Salaam Baalak Trust

>

> subharaghavan@... <mailto:subharaghavan@...>

> wrote:

>

> > Dear Forum Members:

> >

> > Welcome to the Structured Discussion on Enhancing

> Access to Care

> > and Antiretroviral Treatment in India.

> >

> > Following are some questions that have been raised

> previously during

> > many of our discussions. We will not limit the

> discussion to these

> > questions only. We have many more questions to be

> posted and also

> > anticipate adding many more questions (raised by

> forum members) as

> > we move forward.

> >

> > To do justice to each issue, we have decided to

> limit 2-4 questions

> > for 2 days. We will appreciate you using facts,

> data, successful

> > examples as much possible for your arguments,

> wherever feasible.

> > Please also try to focus on strategies we can come

>

> > up with for the existing problems.

> >

> > It is very important for us to think various

> levels:

> > local, district, state and country level, rural

> and urban, poor and

> > rich, children and adults. Etc.

> >

> > PLEASE FEEL FREE TO FORWARD ANY ADDITIONAL

> QUESTIONS YOU MAY THINK OF

> > THAT ARE RELEVANT TO ACCESS TO CARE AND TREATMENT

> IN INDIA?

> >

> > Questions for Next Two days are:

> >

> > 1) How should we proceed together to advocate for

> enhancing access to

> > care and antiretroviral therapy in India? Please

> specify specific

> > strategies e.g. Signed letters, demonstrations,

> position papers etc.

> >

> > 2) How should friends of India from abroad proceed

> to advocate for

> > access to therapy in India?

> >

> > 3) What are the barriers in accessing care by

> people living with AIDS?

> >

> > 4) What do we need to enhance the access to care

> at primary health

> > care centers, district, state and country level.

> >

> > Thank you for your participation.

> > SAATHII and AIDS INDIA e-Forum Moderators

> >

> > --------------

> > To join forum, please send a blank

> message to

> > -subscribe

> <mailto:-subscribe >

> >

> >

> >

[Guest guest]

Dear all,

Greeting. Much has to be said about ART but

informations are kept aside. This has allowed alot of

quacks to make noise. I am much concerned because they

talk of magical cures and this has been disappointing

PLwH and also the public who believe that there is a

cure, which may lead reduction in condom usage.

Dr.Manorama

__________________________________________________

[Guest guest]

Dear Forum Members:

This is in response to Dr. Rashmikant's and the

anonoymous mailer's response towards the ongoing

discussion on Questions on enhancing access to care

and antiretroviral treatment. I totally agree with the

anonymous that " if collectively we act ARV can become

accessible for every individuals " . After all, " health

for all " is a " right " not " privilege " .

Having said all that, it is fair to say that our

current knowledge allows us to contemplate the

possibility that if all goes right, an antiviral

regimen may be successful for years and years and even

decades later. But clearly this is not the story for

all. What percent achieve this success varies greatly.

What is in the way of success? There are four

components that if present, allow an individual to

make the decision of whether or not to take the meds

and know whether or not it is going to be successful

to anyone:

1 - the meds we pick must be active against that

person's strain of HIV. For those who have already

been on meds, and acquired some drug resistance, this

clearly gets harder, since while we have more than 20

meds - some of them are " cousins " - if HIV learns

resistance to one, it may have learned some tricks

allowing it to become at least partially resistant to

other meds as well. This issue is also a concern for

someone who has never take a pill - since for perhaps

like many PHA (Person with HIV/AIDS) in Indian

Subcontinent- the HIV they start with came from

someone who had drug resistant HIV - and they start

with this resistant strain. Fortunately, we can

sometimes measure these resistant strains through

testing.

2. Someone needs to take enough of these meds to keep

the blood levels active enough to stop HIV. This is

the key issue - called adherence. Now, much has been

said about this - but key concepts here include that

adherence to some meds may be fairly demanding, but

progress has been made such that, for some meds, there

is flexibility with dosing times. And we have

improvements here including having at least a few of

our meds that can be taken just once a day, as well as

combinations allowing people to take just a few pills

total per day - all of which may help make pill taking

easier. But we have learned that this issue is among

the biggest obstacles to more frequent success. Since

it is simply hard to remember to take pills once or

twice or more each day every day.

3. The regimen must be potent enough for that person.

We have seen evidence that those who have a higher

initial viral load (off meds) - higher often defined

as somewhere above 100,000 copies - and/or a lower CD4

count - somewhere below 200 cells - may need a more

potent regimen than others. The potency can be

manipulated - sometimes by using four drugs instead of

three, or by " boosting " the potency of our meds in

various ways. However, we know a regimen is potent

enough if it drives the viral load to below 50 - since

when that happens - the response can be durable -

perhaps for an indefinite period of time.

4. However - there is a key fourth issue - Safety.

Since if we have ways to create potent combos that

people can successfully adhere to - they must then

monitor for side effects. These side effects can

happen early on like the first month or two, or later

on like after a year or more. But this is the current

challenge for us - since we ARE more successful - and

therefore need to define who can best take which meds

- so they can avoid side effects and maintain the

benefits.

These are some of the issues that both Physician and

the PHA must consider before deciding whether or not

to go for ARV. This is my opinion.

Warm regards

Sanjay Dasgupta

Ann Arbour

Michigan

USA

__________________________________________________

[Guest guest]

Dear Forum Members

Thanks for your responses.

I certainly mean that every one should get ARV. Since it is not affordable by

many and my personal experience suggest people take big loans and eventually

they land up in major finanical trouble. Until ARV becomes available/affordable

to all it is a false hope.

Rashmikant

rashmis@...