Kerala: Government docs of state set model in the PPTCT

[Guest guest]

Government docs of state set model

Thursday July 5 2007 13:16 IST

T'PURAM: A week back, Raheen Abbas, a slum dweller in Uttar Pradesh,

was forced to pull out the baby out of his HIV+ wife as doctors at

the Meerut Medical College refused to do the job for fear of

contracting AIDS.

Down south in Kerala, doctors, government doctors to be precise, are

making the country proud by treating the HIV+ patients. Over the past

four years, they performed Caesarean sections on 131 HIV+ women,

which has undoubtedly made the state a role model for other states.

More interesting is the fact that out of the 131 deliveries none of

the babies have been affected with HIV.

Thanks to the efforts of Kerala State AIDS Control Society (KSACS),

which is actively involved in the Prevention From Parent To Child

Transmission (PPTCT) programme, the doctors have been equipped to

deal with AIDS patients.

The deliveries of HIV+ patients are done only through Caesarean

sections in order to prevent the spread of disease to the infant. The

doctors are performing these surgeries at a very higher risk rate.

But still, with the help of KSACS and by taking adequate preventive

measures, the doctors of the government hospitals across the state

are doing a commendable job.

The irony is that it is happening in the same state, where five HIV+

children are fighting against a whole society for getting quality

education in a school at Pampadi in Kottayam.

Till May 2007, 29 deliveries of HIV+ patients have been performed in

the state, in 2006 69 deliveries and in 2005 31 deliveries.

The HIV+ deliveries became more accountable with the initiative of

KSACS. In 2004, before the KSACS became fully established, only two

deliveries have been reported.

The KSACS began its PPTCT campaign in 2004 by establishing SNEHA

centres across the state. By 2005 end the 51 SNEHA centres became

fully operational and this has helped in collecting the data of the

HIV+ patients from each district.

This has certainly enabled the patients get better treatment at the

government hospitals.

Over the past four years, they performed Caesarean sections on 131

HIV+ women.

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[Guest guest]

Dear Forum,

Re: /message/7506

This e-forum is most useful and sometimes I wish all Doctors all across India

would get to read its contents at least every ten days.

I am appreciative of the report of the medical profession (state services)

making obstetric services available to PLHIV women in Kerala. What complexities

this epidemic has raised- there are 5 children in one location being stigmatised

and discrimated on the issue of their education at the same time! How many other

undetected being discriminated is anyones guess!

If only Obstetricians in the private sector would also whole heartedly shed

their fears/inhibitions and participate. It has been our sad experience in

Mumbai (and other states that I visited during my involvement with HIV care)

that linking PLHIV women for obstetric services, particularly delivery, is

exptremely difficult, due to unreasonable fears/inhibitions/lack of

training/unnecessary overcharging. The potentially wonderful participation of

Obstertricians in the human miracle of parturition, most often becomes a horror

story because of the lack of involvement!

Incidentally, why should those 131 deliveries have been Caesarean sections? Over

four years, were they no other normal vaginal deliveries? The current

norms/guidelines (WHO for Resource limited settings on which NACO guidelines are

based) do not provide any specific benefit by caesarean section if proper

antenatal monitoring, appropriate PPTCT medication and appropriatae intranatal

procedures and restrictions are employed.

I am ever hopeful that more Obstetricians in the private sector would make the

gift of their professional services available (after due upgradation of

capacities, which is easily achieved for them) and care for the PLHIV women and

the awaiting next generation, all over India.

yours truly,

Dr Shashi Menon.

Director, Kripa Foundation.

Faculty, WHARF.

e-mail: <msmenon@...>