Re: Anti Retroviral Therapy in India

September 6, 2003

Dear forum,

I Want to share some of my concerns about ART- it is being projected as a

panacea to HIV. there are several challenges in ART apart from the very obvious

cost factor. First of all, there are very few practitioners who really know how

to practice HIV medicine. There are several horror stories of doctors blithely

prescribing one- drug regimens when now the norm is at least a three - drug

regimen. And there is no follow-up or monitoring of patients subsequently. And

i am sure you will argee that ART in the hands of doctors who do not know enough

is far more dangerous than no ART at all.

The other challenges are that ART reqiures a very high level of adherence, which

even in the West with all their high tech tools to improve adherence have not

met with much success. Our track record in adherence in other therapies like TB

and leprosy, which are again not life- long, have been very poor. And

defaulting with ART has much more serious consequences. And one cannot ignore

the element of side- effects that may contribute to poor adherence.

Perhaps we all need to remember that ART is for life. And there are many

lifestyle -related issues that will have to be addressed before prescribing ART.

For example, if a person regularly uses alcohol then that will have to be

addressed before one can start on ART. So it is not as simple as knowing the

regimen and prescribing. A person on ART will also need a lot of counselling

support to ensure adherence.

This is not to say do not have ART. But instead to understand the various

complexities involved and making a decision after carefully weighing the pros

and cons of it. Also understanding the relative benefits of preventive and

promotive meassures which perhaps get sidelined in the clamour for ART. Some

very critical lifestyle changes can help prolong the lives of positive persons

and not just ART.

But let us all hope that ART becomes more simple and more effective that what it

is now. At the same time let us lose sight of alternatives.

Akhila Panchamukhi

E-mail: <akhila_punch@...>

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