Health

After drug stock-outs, shortage of condoms now hits fight against AIDS

After a series of drug stock-outs, India’s national AIDS programme is now nearly out of condoms. To make things worse, people living with HIV (PLHIVs) are battling red tape in States like Maharashtra, where the government dispatched the condoms via snail mail, to be delivered in alphabetical order to districts.

Given the situation, commercial sex workers in high-burden districts like Sangli, (which has the highest incidence of HIV in Maharashtra after Mumbai) are now dependent on condom donations.

Alphabetical order

“We approached NACO and they agreed that there is a crisis. Instead of showing urgency, they put packets of 4500 condoms — which is way too little for us anyway — in post. To add to the problems, for the last two years, the State AIDS society has been dispatching condoms via snail mail, alphabetically. By the time, Sangli’s turn comes, a lot of our commercial sex workers would have exposed themselves,” said Meena Seshu of the National Network of Sex Workers (NNSW) who runs SANGRAM, a grassroots health and human rights NGO for sex workers.

“What is the point of counselling people coming into our offices, if we cannot help them with something as fundamental as a condom?” Ms. Seshu asked.

The government’s response is that the guidelines specify that India Post be used to dispatch condoms. “At the review meeting of all project directors held at NACO on April 28, we were told to speed up supplies. So we can now use private firms to dispatch condoms. As per procedure, we have to send the stock in alphabetical order and since there was no pending demand for condoms, we went by the system.

We have been following this system from the beginning, but now it [the dispatch of condom boxes] will be based on priority,” said Mukund Diggikar, additional project director, Maharashtra State Aids Control Society.

Less than a month’s supply

The Indian government has been providing free condoms under its community-based AIDS prevention programme for high-risk groups like commercial sex workers. While the shortage is country-wide, according to National AIDS Control Organisation’s (NACO) weekly stock update on April 23, Andhra Pradesh, Delhi, Madhya Pradesh, Manipur, Punjab, Rajasthan and Sikkim are the worst affected, with less than a month’s supply. The norm is to keep a buffer stock of six months — so that sporadic stock-outs can be met. Not a single State in India, barring Haryana, has stocks worth six months.

“Frankly, we are out of money. There are any solutions to offer. In Sangli’s case, we are aware of the distribution problems. Somehow, we have not been able to sort that out.

The system of sending condoms by post is not new. The rest of Maharashtra is not as bad as Sangli. We have told them that they can go and collect it from the post offices,” the official added.

Sangli district alone requires 75,000 condoms each month. For now, humanitarian aid organisation MSF has offered to donate a month’s supply to SANGRAM, said Ms. Seshu.

Short of kits too

While the United Nations is setting ambitious goals of ending the AIDS epidemic by 2030, India is also struggling with shortage of critical antiretroviral drugs, particularly Zidovudine and Lamivudine (ZL), and viral load testing kits across the country. As a part of the government’s intervention, NACO provides 15 free ARV drugs used in first line, second line and paediatrics combination regimen.

In the case of adult dosage of ZL, the national consumption was 24,34,914 in March 2016, leaving a balance of 13,10,672 on April 21 — just enough for 15 more days. Which means, as of this week, the national programme is entirely stocked-out.

The shortage in the national programme is putting patients at the risk of developing drug resistance.


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