PRIMARY CONCERN: Most of the primary health care centres in India lack trained healthcare personnel to deal with HIV/AIDS patients

The world came crashing for Tanu when her husband died three years ago. Only then did she come to know of the scourge called AIDS, which had claimed her husband. Says the 24-year-old widow: “I was bewildered when the doctors advised me to undergo certain blood tests. It's my husband who is sick. Why do I need to have these tests, I argued with the doctors.”

But Tanu is not alone in her shock and bewilderment. Several other “AIDS widows” in Domjur, West Bengal, stumbled on the existence of the disease only when they lost their husbands.

Domjur is traditionally associated with goldsmiths famous for their skills. They are much sought after by owners of jewellery shops and rich clients across the country. Thousands of goldsmiths from Domjur and other parts of West Bengal have migrated to work in jewellery units in cities like Mumbai, Surat, Ahmedabad. They toil throughout the year to bring home money that has also triggered development in the region.

But these migrant goldsmiths have also brought back something more sinister to their villages. “The flip side to the development is that we now have HIV/AIDS,” says Subir Chatterjee, Domjur’s village headman. That’s borne out by the fact that the majority of the men who have died of HIV/AIDS in Domjur are migrant goldsmiths. “We need to collectively address the problem,” he adds.

It was in this spirit of collective action that leaders from 189 countries had convened a UN General Assembly Special Session (UNGASS) in 2001. The session discussed efforts to halt and reverse the scourge that has killed 25 million humans globally. It was also for the first time in the pandemics history that world leaders signed a UNGASS Declaration of Commitment. UN secretary general Kofi Annan asserted that the declaration was a “landmark in global efforts and would galvanise global action (against HIV/AIDS).”

The UNGASS met again in New York this year to review the efforts to halt and reverse the scourge so far. But the review report makes for very dismal reading. Globally, the report says, fewer than 10 per cent of pregnant women with HIV have access to relatively simple drugs and treatment that prevent mother-to-child transmission. This is the main reason three million children were born with HIV in the past five years.

The India Progress Report presented at UNGASS is equally disappointing. With the exception of four states where the rate of infection has slowed down, HIV infection has increased by 32 per cent since 2001, it says. Moreover, the government has faltered on its commitment to provide free anti-retroviral (ARV) drugs by the end of 2005. It has now proposed to provide 180,000 patients free ARV drugs by 2010, and also distribute drugs to prevent parent-to-child transmission through community and primary health centres.

Experts, however, argue that these steps are not enough. “There is a misconception that universal care means only access to ARV drugs,” says Elango Ramachandra, president of the non governmental organisation (NGO) People Living with HIV/AIDS, Karnataka unit. “Comprehensive care must include counselling and providing other drugs and proper nutrition. It’s easy to dole out medicines and ignore the care and support that are most essential in the treatment process,” he adds.

ARV drugs, however, are essential and undoubtedly prolong the life of a patient. But doctors warn that these medicines have side effects and the virus could develop drug resistance, which would prove disastrous for patients. Moreover, the therapy demands continuous and stringent monitoring in a structured health system; otherwise patients can suffer even more, says Ritu Priya, a researcher at the Centre of Social Medicine and Community Health at Jawaharlal Nehru University.

In reality, she adds, “we need about 7,415 community health centres (CHCs), but there is fewer than half that number in India”. About 62 per cent of the primary health centres lack adequate facilities and trained health personnel.

This dismal scenario is best exemplified by the Domjur Rural Hospital. Let alone providing treatment to HIV/AIDS patients, the hospital even lacks basic health services for dispensing healthcare for common ailments like diarrhoea and fever. “For even medicines to bring down fever, the doctors ask us to go elsewhere,” says Shanta, an HIV/AIDS patient. This is the major reason Shanta and other sufferers like her have to spend their savings on numerous visits to private doctors, expensive tests and medicines.

Private doctors, on their part, are more than happy to provide “subsidised drugs” to the HIV sufferers flocking their clinics. These self-styled AIDS specialists get the drugs free of cost from pharmaceutical companies. The doctors also get fat commissions and kickbacks for prescribing the drugs. And in the process, they turn a blind eye to the scientifically accepted treatment protocols.

“Drug companies know we are doing good work. So, they give us cash and gifts. In return, I write their products in my prescriptions and so both sides are happy,” admits Dr M Khara, who has “treated” at least 250 HIV/AIDS sufferers and provides subsidised ARV drugs to his patients.

But there is no escape for poor patients like Shanta, who are caught between a dysfunctional public health system and unscrupulous private practitioners. Many of these patients have now become destitutes and sometimes don’t even have food for their hungry children. Says Domjur’s village headman: “It’s a nightmare. The less said about the situation, the better.”