Re: Regard to moving India forward

[Guest guest]

Hi all,

The gap lies in understanding and orienting the AIDS policies and

practices towards the Indian cultural and social practices prevalent. We

need to build our own strategies which need to be focussed keeping in

view the regional practices which are prevalent. At some places, the

faciliites for testing and treatment options are abundantly available

(in metros) and at many places - even 25-50 kms away, there is no

testing facility available. Our programs are at the moment metro centred

and major town centred. E/R/S testing must be made more freely available

and at a cost which an individual can affor (Rs 30 - Rs 50). Presentlty,

here in Ahmedabad, pvt labs are charging Rs 150-Rs 200 for E/R/S test.

Govt hospitals are definietly not charging, but many a time the kit is

finished, reagents not available, CD4 count not available due to non

working machines/kits NA etc.

Second, majority of our HIV+ cannot afford a CD4 count and WB tests in

pvt sector, yet there is a recomemmndation, that it may be done every

now and then to monitor the status and progression. We may need to

enhance our clinical acumen to corelate the presentation of HIV+ at the

health care facility and correlate the possible CD4 level to initiate

HAART or other form of treatment.

Our HIV+ tend to present at a late stage in disease history, hence the

residual life is limited and interventions are also limited. It may be

due to poor economic conditions.

Confidentiality issues - are they relevant in Indian contecxt. I have

interviewed some 100plus HIV+ in western india. One striking feature, is

the family support available to them in care and support. The family

memebers know about the HIV (though they are not able to grasp the

intensity, extent and meaning of the disease) and accept it in their

kith and kin and tend to look after them. Very few cases tend to put the

blame on the spouse.

If we are seeking community support in care of hiv+ and their acceptance

of such patients as normal patients who have to be treated as such

without stigma and discrimination, then confidentiality issues may have

to be debated. Do we then really need a separate Hospice care for them?

Are we taking them away from stigma and discrimination or are we

promoting the same.

There may be linkages between the SACS, NGOs and others, but, I feel the

there is a paucity of linkage or maybe very few NGOs who are in the

field, that they pick up the patients from SACS/treating hospital and

follow them up in community and offer care and support at community

level.

Are NGOs being restricted by availabilty of - funds, expert manpower to

scale up their projects or are they myopically focuused only on certain

aspects of prevention and care programs.

What is feared is a state where the public is made to believe that HAART

is the only form of drug available to control the spread of HIV by

making it easily available to the public and HIV+, bring down the cost

etc. The message going out is - " ok do manage to get HIV+, there is

HAART to prolong the life " .

There is no sysytem of epidemiological surveillance and tracking of HIV+

at state level - of guiding them that once they leave their area of

normal residence and migrate, not only should be encouraged to report to

NGO involved in care and support, but their names may be exchanged at

SACS level as well.

This brings to the fore, the need to empower and encourage the HIV+ to

have an available list of NGOs/Hospitals (pvt or government) whom they

could approach in the time of their need

Lastly, I wonder, how many exposures to couselling sessions may be

appropriate before we can expect the HIV+ and their family members

providing support, to adopt safe paractices. My little experience in

interveiwing 100 of them suggests that only approxx 40-50% had been

counselled only once in their lifetime of exposue since having tested

positive and now reporting with an illness

Pvt sector needs to be more sensitised and motivated to actively take up

this issues - workplace HIV, launch own community programs or support an

organisation involved in these programms.

Best regards

Dr Ratti, MD

E-mail: <ratti2@...>

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