Epidemics Dec 14, 2003 7:50:32 GMT -5
Post by Big Bunny on Dec 14, 2003 7:50:32 GMT -5
NAME AND SHAME
The International Labour Organisation says that it has come across cases where Indian hospitals have published lists in local newspapers of the names of people testing positive for HIV.
It also found that doctors have refused to perform Caesarean sections or help with deliveries out of fear of infection; and some hospitals have refused treatment in life-threatening situations.
“In a case from the town of Karur, a man was brought into a hospital for emergency neurosurgery,” an ILO report said. “The surgeon, finding out about his ‘high risk’ status, called for a blood test before beginning surgery. The report was negative but the patient was dead before he could be helped.”
The study also found that women face more discrimination, since society often assumes that women are either the source of the infection or that their failure as wives has caused their husbands to have sex with other partners.
“In India, the man is king,” Sequeira said. “If the man dies, it is not blamed upon the man that he got HIV, it is blamed upon the wife, and she is usually thrown out of the house. The only options they have are to find a shelter or go into commercial sex work.”
A survey by NACO found that 36 percent of respondents thought people with HIV should commit suicide and one-fifth of them thought it was a punishment from God.
Children of HIV-positive parents, even if they themselves do not have the virus, experience discrimination, and are often excluded from school and other activities.
While the general public and rural areas are now facing dramatic rises in infection rates, prevalence among high-risk groups such as sex workers, truck drivers and intravenous drug users has still not levelled out, and has soared to 70 percent in some states.
The World Bank says infection among drug users is on the rise, since many seem to be switching from inhaling to injecting.
While significant intravenous drug use is limited to northeastern states, major cases of HIV transmission through drug needles have increased in urban areas such as Mumbai, Kolkata, Delhi and Chennai, according to Avert.
Avert’s Kanabus told AlertNet there were cultural and religious difficulties with the kind of needle-exchange programmes that had proven successful in countries such as Britain. Such programmes allow addicts to swap used syringes for new ones.
AIDS infection is also still on the rise among sex workers.
Bombay has the country's largest sex-worker industry. Of an estimated 15,000 people selling sex in the city, Avert estimates that 70 percent are HIV-positive.
Kanabus said while it was sometimes difficult for NGOs to reach communities of sex workers controlled by pimps and madams, peer education movements were effective.
"But if you are helping them educate each other, this sort of community action can be effective,” she said.
Sex workers in the red light district of Calcutta in West Bengal campaigned successfully in the late 1990s to raise condom use to over 90 percent in 1992 from three percent in 1998, with the support of the government, NGOs and international agencies, according to the World Bank.
Avert says truck drivers are crucial in spreading sexually transmitted diseases, including HIV.
Between two million and five million truck drivers work on India's vast road network, stopping at "dhabas" or roadside hotels that offer lodging, food and often sex, alcohol and drugs.
Avert said a 1999 study found 87 percent of truck drivers had a frequent and indiscriminate change of sexual partners, and only 11 percent of them used condoms, although their AIDS awareness was fairly good.
Sequiera said India had facilities to provide HIV testing and counselling, but access to antiretroviral drugs that make it possible for people to live with HIV for decades was still limited even though India is one the world's top producers of generic antiretrovirals.
“I cannot understand why India manufactures the antiviral drugs but they are sold cheaper in Africa,” Sequiera said. “It costs people about 1,000 rupees ($22) per month. We cannot afford that.”
Because of the cost, coupled with inaccessibility to clinics providing drugs, he estimated that only 300,000 to 400,000 people were getting treatment.
On December 1, World AIDS Day, the U.N. World Health Organisation (WHO) approved the use of generic three-in-one pills combining the drugs lamivudine, stavudine and nevirapine made by Indian companies Ranbaxy Laboratories and Cipla.
The move drastically reduces the cost. For example, Cipla's generic Nevirapine -- called Nevimune -- cost 135 pupees per tablet ($3) in 2000, less than half the price charged by patent holder Boehringer Iingelheim.
WHO says simplified generic drug treatment regimes are crucial to fighting HIV on the frontline of extreme poverty.
India’s government took the opportunity of World AIDS Day to announce it would begin providing free antiretroviral drugs treatment in the six states where HIV has become a serious problem.