Govt, state hospitals seen as better bet for HIV treatments

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Govt, state hospitals seen as better bet for HIV treatments

Govt, state hospitals seen as better bet for HIV treatmentsPrivate hospitals are

known to turn away HIV-positive people even though they may be better equipped

Radhieka Pandeya

New Delhi: All roads lead to state clinics and hospitals when it comes to

HIV/AIDS, even as lack of experts and fears on safety seem to constrain most

private establishments.

“I would always recommend a (HIV) positive person to visit a government

hospital. They are well trained...and there is a clear standard operating

procedure... More importantly, first line medication is free of cost,” says Loon

Gangte of the Delhi Network of Positive People. “In private clinics, they will

prescribe you expensive drugs, or at times even give wrong prescription, or put

you straight on second-line treatment.”

The government has been steadily bolstering its support for HIV/AIDS. The

National AIDS Control Organisation (Naco) raised its budget to Rs1,100 crore for

this fiscal year from Rs860 crore in the last fiscal year, under the third

National AIDS Control Programme (NACP-III) that runs through March 2012.

ACP’s outreach is expanding fast. From 127 antiretroviral therapy (ART) centres

in June 2007, there are 190 centres today.

According to NACP-III, 2.8 million people are living with HIV/AIDS, of which

roughly 500,000 need first-line ART. It says 180,000 people are receiving free

ART in government and semi-government institutions, compared with just 35,000

people receiving care at private or trust-owned establishments.

Securing access for patients or safety for doctors in states has been a

challenge. “We don’t control state hospitals. We can only intervene in terms of

guidelines,” says B.B. Rewari, national programme officer for ART at Naco.

Naco recently obtained the Supreme Court’s approval for a note directing all

states to provide adequate precautionary equipment to health care workers. It

suggests stringent action against doctors or nurses who refuse to treat those

infected.

To be sure, the memorandum also stresses on care givers’ safety. “You should

assume every patient to be postitive, and hence, take whatever precautions are

demanded in your procedure,” says Rewari.

This is in line with the government’s requirement of universal work precautions

for all medical procedures since HIV testing is to be voluntary.

Testing a patient for HIV requires informed consent. “Informed consent means the

patient must be willing to be tested for HIV after knowing and understanding its

repercussions. This testing is...not mandatory... The private sector, however,

does not follow rules,” says Anand Grover, project director at Lawyers

Collective.

He adds that a lot of private hospitals and clinics have misinterpreted the

World Health Organization’s guidance on this matter and made HIV testing

mandatory by disguising it as a routine test.

At Fortis Healthcare’s La Femme Hospital in New Delhi—a unit especially for

women—HIV testing is recommended for everyone. “If someone insists they don’t

want it, we send them for counselling. If they still refuse, we don’t...test,”

says gynaecologist Shivani Sachdev.

But Dr Sachdev, who was earlier with Mumbai’s JJ Hospital, one of the country’s

largest health care providers for HIV/AIDS, admits patients are not asked to

sign consent forms and are merely informed that blood tests would include HIV.

“There is no pre-test counselling as a routine (at La Femme),” she says.

There are other problems.

“Sometimes private hospitals prescribe unncessary drugs...that may not be in

accordance with the (government) protocol,” says K.K. Abraham, president, Indian

Network for People Living with HIV/AIDS.

Private hospitals are also known to have turned away HIV-positive people. “More

than 80% (private) doctors refer positive patients to other doctors even though

they may be well equipped to handle the case,” says Shomasree Dey, programme

manager for the Wockhardt-Harvard Medical International AIDS Research and

Education Foundation.

Wockhardt Hospitals, which follow universal precautions, accept positive

patients for surgeries and ensure their surgeons are well protected. But this is

not the case everywhere.

“When at a private hospital a person is found to be positive, 95% of the time he

is turned away and sent to a government hospital. Here, we doctors follow all

necessary precautions, so our own safety is not at stake while dealing with

positive people,” says Harshal Gawai, casualty medical officer at JJ Hospital.

Nalin Nag, a senior consultant for internal medicine at Apollo Hospital in New

Delhi, is one such doctor who often attends to patients who are turned away by

other private hospitals.

“At Apollo, we practice informed consent by way of getting it signed. We try to

motivate patients to know their HIV status.” He agrees that at many private

hospitals across the country, HIV testing is marked as a routine test and people

are not counselled properly.

“Private health care providers have the choice of turning people back and so,

for their own protection, they do just that. The problem is also that there are

only a handful of doctors who know how to handle HIV,” Nag adds.

Graphics by Ahmed Raza Khan / Mint

http://www.livemint.com/2009/01/06220002/Govt-state-hospitals-seen-as.html