There are few takers for free bus passes introduced for HIV positives

Kannan, a daily wage earner, is ready to lose a day's wage and travel for nearly four hours to maintain a secret — he has silently battled AIDS for seven years. He shuttles between Chennai and Madurai to collect his quota of antiretroviral or ARV tablets but many a time he requests his friends in Madurai to courier the tablets to him.

Many patients who find it hard to forgo their day's salary skip some tablets in their treatment cycle. Ponpandi, 30, missed his course of tablets whenever he felt the pinch in his wallet. After availing himself of the newly launched government bus pass, he is able to continue his treatment without a break.

For people with money constraints, the government offers passes for two free trips a month to collect their ARV tablets and treat opportunistic infections. Surprisingly, in Tamil Nadu only 10 per cent of those eligible for such a pass have collected them.

“People go to other towns just to keep their heath status a secret but this card exposes HIV positivity status,” says Ayyappan, President of the Vaigai Network of People Living with HIV/AIDS.

Fear of discrimination

What prevents most people from using the special bus pass is the fear of discrimination, he feels. “There are instances where people are looked down upon by co-passengers, neighbours and relatives. People are ready to enjoy benefits such as free bus passes but not at the cost of exposing their health status,” he says. He adds that not even one out of 100 is ready to come out of his self-imposed cocoon.

“Perhaps this bus pass issue is going to break the myth behind the claim that discrimination is dwindling. But this is just the tip of the iceberg,” says Ayyappan, who has evidence of conductors forcing pass holders to buy tickets and treating them inconsiderately.

B.V. Babu, President of the Madurai Network of People Living with HIV, says, “People who are below the poverty line and illiterate are ready to use passes but not the literates, though they struggle hard to make ends meet.”

He adds, “If the government could remove the TANSACS symbol printed on the card and make it general, it will not give a special identity to the card holder.” It would also save beneficiaries from the scornful looks of fellow passengers, he feels.

Selvaraj Manoharan, Senior Medical Officer (in-charge) at the Government Rajaji Hospital, disagrees. “It is not true. There are a few bold takers who come to ART centre at Madurai in Government Rajaji Hospital for the approach and counselling it offers,” he says. Besides, the centre gives free treatment-based counselling and CD4 test (used to monitor the immune system), which otherwise would cost Rs. 1,500 if done in private clinics.

Especially among infected children less than five years old, CD4 percentage is more important and ART counsellors keep a constant watch on the health of children, he notes.

“Moreover, the presence of link ART centres in Melur, Thirumangalam and T. Kallupatti has reduced the burden of travelling to collect medicines,” says Dr. Manoharan. “But, to motivate people, the centre has taken necessary steps in organising sensitization and awareness programmes among drivers, conductors and other officers in transport department,” he adds.

“Non-acceptance of bus passes is not a reason for lapses in the treatment,” says Dr. Thennarasu, Regional Co-ordinator (in-charge) of the National AIDS Control Organisation, Tamil Nadu and Puducherry.

“People argue that the card should not have the symbol of the accredited organisation. But, if that is removed, the authentication is under question,” he says.

“Of course, people do not want to reveal their health status in public. But the prime factor is affordability,” he says and adds that courageous people accept the fact and avail themselves of the free passes. “Free pass scheme is picking up, but at a slow pace. This is evident from the increase in the number of beneficiaries from two to three digits.”

Former peer counsellor Doss, who travels from Dindigul to Madurai every month, says that he had made up his mind to face discrimination in the battlefield of life. But the truth remains that not many are as gutsy as Doss.

The Scheme and the Numbers

Free bus passes were introduced in 2010 and distributed from 2011

40,000 people are registered in Tamil Nadu, of which around 5000 collected their passes.

There are 43 ART and 90 Link ART centres in the state

In Madurai, 14,604 were registered till September 2011

3669 people are on ARV treatment and 866 received bus passes

796 children are registered and 161 are on ARV treatment

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MetroplusJune 28, 2012