The Hindu : Shoddy treatment

Online edition of India's National Newspaper
Sunday, Nov 17, 2002

Opinion

Opinion - News Analysis

Shoddy treatment

The focus on prevention has led to the neglect of caring for those who have already tested positive,Ramya kannan reports.

EARLY THIS month, the U.S. Ambassador to India, Robert Blackwill, speaking to an invited audience in Chennai, promised that his nation would contribute $120 million towards the battle against HIV/AIDS in India over the next five years.

Outside the banquet hall where Mr. Blackwill had just made his promise, voices were already asking, "if there are billions of dollars in this country for combating HIV/AIDS, how come we get nothing for care?" In the shadow of the Ambassador's visit then, persons living with HIV/AIDS and healthcare professionals in Tamil Nadu found an opportunity to raise an issue they felt was most serious in the battle against AIDS.

Today, as it was nearly 16 years ago when Tamil Nadu led the nation in a pell-mell battle against HIV/AIDS, producing the first documented evidence of HIV infection in India, medicare facilities for persons living with HIV/AIDS are secondary on the agenda. Strangely, it has not mattered much that the battle today is being fought on more focussed, scientific and humanitarian strategies.

The principal aim of the National AIDS Control Organisation (NACO), which dictates national and State policy on HIV/AIDS, remains "prevention and control of the disease". However, mention is made of "improving services for the care of people living with HIV/AIDS (PLWHA) in times of sickness both in hospitals and at homes through community care". While the primary aim has been laudably well executed, a similar intensity in implementing the latter clause has been missing.

"How can we pitch prevention against care? Both have to go hand in hand. Unless we ensure a better quality of life for HIV-positive persons and educate them about spreading the infection (secondary prevention) how can we reduce the burgeoning numbers," asks Suniti Solomon, credited with the discovery of the country's first HIV infection.

At a meeting in Delhi, attended among others by Bill Gates, Microsoft chairman, K. K. Abraham, president of the Indian Network of Persons Living with HIV/AIDS (INP+), decided he would use his few minutes to articulate the disappointment of the PLWHA. "Today," he said, "I am here to remind you that we are losing friends to HIV more than before, because prevention efforts are not supported with care for people living with HIV. Because the public sees us as people who are dying, billboards tell us that HIV is equal to death, messages issued by both the Government and the private sector tell us that we deserve to die."

Mr. Abraham says, "less than one per cent of all the money in this sector is spent on care and support for PLWHA. Whatever care that is now being provided is mainly for opportunistic infections."

Members of the Chennai-based INP+, who have often urged the Government to spend more on care, say, "we get the response that the health budget cannot accommodate the heavy demands that care would make. At present drugs are expensive, but there is a lot of money coming into the sector. Just spread it around, so there is enough for care."

P. Kausalya, who started the Positive Women's Network in Chennai to bring together women who had contracted the infection, says, "even if a quarter of the money spent on prevention had been utilised carefully for providing care, the situation would not have worsened so much". She feels, as do members of her network, that even information about care is hard to come by.

Admitting that prevention was the first on the agenda, the Tamil Nadu State AIDS Control Society (TNSACS) director, K. Deenabandu, however, says things are improving. Treatment is pretty expensive for a PLWHA, costing anything between Rs.1,800 and Rs.2,400 a month for a drug regimen alone. In addition there are the regular living expenses. "This requires a phenomenal financial commitment by the state. We agree money must be found and we are slowly expanding our area of operation to include care too. We intend to strengthen district level hospitals and even PHCs to ensure that care is made available at every level," he says.

For instance, under the State Government's Mother To Child Transmission project, the expensive anti-retroviral drug therapy is being given to pregnant women in the 13 medical college hospitals and all district headquarters hospitals. The Government Hospital of Thoracic Medicine in Tambaram, he points out, is India's largest AIDS care centre. However, the treatment and care provided there leaves much to be desired, according to the direct beneficiaries — PLWHA.

Dr. Solomon says that though Tamil Nadu has fared better than other States, much needs to be done. "Here we have the Tambaram hospital which is supposed to be dedicated to the care and treatment of persons with HIV/AIDS. Though it was supposed to be a model set-up, the hospital has a long way to go before achieving that status. Authorities must make an attempt to get things going, with available resources and facilities."

The problem, apparently, lies in the numbers. Hospital sources say the number of cases reporting in has been increasing steadily over the years. From 600 new patients who sought treatment in October last year, the figure has nearly doubled to 1,151 this October. Again, for a hospital with a sanctioned strength of 776 beds (and a 120-bed rehabilitation centre), handling over 1,000 in-patients and another 1,000 out-patients every day means a severe strain on resources.

To make things worse, the hospital staff has remained static in strength since the 1980s. Of the sanctioned 251 servants posts (to provide a clean and hygienic environment) there are 57 vacancies.

Counter-arguments notwithstanding, the questions remain as the battle intensifies. Political will, Mr. Blackwill indicated, was absolutely essential to deal with HIV/AIDS at all levels, to avoid a disaster. Political will to share the focus with care. As Mr. Abraham says, "the key in our strategy is treatment for people living with HIV. When treatment is available people enjoy good health. Then there will be hope in prevention programmes. When there is hope people will volunteer to get tested. Then prevention will work."

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