Government lacks Commitment in AIDS Treatment!

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Government lacks Commitment in AIDS Treatment!

- By Swaminathan Nagarathinam -

Not even one full fledged ART centre in the state, Insufficient testing

facilities may lead to increased death rate, Growing need for Second line

Medicines, Efficient medical care the lone solution for checking prevalence

Melakkulam is a quiet hamlet about 15 kms away from Tirunelveli. In a small

house, Nidhyanandham (aged 36) lies amidst his anxious parents.

Nidhyanadham has AIDS; he is immobile. Of the two children, one is 6 years and

another one is 8 years old. They were tested negative for HIV, but his wife

aged 28 is HIV Positive.

As yet there is no Medicine for curing HIV. However we do have the

medicines to control the HIV virus - Anti Retro viral Treatment, known as ART.

The medicine increases the immunity of the body by controlling the

multiplication of HIV. In addition, it helps to prevent the body from infecting

other opportunistic diseases.. It helps to increase the longevity of the PLWHA

as well.

Currently this medicine is given free of cost in 13 Govt. Hospitals in

Tamilnadu. It is not necessary for all those infected with HIV to undergo ART.

Only through CD-4 test, the immunity level of the patient is ascertained. For a

normal person the CD-4 count will be between 800 - 1200. When the CD-4 count of

a HIV positive falls below 200, he is medically into the threshold of AIDS and

requires regular ART Medication.

This medicine is of two kinds. The first line medicine will be effective only

during the initial years. Afterwards the HIV Positive person's body develops

resistance towards that. Thereafter the need for second line medicines arises.

Three years back when Nidhyanandham was examined, his CD-4 count was only " 8 " .

As a result he was infected with TB and he was taking ART at Government Hospital

of Thoracic Medicine Tambaram Sanatorium, Chennai. There was a remarkable

improvement in his immunity CD-4 count. Still the medicines had side effects.

First there was loss in his vision. Now, the pain in hip region has made him

immobile. He has also lost up to 15 kilos. It is his aged mother who is helping

him in his daily chores. Nidhyanandham narrates his bad experience; when he

approached Tambaram hospital to transfer him to nearby Tirunelveli ART centre...

:

previously I was taking medicines from Tambaram ART centre. As a new centre was

opened in Tirunelveli, I approached them for medicine. But my request was denied

categorically and I was told that I must get my name transferred from Tambaram

to Tirunelveli. With great difficulty when I reached Tambaram, they treated me

very rudely. Evey time they promise me the transfer, which has never happened.

It is shame that I gave up going to Tambaram because physically I could not, he

told.

A Chennai Govt ART Doctor comments, " For some the first line medicine becomes

resistant in their body in few years. Though they have to go for second line

medicines, they are forced to continue the ineffective first line medicine. At

least 20-25 patients whom we treat belong to this category, he told

As some of those having AIDS are physically unable to go to the ART centers,

they could not get the medicine. There is no outreach activity to provide the

medicine. So their condition deteriorates further.

For HIV positives, getting the proper treatment is their right. With the quality

medical care, we can control the disease very effectively.

Brazil demonstrated that only proper treatment can reverse the rapid spread of

the disease. Those with high Viral Load have propensity to spread the virus very

fast. Only through proper administering of the first and second line medicine,

we can check the fast spread of the virus and reverse the prevalence rate. If

this process continued steadily, the pace of the spread will be within the

controllable limits. Brazil's success is a proof of this.

Though HIV was detected in India as early as 1986, life extending medicines are

being distributed free only from 2004.

" Now it is being advertised that first line medicines worth Rs 1,200 for a

month, is given free to every individual with HIV positive in 13 govt hospitals

in Tamilnadu. This should have been done long back. Though the second line

medicines are expensive, if the Govt is committed, it can supply those medicines

also in reduced rates " says Regin, a HIV positive.

According to information available with Tamilnadu AIDS control Society,

(TNSACS) 52.1 Lakh people are HIV positive in India. In Tamilnadu alone, 3.5

Lakh people are infected by HIV. Of this 45,000 HIV Positives have registered

themselves in TN. As of now 11,000 people are under ART.

So far no data is available regarding the number of persons in the edge of

taking second line medicines.

While Brazil can boast of giving ART to 83 percent of those who need and

Thailand caters to 60 percent of them, India covers a meagre 7 percent.

In these circumstances, can Tamilnadu ever attain this target? Within the year

2007, providing ART medicines for one lakh PLWHA will not be enough.

The mortality rate is reduced due to the supply of First line. Now it runs the

risk of shooting up once again, as no second line medicine has been made

available.

UK's Children Investment Fund Foundation (CIFF), concerns itself with protecting

the children orphaned by the death of their parents due to

HIV. CIFF offers second line medicines and Nutrients free in three

hospitals, Chennai (Kilpauk), Salem and Tirunelveli. This must be

implemented all over the state.

Generally speaking some of the ART centres have no proper ventilation. In

Tirunelveli because of congestion there is a possibility of contracting

opportunistic diseases.

The entrance of ART centre at Madras Medical College Hospital stinks.

The PLWHA arrive at the hospital by 7.30 AM . The doctors who ought to be there

at 8.00 AM are seldom there.

All centres should have seating arrangements as in the Tambaram centre.

Namakkal Hospital allows in-patients for five days when a person is

confirmed that he is HIV Positive and needs ART. As the HIV positive persons

tend to get diarrhoea, skin rashes etc. while taking medicines, they feel

confident when they are in the hospital. The adherence and behaviour of taking

medicines at every 12 Hours get developed there. All hospitals can follow the

Namakal Model.

Not all the Govt. ART centres in Tamilnadu are of same Standard. Not even hot

water facility is made available to them. Because of the stigma, there is

callousness on the part of hospital staff. The lack of coordination between Dean

of the GH and TNSACS is visible.

What are the facilities an ART centre must have? When asked, Namakkal HIV Ullor

Nala Sangam (HUNS) Project coordinator Swaminathan says... " Treatment is meted

out to the PLWHA at the Govt Hospitals is indignant. We need to have equipments

to ascertain whether ART is working or resistance developed in the body. As

things stand, not a single Govt Hospital has this facility.

The alternative is to go for the Resistance test in the Private Hospital which

charge exorbitantly - Rs 6,000 for a test. If a person has to move on to the

second line medicine, this test is very imperative " .

" The insufficient supply of vitamin tablets leads to a fall in the

haemoglobin count of the HIV positive so is unable to continue ART.

As some of ART centres do not have CD-4 machines, there is problem in

administering the medicine. There is no facility to find out the Viral Load in

the body. Hence the inability to detect the chances of getting other infections.

The same amount of urgent measures taken in the case of DOTS in TB

eradication by the district level committee should be extended to AIDS as well.

All the Primary Health Centres should have the HIV support unit.

We are offering first line medicine at a reduced price of Rs 525. If the Govt.

has the commitment in providing second line medicines, it is possible to provide

in low cost. Without fulfilling the needs of the ART centers, the delay in

providing secondline medicines will shoot up the mortality rate " warns

Swaminathan.

When asked, TNSACS Planning Direcor, Supriya Sahu, said, " As of now, there is

equipment available with us for identifying the Resistance with us. Of course,

we do have 6 numbers of CD-4 machines?. Each costs Rs.30 lakhs.

Incidentally, Tamilnadu has the largest number of such machines. We are shortly

getting 4 more from the Clinton Foundation " .

Tamilnadu, the 4th fastest AIDS spreading state lacks ART centre in the rural

areas. It is imperative that atleast every district headquarters has one such

centre.

World Health Organisation estimates that 7,70,000 people are to be treated with

ART in India. The Supreme Court has recently rapped the Government for its

failure to treat 1 lakh people before 2005. The sudden efforts are to justify

this number only.

Medicines cost Noori Rs.20,000 a month

She was the third in the country to be tested positive for HIV in Chennai during

1987. Noori, a former sex worker is based at Chennai. She was more than willing

to come forward and undergo the screening procedures for identifying HIV due to

the ironical understanding of her profession. Says Noori, " Those were days when

not awareness of HIV was almost nil. Life elongating medicines were yet to come.

Not many were in the field to offer counseling. It was in Australia during 2001

when I became aware of the impact of the virus that made my CD-4 count 180. I

was told unambiguously that without medicines I would not survive.

From a monthly income of Rs.2600, I had to spend Rs.3600 every month.

Ironically, there were times when I actually had the required money whereas the

medicines were inaccessible. I had to struggle to get them and later I became

resistant to the very same medicines. I was told to take the Second line of

medicines for HIV. But they are very costly and unaffordable. Now I spend

Rs.20,000 a month. The government should intervene here to help the HIV

infected by providing an easy access to the costly medicines by giving them at

reduced price. Like the well-implemented Prevention of Parent to

child Transmission of the virus (PPTC), the government should ensure surgery for

the PLWHA.

ART alone will not save the PLWHA. ART with additional nutrition will be the

only way to save them " says Noori. who also feels that As she aptly

concludes, she is not anxious and bothered about HIV rather it is the other way

up. It is HIV, which should bother about her she

feels. She strongly opines that the stigma and discrimination lie with the

treating doctors.

The story of Kumar

The story of Senthilkumar of Chennai, an IDU should be known to the youth. He is

now a HIV positive obtained out of sharing injection drug needles with 8

persons. Detected in 2004, he now gets rehabilitated with the effective

intervention of " Freedom Foundation " to his rescue. Senthilkumar did not hide

his addiction of injection drug abuse to Freedom Foundation and he has now come

out of his addiction completely. " The results are now showing up.

With treatment and proper medical counselling, I am improving including a

gradual gain in weight from 43 Kgs to 53 Kgs. The urge to carry on living is

strong now " says Senthilkumar.

There is a strong correlation IDUs and acquiring HIV. K.N.S. Varadhan,

Project Coordinator of Freedom Foundation elaborates further: " Not

surprisingly 97% of IDUs get infected with Hepatitis C. It is common

knowledge now that an IDUs usually gets infected with Hepatitis C which when not

disclosed will prove fatal to liver failure if the person is also infected with

HIV and getting Anti Retro Viral Treatment. I see 15-20 persons in past one and

half years, the HIV positive IDUs who took ART medicines had died of failure of

Liver.

ART In Govt Hospitals there is no facility to identify the Hepatatis C virus in

blood. Whether the government has any plans to provide facilities to screen

people simultaneously for HIV and Hepatitis C in the context of drug abuse is

highly doubtful " opines Varadhan Strangely, the government is not aware of the

importance of this

inter-relation between Hepatitis C and ART.

Every place needs a Ponnuchamy

It is rare to see a completely dedicated outreach worker like Ponnuchamy in

Tamilnadu who work for the PLWHAs. Ponnuchamy, is an outreach worker associated

with St.ph Leprosy Hospital and HIV Care Tuticorin. With the heavy stress

levels when they come to know that they have HIV, their adherence to a strict

medicine consumption pattern becomes difficult.

Ponnunchamy's commitment includes monitoring of their timely intake of

medicines, whether they attend to their normal duties and their food intake etc.

The PLWHAs should take their medicines every 12 hours.

Thus no PLWHA could utter a lie to the doctor about taking medicines amidst the

watchful monitoring of Ponnuchamy. But he runs the risk of making the PLWHAs

feeling intruded into their private lives. When asked about it, he said, " I take

utmost care in not letting such a feeling creeps in. When I realize that they

would feel like that, I would just slip out of the scene " he said.

When asked about whether the TNSACS is having a similar outreach plans,

" Training has been given to Village Health Nurses (VHNs) on HIV/AIDS. We also

look at using the services of experienced field workers to outreach the PLWHA

through NGOs " says Supriya Sahu, Planning Director and Member secretary of

Tamilnadu AIDS Control Society.

Workers and not drivers alone, are more prone to HIV in Namakkal

Gone are the days, when Namakkal was known for AIDS to drivers. The

Government Hospital in Namakkal has an ART centre, which has a registered HIV

Positives of 4407, in which truck drivers constitute only 15-20 percent.

Of them, 1476 are taking of ART Medicines. The rest comprises of others who have

high-risk-behavior viz., masons, mill workers etc. Vennila, the woman counsellor

of the Namakkal ART centre, who had participated in a BBC Programme at London

says, " The agonies of the wives who have got HIV from their husbands are hard to

be addressed.

They need regular counselling, which explains the dire need for them to be on

medication in the best interests of their children and family welfare. The

fortunate fraction of women who have not got the virus from their husbands are

suitably guided about how to safe them from HIV in future " .

_________________

The study was conducted by a Senior Journalist Swaminathan

Nagarathinam, through a financial grant from The European Union - India Media

Initiative on HIV/AIDS implemented by The Thomson Foundation UK.* The writer

visited Tirunelveli, Madurai, Namakkal, Chennai (two centres), in toto, 5

centres in Tamilnadu.

Nagarathinam

e-mail: <snagarathinam@...>