Re: Supreme Court pulls up health ministry for missed 2005 AIDS drug target

[Guest guest]

Dear Friends,

Good to see that Sahara, common cause sankalp & VHA Punjab raised the right to

treatment with the supreme court .

Right to proper diagnosis, rational treatment, & follow up must be continuously

emphasized . If under Supreme court directions action is taken without proper

preparation eg; proper counseling, CD4 testing to monitor proper dosages,

continuous drug supply and ensuring its rational use.

If Govt gives it free in some places the issue of drug pricing for other paying

patients remains.

Will others who may not be HIV positive but have RTI or other STDS, their

testing & treatment how is it is supposed to be addressed & also opportunistic

infections?

In TB Program Anti TB drugs were given but a lot of TB suspects with chronic

productive cough go for treatment with or without diagnosis (A large percentage

of medical care being in private sector for various reasons).

At one point I was told in late 70's that to pick up one sputum positive person

with TB 20 sputum tests from 20 TB suspects with chronic productive cough must

be diligently done must be done. These may be chronic bronchitis, asthmatic

bronchitis, bronchiectesis.

Since TB program was exclusively for TB, the others were usually unceremoniously

packed off.

Right to early, effective rational diagnosis & treatment must be supported

We must also simultaneously address the issue of rational use of drugs & what a

haphazard treatment can do when dealing with anti infective drugs, antibiotics,

anti bacterial and antivirals.

This awareness should be part of general public awareness.

Drug Resistance is emerging as a major public health problem which we as

individuals, as families & as a nation cannot afford. Neither can our people

afford high drug costs.

Please do also look at the drug prices since positive people also have to face

other health problems.

Regards & in solidarity for rational drug use, rational health care and a caring

society.

Dr Mira Shiva

e-mail: mirashiva@...

[Guest guest]

Dear FORUM,

So many relevant matters are canvassed in this brief summary but they are all

highly relevant and getting worse over the last five years rather than better.

I referred a patient to a treatment centre in Delhi who was +ve and had enough T

cells to maintain his health without HAART and because of language problems I

was relying on the hospital and a mutual friend who is a travel agent and my

interpreter in Delhi. (also a

close friend of the patient)

Now I am receiving messages that he appears to have disappeared after being

admitted very sick and unable to do more than whisper a message to contact me.

His family have disowned him and are not providing any information on his

welfare and I have fears that in the space of 10 months he may actually have

died but no one seems to be able to confirm the same. If he did die I would want

to know why because there was no immune functional reason for him to be that

sick in that space of time.

Increasing numbers of drug resistant patients in all prescribing classes are

still increasing and this has a double problem. Higher costs of treatment and

more alarmingly highly drug resistant mutations of virus getting out in to the

wider community.

The reason I decided to write at all on this topic was the apparent rejoicing

that this had become an item on the Supreme Court's agenda.

Having been following remits to that Court involving disputes from the States

and even Chief Ministers in particular made me amused many times when despite

Supreme Court rulings nothing changed at the State level at all.

I formed a view that the Supreme Court of India was a bit like the President.

Good visuals but when it comes to actually making a difference for the Indian

people, either a lame duck or a toothless tiger.

In a nation that has had great balance of payments figures and just inherited

the title of global country most affected by HIV, surpassing Africa, what

Central Government needs is a jurisdiction that can actually make a difference

in the behaviour and the outcomes.

HIV should be a bipartisan concern for the sake of the Country and it is not.

The Medical, scientific and drug communities are having answers and they are not

being heard, The affected and infected communities are still having models of

best practice in some places and far too many examples of worst practice or no

coherent structure at all. SACS vary so much that it is often so obvious that

radical overhaul of the policies and practices must become national priorities

and uniformity in care, treatment and support mandatory.

The actual SACS memberships need radical overhaul as well. This should be a very

representative cluster of experts and patients and not a prized seat for retired

bureaucrats and academics.

Infected communities migrate around the country across State borders and the

cross subsidising funding never seems to follow them and there are glaring

examples of this when a good treating hospital establishes in one State patients

from three adjoining States

migrate to the treatment centres often in great hardship and with many high risk

behaviours along the way.

India has to collectively and centrally organise itself to face this pandemic.

It must start educating for safer sexual knowledge and information before

puberty occurs whether the teachers and parents like it or not and I can tell

anyone reading that this that the Teachers will be the biggest hurdles not the

Parent groups.

Families ought to be more confident and willing to discuss issues that can

mitigate against their own families getting caught up in behaviours that

unwittingly get them infected.

Best practice examples abound in India but they are the exception rather than

the rule.

I still conclude that whatever the Supreme Court of India might decide regarding

the rights and needs of the citizens the mechanism for implementing any change

is far removed from their control or the control of the President or even the

Prime Minister and that seems to be the essence of both the argument and the

solution.

While Health remains such a poorly perceived ministry with a continuing paltry

budget allocation and whilst we continue to just wait till people get sick to

treat them instead of preventing much of the sickness from occurring we will be

like the dog chasing its tail.

Let the debate and the discussion continue and if the cap fits then India should

have to wear it. The people have a right to a better health service.

Who in the Health Ministry is suffering and what changes are in the pipeline now

that the Supreme Court has " pulled them up " . They might have been " pulled up "

but all that seems to happen is that they all just put their collective noses

back into their chaff bags and wait for the whip crack that sends them off again

into a directionless gallop.

Health for every Indian is a Ghandian Principle enshrined in the Independence

Charter

Surely!

Geoffrey

Geoff Heaviside

P.O. Box 2400 s Lakes 3038

. Australia.

e-mail: <geoflowd@...>