State Consultation on ARV Treatment Access - Chandigarh

[Guest guest]

State Consultation on ARV Treatment Access - Chandigarh

INP+ and CNP+ on 18th and 19th October, 2006 at the CYP Asia Centre,

Chandigarh

Two day workshop on `State Consultation on ARV Treatment Access -

Chandigarh' was conducted by INP+ and CNP+ and funded by DIFD and PMO Emergency

Fund on 18th and 19th October, 2006 at the CYP Asia

Centre. Invitations for participation and Facilitation were sent to

different organizations and individuals in Chandigarh.

Around 30 PLHA and their family members from Punjab, Haryana, Chandigarh and BSF

participated in the workshop, which was facilitated by trained facilitators who

were actively working in the field. This workshop was well received by the

media.

All the participants appreciated the arrangements made for the conduct of this

Workshop and participated in various sessions of Workshop and deliberated on the

State Consultation on ARV Treatment Access, Care, Support and Rights of PLHA.

The key issues, suggestions and commendations on different issues are described

below.

PLHA, Medical Professionals, Para Medical, lawyers, social activists, NGOs,

academicians and others took part in this Workshop. The Workshop was open to

all, by way of information through invitation.

The participants, facilitators and others were welcome to workshop by Ms. Pooja

Thakur, President CNP+ and the workshop was inaugurated by Dr. Trikha,

Project Director, SACS, U.T. Chandigarh. She

exhorted the participants to organise themselves, and work for the

development of the Community. This can be done by first empowering

themselves through education and skill building.

After the inauguration Ms. Meena Dalal, President, HNP+ Highlighted the

Objectives of the Consultation and Brief on Agenda of Workshop was discussed by

Mr. Manoj Bharti, HNP+.

A significant number of HIV positive persons from north India

continue to remain uncovered so far as treatment for the infection

goes. Until very recently, the PGIMER, Chandigarh, was the only

hospital in the region administering antiretroviral therapy (ART) to

those in need of it. Even after three centres have been added – two

in Punjab (Jalandhar and Amritsar) and one in Haryana (Rohtak, PGI) –

PGI's load continues to mount for obvious reasons. It has better-

trained staff to handle and administer ART and it inspires faith

among adults as well as children on treatment. That explains the

reigning statistics – 1644 people living with HIV (PLHIV) are

currently registered at PGI's ART Centre which came up in January

last year. These hail from northern India, including Himachal

Pradesh, Punjab and Haryana which now have a few of their own ART

centres.

A noticeable trend is the increased registration of children living with

HIV/AIDS. Of the total number of PLHIV registered with the PGI, maximum are men

(907), followed by women (534) and children

(203). Of the total registered cases, 1205 persons are on ART – 722

being men, 367 women and 116 children. They had come from far off

areas like Karnal, Gurgaon, Fatehabad, Hamirpur and Sangrur. Along

with them were their HIV positive children — some who have been on

treatment at the PGI for as many as seven years and have been

healthy.

Considering PGI's treatment load, it is no surprise that doctors have been

calling for more and more effective ART Centres. The first HIV positive child

was detected at the PGI in 1991. Right now we have 250 registered children,

among who are those infected by HIV as well as those affected by it. The latter

category comprises children who are not themselves infected but whose parents

are HIV positive.

We are equally concerned about the wellbeing of such children and we are happy

to see that not a single child orphaned due to AIDS has been left in the lurch.

He or she has always been adopted by extended

families. "

The technical sessions were conducted by different Facilitators Dr.

Archna Mohan – State ART Programme, Care and Support, Dr.

Trikha – State Vision, Mandate and Plan in Care and Support, Dr.

Kavita Chawan – Signification of Prevention of STDs, Mr. Sandeep

Mittal – Role of NGOs in Minimizing Stigma and Discrimination with

PLHAs, Ms. Anita Bansal – Meditation and Positive Attitude, Ms.

Shikha Narang – Role of PPTCT, Peer Counselling and Condom Promotion, Dr. Avnish

Jolly – Role of Yoga and Healthy Life and Ms. Veena Sharma – Rights of PLHA on

Treatment / Education; Situation and Quality of Service in Government ART

Centers.

Sessions on Group Discussion / Initiatives, Issues and problem

Sharing and Role Play were conducted by Ms. Neetu Yadav and Mr.

Ranbir Singh. Panel Discussions and Different Questionnaires were in

detail discussed in interactive sessions by Mr. N. K. Jha.

Mr. Hassan Shafiu emphasized during the workshop that CYP initiative - Youth

Ambassadors for Positive Living plays important role for combating HIV/AIDS.

Throughout the workshop the speakers discussed in detail with the participants

the skills required to be good peer educators.

They were advised how to form network in their areas and villages, and how the

members could derive the maximum benefit from them. The

participants were also empowered on different health related issues

and different guidelines and home remedies were discussed with them

in length to copeup with stress, maintain their activity of daily

life and whom to contact during illness. The workshop was concluded

by Mr. R. K. Mishra, Regional Director, CYP Asia with hope that the

public can show love to AIDS patients and HIV+ people and allow them

to rebuild their lives in the community.

Recommendations that emerged from the State Consultation on ARV

Treatment Access are following;

PLHA and their Children shared their experiences and concerns on

issues that ranged from social isolation, being orphaned, denial of

services, access to education, emotional distress and their dreams

and aspirations for the future.

The group recognized that Treatment, care and support were addressed

comprehensively and key activities and indicators developed in

programs providing care, support for children infected and affected

with HIV and AIDS ensures improving the quality of lives. While the

document deals with most of the key components relating to children

affected by AIDS, it is suggested the following issues can be

incorporated to make it comprehensively responsive to the needs of

PLHA and their family members.

• Free Availability of Second Line Treatment.

• HIV test before marriage must be mandatory.

• The need for support groups to be established at district

level facilitated by positive women's groups as a part of care and

support programs.

• Ensuring access to correct information: Family, extended

family members, carers need to be provided with correct information.

• Psychosocial support for PLHA and their Family Members.

• Revise existing guidelines for counseling to address needs of

children affected by HIV and AIDS.

• Counselors to address violence against PLHA and their family

members.

• Ensuring access for parents/carers of affected children with

Rural Employment Guarantee Scheme, Widow pension, schemes for

homeless women, Economic empowerment for SC/ST through girl child

marriage scheme, vocational training for girl children and various

other support schemes

• Expert committee to explicitly monitor quality of facilities

for PLHA and their family members.

• Evolve monitoring indicators for key indicators in providing

care support for PLHA and their family members.

• Prioritize stigma and discrimination reduction among friends

of children affected through School AIDS Education Program and

Adolescence Education program

• Involve PLHA and their family members in program and policy

designing, planning, implementation, monitoring and evaluation.

..(GICA- Greater involvement of Children living with HIV/AIDS, Support for CAHA -

Children affected by HIV and AIDS)

• Include measurement of stigma and discrimination among school

children and young people in the national BSS

• Institutional strengthening for training, human resource

support and resources to build capacity support for children living

with HIV and AIDS in community, home based and institutional care.

• Need for specific schemes for economic support to the care of

children living with and affected by HIV and AIDS.

• Facility for voluntary testing and confidentiality for HIV

positive prisoners.

• Training of Prison Doctors on `HIV Issues'.

• ARV Treatment for prisoners who are affected by AIDS.

• Scaling up of ART centers in all Districts with CD4 machine.

• Micro (Vitamins tablets), macro (vitamins in powder

formulation) nutrition supplement shall be supplied through ART

centers.

• The PLHIV required conveyance those who are coming from far

distance to ART centers.

• In each ART center two counselor should be there(male and

female)

• Adequate infrastructure (waiting rooms) shall be made to

maintain confidentiality.

• Infrastructure Facilities like drinking water, seating,

arrangements; sanitary facilities and shelters should be provided.

• Periodical training to health care providers

(Doctors/Counsellors, Pharmacist, Lab Tech. etc.)

• There should be time punctuality for doctors/counsellors/

pharmacist lab tech. at 9.00 am to 5.00 p.m.

• Provision of Out Reach Workers in ART centers to do follow-

up/home visits alongwith per counseling.

• State level campaign programme on ART in all the media.

• First line and second line drugs to be available at all ART

centers.

• Specialized health care providers required for children

(Pediatrician) in all ART- District.

• All the Hospital Staff to be sensitized on ART facilities.

• Universal precaution materials shall be made available at all

hospitals up to District level.

• Pediatric medicine for first/second line regimen and provide

same colour codes to maintain adherence( e.g. DOTS medicine)

• IEC materials on ART education/adherence shall be developed

and disseminated.

• Information about marginalized community to be disseminated.

• To avail of ART all over country there should be particular

government system.

• All the Districts and all PHC should have accessibility to OI

treatment.

• IEC should be developed easy manner on OI treatment and

disseminated with the simple language, which will be very useful and

easy to understanding for PLHA.

• Periodic capacity building workshop to health care providers.

• All OI services should be provided under one roof.

• Easy access of Opportunistic Infection (OI) I treatment and

OI should be provided in center.

• Counselor should be appointed for OI treatment in all

government hospital.

• Doctors should consult or treat person minimum five minutes

and should be available all six days.

• Lab department timing should be increase 9.00 am to 5.00 p.m.

• IN STD clinic, we required male and female doctors for six

days in a week.

• Disclosing of the PLHIV status should not happen in Govt.

Hospital Stage.

• Quality of services/stigma discrimination/community care

center.

• In care home centre's bed should be increased.

• In care home they should appoint more care takers.

• Training and sanitization programmes for health care

providers (HCP) and also for other departments in Hospitals.

• While prescribing any medicine to PLHIV junior doctors should

consult senior doctor.

• All health care providers in all government hospital should

maintain confidentiality.

• PLHIV should not be discriminated at any place particularly

in Hospital, NGO's, workplace, schools and family.

• There should be equal treatment for HIV Positive in all

government hospitals.

• If government hospital prescribed to do the CD4count and OI

medicine at outside in that case reimbursement can be made for the

PLHIV.

• Ensure Universal precaution material available at hospitals

up to District level.

• New PHLIV should be informed about the network by the concern

counselor and doctor.

• Care home should be run by PHLIV network.

• Adequate infrastructure (waiting rooms) shall be made to

maintain confidentiality and to avoid isolation by general community.

• VCTC and PPTCT should be at all District levels.

• In PPTCT HIV positive women should not suffer in queue.

• Lab technicians should give proper attention on clients while

taking the blood samples.

• At VCTC and PPTCT there should be infrastructure facilities

like drinking water, seating arrangements, sanitary facilities and

shelters.

• Trained and sensitize counselors/lab technician should be

appointed at VCCTC and PPTCT who can understand our feelings.

• HIV positive peer counselor should be appointed at VCCTC and

PPTCT for regular follow up of the PLHIV.

• There should be laboratory near to PPTCT.

• Counselor must do condom demonstration at VCCTC and PPTCT.

• Great involvement of people living with HIV/AIDS(GIPA)

• Involvements of PLHIV in health care providers committee,

District, TB control committee, Care for PLHIV committee, IEC

committee and Executive Committee.

• State level GIPA implementation plan to be developed.

• Capacity Building for PLHIV Network.

• Training on issues of PLHIV

• Training on positive prevention

• Training on MIS & leadership.

• State level conference.

• Strengthening District and State level network.

• Free Traveling under Disability Act

• E cards in Hospitals to maintain confidentiality.

• Confidentiality must be maintained on Discharge Card or

Fitness Certificate issue by any Medical Authority.

•IEC material on ART and Diet must be available in local

language.

• Insurance Schemes for PLHA and their dependents.

• Pension for PLHA.

___________________

Dr. Avnish Jolly,

#3008,Sector-20D,

Chandigarh 160020,

India.

Cell: +91-9814213809

e-mail: avnishjolly@...