Inter Press Service - December 30, 2002
Lalitha Sridhar

In an example of the insensitivity with which HIV-positive pregnant women are treated in southern Tamil Nadu state, Mallika was informed of her status and hustled off to the government facility the minute the test results were known at the private hospital where she had gone to deliver her baby.

At the government hospital, Mallika could avail of PMCT -- short for prevention of mother-to child transmission -- using the controversial drug Nevirapine for free, but not decent handling from poorly trained, insensitive staff.

Treatment with PMCT began earlier this year as part of the activities of the World Bank-funded National AIDS Control Organisation (NACO), which had till then confined its activities to information, education and counseling.

Mallika knows nothing of the toxicity associated with the Nevirapine or what it could do to her or her unborn child, and no one seems to think it worthwhile informing her. "I just want to save my child," the homemaker sobbed.

Voluntary organisations such as the AIDS Anti-discriminatory Movement (ABVA) and the Joint Action Council (JAC) have argued that PMCT completely ignores evidence of Nevirapine's high toxicity, which they say forced its withdrawal in the United States as a prophylactic for health care workers.

Tamil Nadu state currently has 22,826 people living with HIV/AIDS, or more than half of the national figure of 40,000 reported cases in India.

This makes the state the ideal setting for PMCT administration carried out at Chennai's Tambaram Sanatorium (Government Hospital of Thoracic Medicine), the largest tuberculosis hospital in South Asia, along with 10 other 'centres-of-excellence' across the country.

In a state that has comparatively favourable figures for human development indicators such as education, health, nutrition and family planning, the apparent HIV/AIDS epidemic raises many questions.

Officials at the government's Tamil Nadu State Aids Control Society (TNSACS) attribute the high figures to better reporting through a comparatively efficient testing system. This includes voluntary counseling and testing centres (VCTCs) at all its medical teaching colleges and at 27 other centres.

Dr Suniti Solomon, founder of YRG Care, an NGO providing a range of HIV/AIDS-related services for a moderate price, including anti-retroviral drug therapy for those who can afford it, endorses the view that better reporting is what accounts for Tamil Nadu's high figures of people with HIV/AIDS, compared to other states.

"Management of the disease is not just medical. It is equally important to give support services like counseling, legal services, employment, education, insurance, marriage, fertility counseling, nutritional counseling," she said.

Tamil Nadu's centres have screened 820,000 cases in the last seven years and, in the past year alone, discovered 4,178 HIV-positive cases. The PMCT programme alone tested 46,552 women and found 159 of them HIV-positive.

Claims Muruganand, deputy director for information, education and communication cell of the TNSACS, explains that there is 98 percent awareness level about AIDS in Tamil Nadu.

"This is much better than several other states, where even awareness and acceptance stages have not been passed. We have put behind the first phase of mass communication. Now it is the next stage of actually creating behavioural change, in which area we have not been successful," Muruganand said.

His colleague at TNSACS, G Palanisamy, deputy director of the sexually transmitted diseases division, is even more upbeat.

"Tamil Nadu is the first state to provide the correct statistics. With awareness levels so high, more people get themselves tested. The media likes to make it all sound alarming but actually, the statistics present a true picture, unlike in other states where people do not come to test themselves voluntarily," said Palanisamy.

But P Kausalya, president of the Positive Women Network of South India, says things are not so clear cut.

"When we say 98 percent awareness, it is more about people knowing that AIDS is a deadly, potentially fatal disease, a 'bad' problem which happens to 'bad' people," Kausalya explained. "Beyond that, the myths and misconceptions are same as everywhere. "

The Tambaram Sanatorium now handles a deluge of referrals, upwards of 300 AIDS outpatients everyday with a similar number of inpatients getting admitted to its eight exclusive HIV wards, including children and women with STDs because there is nowhere else they could go.

Here, a patient with the most common opportunistic AIDS infection, cryptococcus meningitis, cannot be treated until a written application is made, a file created and a medical officer secures the necessary drugs in a process which takes up to 10 days -- should the patient survive the ordeal.

Visitors to the sanatorium brought on guided government tours are shown neatly made beds, well-fed and clothed patients with compassionate staff in attendance.

But on an 'ordinary' day, patients are poorly treated by under-trained medical personnel, often having to share the floor for want of beds.

Nevertheless, activists commend the city for having at least this degree of infrastructure. In interior districts like Ramnad and Dindigul, even doctors are clueless about the course of action to be taken where HIV-positive patients are concerned.

There have been no studies that conclusively correlate the levels of awareness to the escalating statistics. Most women, even those who are literate, do not have access to information or treatment.

Thrown out of their homes with no rights to property or support, HIV widows or AIDS victims are suddenly required to deal with their deteriorating condition, as well as acquire vocational skills in order to sustain themselves.

The overwhelming stigma attached to the disease belies all claims to awareness building made by the TNSACS and voluntary agencies. This is why HIV-positive people like Mallika can only expect rough treatment from the very people charged with helping them. (END/IPS/AP/HE/HD/LS/RDR/JS/02) .

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