Manipur. ARV’s: Unkept promises

[Guest guest]

Footnotes: ARV's: Unkept promises

By: Chitra Ahanthem

It has been a long time since the World Health Organization bandied

about what is known as the 3X5 initiative for people living with

HIV/AIDS (read as 3 by 5, appertaining to WHO's vision for

treatment/therapy of 3 million people by 2005). The announcement of

free ARVs for India came on the eve of the World AIDS Day in 2003

with the Union Minister of Health Shrimati Shushma Swaraj saying

that they would be provided to 6 HIV/AIDS high prevalent states in

India: Manipur, Nagaland, Tamil Nadu, Andhra Pradesh, Maharashtra

and Delhi from April 2004. In the following 6 months there was no

effective means of involving different stakeholders in the free ARV

initiative: doctors and health experts who were working in the

field, grass roots NGOs that dealt with providing HIV/AIDS related

services and activists from within the community of People living

with HIV/AIDS (PLWA).

But in a state like Manipur which has for long been under the

specter of HIV/AIDS, the activism of grass roots NGOs came out to

the fore and a common platform called " GIPA Alliance " was formed for

all PLWHA to come together and freely voice their rightful demands;

respond synergistically to whatever steps the government or any

other relevant agencies take up; ensure their access to care and

treatment and endorse GIPA (Greater Involvement of People Living

with HIV/AIDS) in spirit and action.

The Alliance is constituted of 4 Drug User Organizations: Social

Awareness Service Organization (SASO), Lifeline Foundation, Kripa

Society and Care Foundation; 2 networks: NEIHRN (North East India

Harm Reduction Network) and MNP+ (Manipur Network of positive

People, besides 40 Self Help Groups of PLWA. The Alliance conducted

a series of consultative meetings and 2 state level workshops

participated by representatives of Government Health care settings

(notably the two main Government Hospitals in Manipur: Regional

Institute of Medical Sciences (RIMS) and Jawahar Lal Nehru Hospital

(JN Hospital), MACS officials and representatives of various SHG,

PLWA, drug user groups.

The recommendations arising out of these discussions could have gone

a long way towards a more PLWA friendly ARV treatment roll out

program, if only the Government machineries had taken the ground

experience of grass root workers but in the end, the many voices

that have been raised over and over again in Manipur still continue

to be a wasteful exercise. Among the many recommendations that came

up through these consultations was one that called for the formation

of a State Working Committee for developing state plan/policy on ART

program which would chalk out future course of actions for getting

the policy endorsed by the State cabinet.

It was also decided to hold consultative meetings at different

sectors/levels/groups to formulate an effective State Plan on ART

scale up program focusing on significant issues: Drug dispensing

through all district hospitals and other capable non governmental

set ups; PLWHA groups, NGOs, CBOs (Community Based Organizations),

FBOs (Faith based Organizations) to be incorporated for follow-ups

and adherence education/counseling; Develop monitoring committee

that includes PLWA.

For reasons best known to the officials who themselves worked to

arrive at these recommendations, there seems to be no realization of

the assurances in the present day ARV situation. Rather, what was a

matter of grave concern has now become a stark reality. In layman

terms, ARVs can be described as therapy for people with HIV. These

ARVs come in different combinations of medicines and have to be

taken without fail every day. The catch in the free ARV roll out was

that there was to be only two regimens available despite the fact

that neither included Effavirenz, which was important in light of

the fact that most PLWA seeking free ARVs in Manipur are injecting

drug users who also have Hepatitis which necessitates its inclusion.

Following a directive from NACO, Effavirenz came to be included but

just as the dust looked to settle down; it has not been dispensed

for quite sometime with the rather lame explanation of " out of

stock " . This brings us to the burning question begging for an

answer: what do people who have started taking this medicine do? Is

it ethical for any government agency to dangle carrots and then reel

them in after whetting the appetite? More relevant for us would be

to probe into the sustainability factor of the free ARV roll out.

How free is free if the stocks run out and people are forced to stop

taking their medicines or worse still, compromise with any available

regimen even if it is not suitable for them?

End-point:

Asked to comment on the issue, Ng. Ratan MNP+ Secretariat Co-

ordinator said, " Does 3X5 mean treatment or killing of 3 million

people by 2005? "

Surely it is time to put an end to the absurd blame game of musical

chairs being played out by MACS, the relevant Government

representatives and the doctors at the ARV centers?

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