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From one trauma to another

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Govind D. Belgaumkar

BANGALORE: Life was just getting back into the groove for 40-year-old B. Ramanamurthy (name changed), an HIV positive person from Mandya. It was with great difficulty that he had overcome the trauma and social stigma attached to the infection.

However, life took another unfortunate turn when a fortnight ago his vision started blurring. By Thursday, he had totally lost his eyesight.

One of the hundreds of patients who on Friday visited B. Sathish of Seva Free Clinic, which treats HIV positive persons in Bangalore, he is shattered by the prospect of his total dependency on others for the rest of his life.

Mr. Ramanamurthy may well come to terms with his personal crisis. But not all victims of HIV have his courage. Some end up committing suicide.

"Sudden blindness is highly traumatic," says Ashok Rau of Freedom Foundation, an HIV-AIDS care and counselling organisation. "It is a significant factor in people resorting to suicide," he added.

Though studies published by the World Health Organisation [WHO Bulletin, 2001, 79 (3)] puts the number of HIV victims who lose eyesight at 10 to 20 per cent of the total number of infected persons, there are hardly any statistics on those who commit suicide.

General secretary of Karnataka Network of People Living with HIV/AIDS Asha Ramaiah says she has known a couple of people who took their own lives. Dr. Sathish has seen many more such cases.

According to Rajesh Babu B., Ocular Immunology and Infectious Diseases consultant, Narayana Nethralaya, Bangalore, many cases of suicide of HIV infected persons have gone unreported.

The cause

HIV attacks the immune system's soldiers the CD4 cells. Normal persons have around 380 CD4 cells per microlitre of blood. When it goes under 200, the victims' risk of infections of all kinds increases.

A survey conducted in Minto Eye Hospital in 2001-03 put the number of HIV patients suffering from eye-related problems at 41 per cent. An analysis of HIV-infected persons between 1993-2006 in Chennai puts it at 47 per cent.

HIV affects eyelids, conjunctiva, cornea, anterior chamber, iris, retina, choroids, and optic-nerve head. Corneal ulcers may result in permanent loss of vision. Eye infections could lead to cancer.

The most common infection that destroys eyesight is cytomegalovirus (CMV) Retinitis. It leads to total and irreversible retinal destruction.

HAART (Highly active antiretroviral therapy - which involves consumption of tablets twice a day) has improved the survival rate of AIDS victims. "Some of these patients recover their general health, but infection that occurred during their low immunity period will destroy their eyes," Dr. Babu said.

According to the figures given by the State Government, the HIV prevalence rate in the population in Karnataka is 1.6 per cent. That means Karnataka with a population of 5.3 crore has 8.5 lakh HIV infected persons.

(To be concluded)

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