[Reader-list] No aid for HIV positive ‘outsiders’

[PREETU NAIR]

No aid for HIV positive ‘outsiders’
Preetu Nair
preetu_nair at gomantaktimes.com
(This article appeared in GT Weekender, Panjim edition
dated February 12,2006)


If you are a poor HIV/AIDS patient in Goa and do not
have a ration card, it will be a matter of time before
your family gets your death certificate. Harsh! but
shockingly true. The Goa Medical College has been
refusing to supply antiretroviral therapy (ART) drugs
to non residents or those who have no proof of
residence in Goa, in gross violation of NACO
guidelines and the fundamental right to life, Preetu
Nair finds out how your ration card becomes your life
saving drug.


PANJIM: The outsider versus insider battle has been
dragged even in to the Goa Medical College, where HIV
patients without rations cards or proof of residence
are refused ART life sustaining tablets. Those who can
afford to it can buy it privately, but what about the
hundreds of poor HIV patients who have a right to
life, but are expected to show proof of living in Goa,
to get that right. Check out these cases:

Positively speaking, we don’t treat ‘outsider’ HIV
patients

Lata, an HIV positive is staying in Goa since last 30
years and had a ration card. But as bulldozers razed
her house in Baina on June 14, 2004, she lost her
ration card. As a result she has become an outsider in
Goa where she was born and brought up. Recently,
doctors at Goa Medical College (GMC) put her on
Antiretroviral therapy (ART) but refused to give her
the free medicine because she didn't have a ration
card. She explained her problem but to no avail. Her
problem is dual: on one side she is denied medicines
because she doesn't have a ration card, while on the
other hand government authorities refuse to give her a
new ration card, despite several applications for the
same.

The ART of refusing aid

As the CD4 count machine (a blood check-up for
HIV/AIDS patient which has to be done every six
months) was dysfunctional in GMC in October and
November 2005, Shanti was advised to take her
critically ill husband to a private hospital for CD4
count. The test revealed that his CD4 count was very
low at 111 (normal is 200). The couple immediately
rushed to GMC to start ART but was denied the tablet
because they are from Karnataka and not from Goa. When
they argued that ART has to be given for free to
anyone who has HIV/AIDS irrespective of the state to
which they belong, they were told by doctors at GMC
that they have orders to give free ART tablets only to
Goans. Another doctor added that as the CD4 count was
done at private hospital, they would not receive any
medicinefrom GMC for free.

Want a tablet, go back to your village

A 32-year-old man from Nepal, who came to Goa three
years back to work as a labourer at the construction
site, was detected to be HIV positive in 2005. He used
to have high fever and felt weak. He went to GMC where
he was tested and found to be HIV positive. He was
regularly denied basic drugs. In January 2005 a CD4
count was done at GMC and he was counseled to start.
But when he went to take his free ART tablets, he was
asked to go back and take the medicine free from his
village. Reason? He is not a resident of Goa. He cried
and begged but in vain.


Some free lunches, but no free tablets

Reshma, 25, purchased ART tablets for one and half
year when she was pregnant to avoid HIV/AIDS
transmission from mother to child. This was two and
half years back, when ART tablet was not given free of
cost at GMC. However, she was forced to stop the
medicine later as she couldn't afford it. However,
when she got a CD4 count done recently it was found
that her CD4 count had gone down and she was put on
ART. But when she went to GMC for the medicine, she
was denied tablets, as she couldn't produce proof of
residence.

Believe it or not! From January 2006, if you don't
have a ration card in Goa , you will be denied ART,
which is considered to be an elixir of hope for
HIV/AIDS patients; especially symptomatic patients
with CD4 count less than 200 by GMC. ART drugs, while
they do not cure HIV, can, if successfully
administered, slow and even virtually stop the
proliferation of HIV in the body. This reduces
susceptibility to other diseases and allows for longer
and better quality of life. Though available in the
market, the drugs cost anywhere between Rs 2500 to
5000, thus making it unaffordable for the poor.

This is happening even as Chief Minister of Goa,
Pratapsing Rane in his message in Goa State AIDS
Control Society's book HIV/AIDS in Goa, Situation and
Response 2005-06 has said, "My government is fully
committed to prevent the spread of HIV and to provide
care, support and treatment to people living with AIDS
who access our health services and to mitigate the
impact of theepidemic on communities".

It just doesn't matter that they live, work and love
Goa. What matters is that they don't have a ration
card or an electoral card! All this in complete
violation of Article 21 of the Indian Constitution,
which recognizes the right to life as a fundamental
right and also imposes an obligation on the State to
safeguard the right to life of every person: "The
Government hospitals run by the State and the medical
officers employed therein are duty bound to extend
medical assistance for preserving human life". Failure
on the part of a Government hospital to provide timely
medical treatment to a person in need of such
treatment results in a violation of his right to life
guaranteed under Article 21.

Dr JJ Dias, Project Director, Goa State AIDS Control
Society (GSACS) admitted that many NGO's working with
HIV/AIDS patients have complained that the patients
are asked to show proof of residence in order to get
free ART drugs. "But this is done to ensure adherence
from the patient, so that they don't leave the
treatment mid-way. Otherwise, I don't think there is
any reason to refuse free ART drugs as we want more
and more HIV/AIDS patients to take the medicine," he
said.

But isn't the right to life and health a fundamental
right guaranteed to every person living in India and
is non-negotiable? "That is true. We can't deny the
drug to anyone. But our focus is on adherence," added
Dr Dias. Asha Vernekar, NGO Advisor, GSACS also
admitted that she had received complaints about
patients being denied ART drugs because they don't
have a ration card. "We have also followed up with
GMC," she added.

This is happening even as National AIDS Control
Organization (NACO) envisions an India in which every
person living with HIV is treated with dignity and has
access to quality care. However, many like Reshma and
Lata are denied free ART drugs because
they are "outsiders". This despite the fact that NACO
made the promise: "one nation one resolve: we shall
defeat AIDS together" and for the same launched free
ART drugs to
all HIV/AIDS patients in state at GMC in March 2005,
to provide universal access to HIV care.

"It is done to ensure that there is continuity of the
medicine. What if they stay in Goa for few months and
go to their native place and discontinue the medicine?
By and large medicines are not denied to patients,"
added Dr Rajan Kunkolienkar, Medical Superintendent,
Goa Medical College.

But can a patient be denied medicine on the
presumption that he may stop taking the medicine in
the near future? Well, no one seems to have the
answer!
(Some names have been changed)


Words hurt more that the disease. Here is a sample of
how insensitive medical professionals in government
hospitals are when they deal with HIV positive
patients.


“Leave your HIV positive husband”
•	A 25-year-old local boy was admitted in November in
the General ward of GMC because his CD4 count was very
low and he required immediate medical attention. In
the presence of relatives he was given a bed, but in
the night when the relatives left, he was vacated to a
dark laboratory and made to sit there alone. Scared
and worried, he called his relatives for help. They
intervened and he was got medical attention but not
before his wife was advised by the doctor to leave her
HIV positive husband.
“You are HIV positive, we can’t give you a receipt for
a CT scan”

•	When Shakeela took her 27-year-old husband, who is
suffering from HIV/AIDS to GMC in December, they were
asked to go to Hospicio Hospital, Margao. At Hospicio,
she was charged Rs 200 for CT scan. She paid the money
but didn't get a receipt. When the couple insisted,
the staff insulted them saying they are HIV positive.
“Hey get out of the line, someone may get the disease”

•	Leena and Manoj had left home in Maharashtra and
settled in Goa, far away from friends and relative,
because they were regularly ridiculed by everyone for
being HIV positive. But Leena got a greater shock when
she went to GMC and was ridiculed by a nurse, who
said, "Hey, you are HIV positive, just get out of the
line or someone may just get the disease." She is yet
to overcome the embarrassment and agony she
experienced then.

This is happening even when it is openly agreed that
maintenance of confidentiality of an individual's
health status is one of the cornerstones of public
health. Not only does the principle rest on human
rights norms of autonomy and respect for privacy, but
it has also been viewed as crucial to encouraging
those most at risk to come forward for HIV testing,
counseling and clinical attention.

Even NACO states, "All Government hospitals have been
instructed to admit HIV/AIDS cases without any
discrimination. They have to be managed in the general
wards of the hospitals along with other patients
except cases having sputum positive (open pulmonary
tuberculosis) and when the patient's immunity is
completely diminished. This is required to protect him
from other infections and thus he needs to be managed
in a separate room. Any special marking or board near
the beds for HIV positive patients is discouraged".

Only noise, but no CD machines

CD4/CD8 count facility was established at GMC in July
2001. On an average 6 to 8 patients are screened
everyday for CD4/CD8 blood count facility to verify
and assess the immune status of a HIV patient. In 2005
upto September at least 449 people went for CD4/CD8
count. However, in October and November, the CD4
machine was not working and due to this few patients
who could shell out Rs 1000 plus went to private
hospital, while many couldn't do the test.

Dr Dias admitted that there was a problem sometime
back. "The problem is that at the moment we have just
one CD4 machine and it does give trouble. At the
moment we have three option: have another CD4 machine,
outsource the tests or purchase CD4/CD8 kits so that
it can be used as substitute," added Dr Dias.



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