Re: What is the ARV requirement for a given population of HIV + patients

[Guest guest]

Dear Mr Agarwal,

I think it is a gross underestimation labelling ART just a prolongation of life.

A good ART program not only prolongs life but also improves quality of life

which means No frequent OI infections to cause sickness and it`s cost.

Additionally it has been found to be the single most important effective

motivating factor for people to go to VCTs. Would you want to be tested for an

illness for which there is no offer of treatment? But when there is such hope

people do want to get tested.

ART is also the only way we can show people that being HIV positive

is not the end of life and the acceptance of PLHA in the community and at the

work place will also improve because a PLHA on treatment is as able as any of us

to do anything.

Good treatment also decreases the chance of spreading resistance from the' not

good' treatment which will always be there; and also decreases transmission.

The problems you noted are also not the real problems. I know indian doctors

don`t need any special education to be able to prescribe ARTs.

Infact Indians have prescribed them before most others. The trouble is

affordibility ofcourse. As India is a free market in almost every sense the

prescriptions are determined by not the scientific

evidence but your affording capacity.

This is lack of regulation by the government. I know that even TB treatment DOTS

after many years of trainings given to many Doctors by the national program

doctors still prescribe according to the affordibility.

Mind you for anyone affording Indian doctors prescribe both ARVs and TB DOTS in

the proper manner. So how about for the non affording?

According to WHO out of 770,000 indians who need ART on end of 2004, only 30000

were on treatment The rest 95% was not able to afford.

The government promised to treat 100000 by end of 2005 on the 3x5 initiative but

did only 3000. There was an alternative also for the

budget around 120 million dollars was approved from Global Fund for india only

for treatment and care(in two rounds starting June 2003) but not a single

patient has been treated because of the fatal government's beurocracy for its

implementation.

So all adds up to one single most important problem we have to get Indian PLHA

treated, Government commitment.

Dr Tewo

E-mail:<twoldema@...>

[Guest guest]

Dear FORUM,

This is in reference to the message from Anil (Anil agarwal

E-mail:ashuanilus@...).

I am agree with Anil's plea for addressing the most important needs of PLWHA -

like OI management, psychological support and counselling etc.

It is true that people feel hope as the ART roll out was started since last

year. The availability and existance of ART clinic enhanced more and more

discovery and testing.

We have been trying to work on the areas which you feel important.

Lets first talk about OI management - we have a problem especially financial

problem for manageing OI's by our selves. WE are prone to be infected with any

OIs especially TB - cause, we are poor in

general and living under the poverty line.

As a result there is problem in buying those nutritious food and failed to keep

ourselve in a healthy state.

Addressing of the widen poverty among the PLWHA community will help solving the

problem at certian level.

When we look at the VCCTC - do you know any positive peer counselor working in

the govt. VCCTC. It is important that every VCCTC have a peer counselor from

both the sexes. This is not happening in reality and there are lots of

professional counselor. But, who still need more understanding about the issue.

There attitude needs to be change through sensitization programmes. in the year

2003 when i went to Safdarjung Hospital in Delhi to have another test for the

second time. i met the counselor pre and post

of receiving my report. When i was counselled after receiving the report - the

counselor talk to me and fill up a form. There in the form i was asked of the

number of woman with whom i have had sex. I told him " about 7 to 8 " , then

without clarifying of the background of those 7/8 girls i have mentioned. He

instantly tick the option " Commercial Sex Worker " . And i started arguing with

him by pleading that the girls with whome i had sex were not CSW - some of them

were my class mate, childhood friends - and none of my girl

friends in the past was and /is a commercial sex worker.

This clearly indicate that there is a gap and needs for promoting and upgrading

theVCCTC. Also the involvement of PLWHA as peer counselor should be necessarily

implemented.

In those states where the movement of the PLWHA support group is active with

remarkable performance, the possibility of successful intervention is more

possible. Because, the visibility is high, spreading of information and message

that encourage the PLWHA

to live a positive living is more easy, WE gain confidence by becoming a member

and being with other peers. The fact that all of us could collectively advocate

for our rights secure us mentally and thus effect our phiscal action.

So, it is very clear that the creation and support for building strong community

of PLWHA is one of the most important and compulsory need to keep in our mind.

It is really sad when we learned that there are many PLWHA who need mental

support and follow up after being tested positive. These are the people who are

silently suffering and hiding ; with limited

knowledge about the disease as most of them went underground and stay at home

without visiting the VCCTC for the second or third time. On the other hand it is

almost not practical to follow up those PLWHA at home.

The linkage between the VCCTC and network of PLWHA should be promoted. Before we

have attempted to do the follow-up, but come across with the issue of

confidentiality and privacy. The counselor in the VCCTC have no right to expose

the data of the client.

As a result we are helpless...in identifying people.

This could be address only when every VCCTC centre has each male and female

peer counselor, which is selected and referred by the network of PLWHA.

Within the network,- the very first simple information given to our new friends

is - " To be a responsible person and not to pass on the virus to any other " -

this is very simple but very important and

Practicable.

However, it is really unfortunate that there are thousands and thousands of

people who haven't heard this simple lines and even get the opportunity.

" We can promote and advocate for Positive Living " only if the person is with us

and available.

We have always mentioned that VCCTC are the entry point to care and support and

treatment. Still there are lots of people we have missed out. Its difficult to

trace them and also impossible to approache them in most of the cases.

As you have mentioned, ART is not the very first thing/subject to put up when a

person knows his HIV positive status. this is right and there are lot's of thing

to be done before discussing the subject of ART.

We need cooperation from the government agencies, authority of the hospitals etc

and all these are not happening due to several factors and lack of commitment by

several stakeholders.

We plead that who so ever responsible for this should think again and think it

over again and involved the PLWHA network effectively, just to save more and

more numbers of infections in the future.

Thanks

Ricky Tombing

E-mail: <dnpplus@...>

[Guest guest]

Dear FORUM,

This posting re: Dr. Tewo's reply to the message " What is the ARV requirement

for a given population of HIV + patients

I am also of the opinion that all the PLWHA should get ARV whenever need, but as

per an estimate only 10-15% of the people really need the ARV.

I am talking about the 85% PLWHA who really do not require ARV. I ahve met PLWHA

who have been put on ARV at the time, when they dont need it. I personally have

seen patients who are purchasing ARV inspite of their high CD4 count & not

suffering for any OI. I know Indian doctors do not need any training but they

need orientation about the use of ARVs and strict implementatin of the

regualtions and

guidelines.

I have seen VCTCs where PLWHA come for regualr check up and OI mangement. The

PLWHA are visting VCTCs inspite of knowing that they will not be able to get

ARVs from the VCTC. But the psychologic support they get and early detection and

mangement of OI is very cost effective startegy.

If we can develop and maintain positive attitute and high self

esteem of PLWHA toward life then people can help themselves.

What happenes practially once a person is declared as a HIV positive, inspite of

good counseling most of the people feel depressed. People who were working till

one day before diagnosis starts feeling ill. If the followup counseling is

provided to these people, they can be taken out of the initial depressive state

without any treatment.If they can be motivated to go to their normal work and

regualr psychologaicl support is provided to the people they can continue to

earn and even they can be prepared for the future.

I am of the opinion that the whatever resources are available shold be utilised

properly and judiciously so that more & more people can be helped and if we all

can plan and think of some of some insurance scheme sort of think so that the

ARV are available universally.

Even a smaller contibutions can make big change. I am not against ART but I am

alos in favour of Comprehensive step wise care & support

services. ART is a component of that.

My submission is that people are worried more for ARV than other components of

comprehensivecare & support.

Thanks, With regards

Anil

E-mail: <ashuanilus@...>

[Guest guest]

Dear readers,

For four years I have been labouring this same point that if we find people

early enough and look after them they can go for years, even decades, without

ART's.

I had a referral in Delhi who responded positively from depression and weight

loss to employment and being asymptomatic in four days of patient interpreter

based counselling about his blood report that he had seen and not understood.

His question to me was " When am I going to die " to which I replied " Just set the

date and within two weeks you will be dead "

I asked him if he had a blood report and he said he did but he didn't remember

anything about it.

I checked his temperature and it was mildly elevated. I asked him how much

fluids he was taking and it was not even enough for a healthy person. He was

also not eating, yet at one time he was a juniour athlete in his school days.

He was advised to increase his fluids and take some panadol and return next day.

I got a different interpreter than the friend he brought with him because I

wanted to ask him some questions that he might not have wanted to answer to a

close friend.

I explained about nutrition and immune system care and suggested that he needed

a reason to get up in the morning. His marriage had broken up and his family had

disowned him because of that. His former wife was not infected.

His friends were a whole group of people with pooled ignorance about HIV.

I asked him to try and find a job and he returned with an offer of a

security guard position which was rotating shifts and was his if he could

provide a uniform. I gave him the 700 INR to get the shirts and trouser and then

his friends started ridiculing him because a security guard position was beneath

his skills and dignity.

They were chastised and told to stay positive when they were with him and if

they could find him a better job then do so but don't derail this one.

We met one more time before I moved on and he was positive about his life again,

eating small and regular meals hand picked for nutrition, he was drinking

potable water but this was a financial burden. He would have improved more

quickly if his family could have supported him but thuis far this support has

not been forthcoming. He had a sparkle in his eyes and he had learned some

english words to show his appreciation.

I would be surprised if he is a candidate for ART's in the next five years. The

economics of eating well and drinking clean water will continue to be a problem

for him as it is for all HIV +ve people and their families.

It is just one example of early detection and competent counselling from people

who actually know enough about HIV, nutrition and hydration and social care and

support and the value of employment. Of course if his employer was to find out

his HIV status we could end up back at square one again because there is no

effective legal protection for infected but capable workers.

I just use this example from Delhi to illustrate the point that was so well made

by my friend Anil in his timely posting. I hope Dr Tewo gets this message too.

What is also critical for people like " Dinesh " is that they can be put in touch

with a member of the medical profession who are not traumatised by the presence

of HIV virus. Oh how I long for the day when this kind of medical professional

out-numbers the present status quo and no where is that more relevant than in

the countries northern States where, in my view, most of the as yet undetected

infection lies.

I stop here and hope that this single example reinforces the message that early

detection and good social supports and proper nutitional and hydration

competence will enable people to survive and remain productive in our society.

This survival strategy will obviate the need for ARV's for most of them. When

the community becomes more user friendly more people will consider testing and

when that testing gets to be guaranteed confidential and when the supports for

positive outcomes are established in affected and infected communities only then

will we see a turn around in new infections.

While people remain undetected they are a risk. While O.I's continue

to be ignored as a means of maintaining healthier out-patients rather than

hospice patients we will always be chasing our tails.

Safer sex messages and effective harm reduction strategies have already worked

in other countries and there is no reason apart from fixing some of the

destructive legislation in India, that it can't happen here too.

Keep the conversations going friends.

Geoffrey

E-mail: <gheaviside@...>

[Guest guest]

Dear Friends,

Quoting Mr. Anil, " I am not against ART but I am also in favour of Comprehensive

step wise care & support services. ART is a component of that. "

Absolutely right. I'm an example. I'm doing well just by maintaining a good food

habbit and a life-style that contains no hard physical work or outdoor

activities. Believe me, there were times when I tought of committing suicide and

now I'm on the verge of starting a new business.

Thanks to the internet. Information were avialable which said that 'this might

not be the end of everything'. If I can maintain a good controlled life, I can

carry on.

Regards,

Shahid

E-mail:<shahid1108@...>