Re: NACO Guidelines on ARVs

[Guest guest]

Dear Facilitator,

This is in response to Ajith's comments on NACO draft guidelines for ARV. Ajith

has raised many relevant issues related to the introduction of ART in India. The

main thing is that there is no point in talking too much about ART outside a

comprehensive health care concept. ARV is not a magic remedy for curing AIDS.

The efficacy of the drug is very much dependent on the nature of care available

to the person. It is often seen that positive people are given prescription of

ARV drugs when the common drugs used as prophylactic measure to avoid

opportunistic infection are not available to them. Some times they buy one or

two drugs according to their capacity though three drug regimen is prescribed

considering efficacy and the resistance problem.

Of course, we know that the pressure for free availability of ART come from

different points. One such strong pressure may be from marketing companies as in

any other case. At the same time there is a political demand from the community

of positive people also for the same. It is not just a simple demand for ARV,

but is an assertion to the basic right to health care to a positive person who

is denied of many other rights to live as a human being.

A positive person living in India is raising this demand in a context where

right to health care is not yet considered for any one. Marginalised and

economically poor people are suffering because of this. The situation is going

to be worse in the coming future as a consequence of TRIPS etc.

Hence, the demand from people for ARV is the demand for affordable medicines,

access to treatment and health care. Care of PLHA includes treatment of

opportunistic infections, prophylaxis, laboratory investigation facilities, ARV

and monitoring system. Except for ARV, all components will improve our health

care system. So, if there is a will we can utilize the resources optimally so

that others also benefit from this.

So, care for PLHA need not contribute to neglect of other health problems.The

problem is not that of ARV, but of our deteriorated health care system.

The ARV issue may help in sensitizing about the issue of rational use of drugs,

since it has got high potential for resistance. The resistance issue cut across

class and other barriers. Any practitioner should be sensitive to this though it

is not happening now except among few.

Commercialisation and the drug industry may be one major contributing factor for

this situation. But can we afford to ignore the factor of corruption in our

beaurocratic system any more? Can we blame " neo-colonialism or neo-liberalism "

as something outside, posing ourselves (any one in the system, whether

Government or Non-Government) as helpless victims?

Even if we do not introduce ARV, we need a continuous supply of medicines in our

hospitals. We need basic laboratory facilities. We need effective monitoring

system. We need people's participation in health care. Let HIV/AIDS and ARV be a

cause for it.

We know what is to be done. We have resources. We have infrastructure. We know

all strategies. What we need is freedom from a colonised consciousness and

responsibility to the other.

Dr. Jayasree. A. K.

E-mail: jayasree@...