NACP III: Differing needs of states

[Guest guest]

Dear Forum,

Yes. These are the questions to be answered.

I think , We should have a program with clear and achievable targets at national

and state /regional level. India is a big county with different social,

cultural and political realities. We should give freedom for SACS or similar

agencies to decide their regional priorities than having a single national

agenda which is irrelevant to many of the states.

For example it is absurd to insist on Giving Nevirapine monotherapy

for MTCT in kerala where our couples consult doctors from the second month of

marriage( either to get pregnant or for antenatal check up). Our own experience

show that even triple drug therapy is feasible in Kerala for MTCT program and

there is no provision to give even Zidovudine monotherapy (leave alone 3 drug

ARV).

We may have to earmark more money for scaling up of health system in states

(or regions) where it is weak and this upscaling should be aimed at providing

infrastructures to support other programs

not ART alone. For e.g. a new PHC will be a better option than a

flowcytometry in a rural area in state where there is health care system is non

existent.

Also from our 4 year experience with " Trichur modal " I would dare to say that

basic HIV care does not need any big investment (probably other than the cost

of ARV) if we have basic infrastructure.

Unfortunately all these years we glorified HIV to an extend that HIV care is

impossible with out millions of dollars and found excuse in not addressing HIV

care.

If we have a basic primary care facility and reasonable secondary care level

centers most of the HIV care issues can be tackled.

For eg:we care hundreds of patients and train all our staff in the last few

years with out any extra recourses that what is available from Government and

SACS.

Once we prepare our system to be HIV friendly it is possible to tackle stigma

at health care setting.

So our priority should be to provide primary and secondary care for everybody

including HIV infected.

Even with our projected 0.9 % prevalence a PHC will not have too many

patients to treat- unlike Africa where the prevalence is much higher.

We may have a different strategy for High prevalence pockets like Mumbai where

some designated HIV care centers may have some role to play.

Please see this study , K.R.; Mathai, Dilip Economics of AIDS care in a

tertiary medical institution in India. J clin epidemol 1996 49 :1:16

Dr Ajith

E-mail: <trc_ajisudha@...>