BBC News - Monday, 17 November, 2003
Charles Haviland, BBC correspondent in Bangalore

It could be a typical Indian household scene. But it isn't.

Vinod, his mother, Rama, and his eight-year-old sister, Jayashree, are all HIV-positive.

The visiting 'uncle' is, in fact, Doctor D Nagaraj, accompanied by his wife Deepa. Both are doctors specialising in HIV and Aids treatment.

The doctors used to care for Rama's husband at their clinic on the outskirts of the city of Bangalore. But he died from Aids last year.

Since then, they have found a new way to care for patients - they go on almost daily home visits.

The response from patients has been generally very good. The visits bring them personal contact that is not always easy to find.

Ostracised

The scene at Rama's home in a quiet village near Bangalore seems pleasant.

Birds chatter in the trees while chillies and lentils dry in the yard.

But, Rama tells me, the neighbours shun the family, including her mother-in-law who also lives with them. Even their own relatives have cut them off.

This is the reality of the stigma that HIV patients across India face. No wonder the doctors, who always visit as a couple, are welcomed as friends.

The two doctors travel by motorbike. It is an inconspicuous means of transport. And for families whose neighbours do not know they are infected, this is invaluable. And they bring medical care.

Today Rama is complaining of numb legs. Although antiretroviral drugs are too expensive, the doctors always carry other medicines and have some for her.

As a result of the home visits, patients have become much better at taking their medication properly.

From pre-test counselling and the taking of blood samples, through to drug courses and palliative care, everything can be brought to the doorstep.

The couple even complement each other as Dr D. Nagaraj is a general physician while Deepa is trained in alternative medicine.

Treating patients away from the clinic brings advantages.

"When we go to their houses, we know the family situation, family background, how they are living their life," Deepa says.

"Patients are more comfortable, they express all their family problems."

Mobilising funds

Home visits make it easier to tell uninfected family members how the HIV virus can and cannot be transmitted.

The visitors also try to help with financial and employment issues, for instance where there is a widow who was previously not earning a salary.

"We try to mobilise funds," Dr D. Nagaraj explains, "and looking at her capacity we try to elevate her, get her a job suitable to her educational status, so she is able to look after her family".

The Nagarajs have, for instance, found people jobs in tailoring and security. They have also helped place newly-orphaned children in homes.

Money remains the chief problem. Their clinic, the Good Shepherd Health Centre, is their only source of funds.

Many non-governmental organisations prefer to channel funds into Aids awareness programmes rather than care. The couple do not charge their Aids patients, most of whom are poor.

They try to raise money "through our own colleagues and friends who are able to give," says Dr D Nagaraj. "Even their resources are very poor."

He sees some hope. He believes that in Bangalore, perhaps because of its relatively highly-educated population, the stigma attached to HIV is gradually diminishing.

Some villages are now accepting patients back into the fold where before they would not even have offered them water.

But it is a slow process. Rama's daughter was asked to leave her school. She has since found a more accepting one.

Hostility and ignorance are still common. In one family in the area all the members decided to commit suicide because of the effect Aids was having on them.

They pulled back from the brink when they heard about the help the Nagaraj couple could provide. As for Rama's mother-in-law, she is already asking when the doctors' next visit will be.

"It makes us feel comfortable," she says, adding, on a practical note, that "there are no travel costs to and from the clinic".
031117
BB031118

Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.