Myanmar to Manipur, a scramble for HIV care

[Guest guest]

Myanmar to Manipur, a scramble for HIV care

By Usha Rai

Monday, March 1, 2010. The Angel's Care Centre at Moreh, 110 km from Imphal,

Manipur, and on the border with Myanmar, one of the worst HIV-infected countries

of the world, has to provide medical help not just to the over 400 People Living

with HIV and AIDS (PLHA) in Moreh but to the infected of Myanmar who cross the

border desperate for medical help.

The fact that Moreh is close to the Golden Triangle (Myanmar, Laos and Thailand)

of the drug route, and within sniffing distance from India's National Highway

39, has compounded the problem. Forty per cent of the Manipuri families inject

drugs and there are 33,403 HIV positive in Manipur.

In fact, Manipur is one of the six HIV high prevalence states of the country

with 1.13 per cent of the people infected. But in Manipur, as in the adjoining

Nagaland, it is a deadly combination of alcohol and drugs in the form of tablets

that the young turn to for their `high.' When this fails to satisfy them, they

have no qualms about injecting heroin no 4 and other drug opiates. Since a dose

of heroin costs just Rs 20 in Moreh as against Rs 100 and more in Imphal, young

people in this small border town resort to it when angry, depressed and even

when happy and in need of celebration.

Though India is the medical destination for a range of ailments -- heart surgery

to kidney transplants and corneal replacement, the treatment of HIV-infected

from across the border is almost a clandestine operation. In a state like

Manipur where adequate facilities are not available for treatment of the local

HIV-infected population, many feel it is difficult to justify treatment of

foreigners, however poor they are, coming from a country that has not been able

to provide medical succour to its people.

Sachin, project coordinator of the Angel Care Centre, and Sumati, secretary of

the NGO Meetei Leimarol Sinnai Sang (MLSS), Imphal, however, feel frustrated

about their inability to help the very young and very sick people from across

the border. Some are 20 years or even younger and others 40. They come with

acute skin infection, TB and other ailments. At any given time, there are 60 to

70 patients from Myanmar and Sachin says they are HIV positive.

Many of them are farmers and daily wage labourers who buy the ART

(antiretroviral therapy) medicines from pharmacies in Myanmar. They do not have

reports on their CD-4 count or level of immunity because they have no access to

these facilities in their own country.

Without a CD-4 count report, they cannot be given ART in Moreh. So they are

treated for subsidiary ailments and sent home. Since MLSS runs a DOTS Centre in

Imphal and there is high prevalence of HIV among the TB-infected, the people

from Myanmar are able to access the TB medicines from Manipur. They cross the

border regularly for the treatment but since they speak only Burmese, there are

problems of communication.

While hospitals in Morey and even those in Imphal are in a dilemma about

treating PLHA from across the border, Dr Priyo Kumar of JN Hospital, Manipur,

says since the country lies on India's border, treating patients from Myanmar is

quite ethical. Besides it also helps protect Manipur's population from the

infected from across the border.

With the present support from the Global Fund for AIDS, Tuberculosis and Malaria

coming to an end this March, Sachin and Sumati are worried about the future of

the Angel Care Centre which has become the lifeline for over 200 PLHA. It has a

10-bedded community care centre and is providing antiretroviral therapy to 55

persons from Moreh-21 men, 32 women and two children. The ART Link Centre was

set up only in November 2009. If instead of upgrading the Angel Care Centre, it

has to close down, there will be a vacuum in the care and support of PLHA. They

will have to travel 110 km to Imphal for treatment, says Sumati.

In Manipur, the combination of HIV with Hepatitis B and Hepatitis C is playing

havoc in the lives of those infected. This phenomenon has not been seen in other

parts of the country. However at the JN Hospital, one of the top hospitals for

treatment of HIV, the increased risk to the life of an HIV-infected from

Hepatitis B is given special attention. Hopefully other hospitals and caregivers

will realise the gravity of HIV with Hepatitis and give it due importance.

There has been a small decline in injecting drug users in Manipur and now the

HIV-infected are joining the network of positive people. They have gained

confidence and some have even become peer educators.

Take the case of Hanglem Bimola, 40, a widow on ART, now working with MLSS as a

peer educator. A graduate from Bishnupur district of Manipur, Bimola married in

1996 an injecting drug user in Imphal not knowing his HIV status and had a baby

girl the following year. When she was pregnant again, her husband died. The

child born in 1999 too died after three months.

Then the discrimination by her in-laws began. They would not eat food cooked by

her and she had to stay in a separate room. She then went to her parents' house

and in 2001 fell ill and was diagnosed as HIV positive.

She tried to support herself and her child by selling vegetables but no one

would buy her vegetables because of her HIV status. So she moved to Imphal.

Bimola recalls that after she bathed in a public pond at Utlou village, people

of the village held a public meeting and disinfected the pond because they

feared the water was contaminated.

Then she got in touch with the NGO MLSS and soon graduated to becoming a peer

educator. Now she works with the Bishnupur Network of Positive People in an

Access to Care and Treatment project.

In the case of Romeo S Misao, 37, he took to drugs to gain popularity among his

peers. He was only 17 then and soon got addicted to it. When his parents found

out and stopped giving him money, he started stealing and selling off things at

home — he even sold his blood — to be able to buy heroin. In 1994 when he fell

sick he was diagnosed HIV positive.

When Misao disclosed his status, his friends began distancing themselves from

him. He took to alcohol to get over the depression. After coming out of a rehab

clinic, he learnt through some articles in magazines that there was life beyond

HIV. He then went for psychological help. Tested for Hepatitis C/HIV, he was

found positive and put on medication. Misao has joined the Network of Positive

People at Senapati and his life has changed for the better.

Dr Priyo Kumar feels creating awareness and getting people to access services is

the biggest challenge of the state, especially in areas that are hard to reach.

The first case of HIV was seen in Manipur in 1989-90. Thereafter for a few

years, many people suffered on account of common Opportunistic Infections, which

could not be detected and some even led to death. Complications like

cryptomeningitis, penicilliosis and toxoplasma were common.

Doctors could not diagnose cryptococcal meningitis and injection amphotericin-B

was not available in Manipur. The cost of medicines was prohibitive and some

HIV-infected had to spend Rs 5,000 per 100 tablets of zidovudine (retrovir).

With the introduction of HAART (highly active antiretroviral therapy) in 1996,

HIV became like any other chronic manageable disease like diabetes, hypertension

or arthritis but treatment was still beyond the reach of the common man. Many

people ended up with incomplete regimens complicating their health profile

further. Side effects were also reported.

But challenges continue to persist in Manipur. Of the six ART centres, only two

are providing good service. There is a dearth of sound health professionals. In

2000, identification of HIV was still a problem especially among wives and

partners of sex workers who remained unaware of their status. Also spread of the

infection from mother to child continued to be a serious issue and inadequate

medical infrastructure led to situations where opportunistic infections were

often undiagnosed and follow-up was inadequate.

http://www.tribuneindia.com/2010/20100301/main7.htm