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AIDS drug crunch worry for patients

A shortage of drugs to treat HIV infection has assumed threatening proportions all over Bengal.

Kalpana Dutta (all names of persons with AIDS have been changed), a resident of Kanksa in Burdwan, returned home on November 27 without the medicine that kept her alive the last six years. This was the second time she returned empty-handed in two weeks.

Diagnosed with AIDS, Kalpana has been visiting the ART (anti-retroviral therapy) centre at Burdwan Medical College and Hospital. But recently it ran out of medicine that she takes.

Kalpana, 28, who works as a domestic help, was asked to come back on December 2, a day after World AIDS Day, by which time fresh stocks were expected to arrive.

“My village is 50km away from Burdwan. I had my last dose a day before I came here two weeks ago (November 17), and I am feeling weak now. Maybe it is because my infection has increased without medication,” she said, worried over who would look after her daughter in case the infection increases and becomes life-threatening.

Dhiren Mondal, 40, of Chhatna in Bankura, was asked to go to Burdwan after the ART centre at the Bankura Sammelani Medical College Hospital ran out of stock of the medicine he was taking. He was a bit more fortunate than Kalpana. He got alternative medication. However, it does not have the same efficacy as the medication he is used to.

“I have been spending Rs 300 for the last three months on each trip to Burdwan from Chhatna,” said the small-time farmer, who used to work in shipyards in Mumbai. “Earlier, we used to get a month’s supply at a time. Now they are giving us medication for only a week,” he said.

“Two months ago, about 10 to 15 per cent of the 720 people enrolled on ART with us suffered a break in treatment and that was because the patients did not turn up themselves. Now it has gone up to 25 per cent because of the unavailability of drugs,” said Ajoy Naskar, the project co-ordinator of South 24-Parganas Network of People Living with HIV/AIDS.

Like Bengal, Maharashtra, Bihar and Delhi are also suffering from drug shortage. Two particular ART drugs are in short supply: Nevirapine and Tenofovir.

“The shortage has, for the last three months, been plaguing over 17,000 people on ART throughout Bengal. Those who can afford it — up to Rs 500 a week — are buying medicine from shops. But 90 per cent of our members rely on government treatment facilities through the National AIDS Control Organisation (NACO),” said Kishore Shau, president of the Bengal Network of People Living with HIV/AIDS (BNP+), which has 45,000 members from all the districts in Bengal.

He reminds that the shortage of drugs can mean a life-and-death situation.

Not all HIV+ people require ART. It depends on the stage of infection.

Top officials at the West Bengal State AIDS Prevention and Control Society (SACS) said drug availability depended on supplies from NACO.

“Supplies of not only ART drugs but also testing kits and blood bags have been irregular. We have had to procure supplies on our own, sometimes from other states like Kerala, and get samples tested before sending them to the ART centres. This has led to considerable unplanned expenditure. But the situation has improved now,” SACS project director Utpal Bhattacharjee claimed.

Contacted in Delhi, A.S. Rathore, deputy director general (care, support & treatment) of NACO, admitted there had been a delay in procuring medicines. “A tendering process in June had to be repeated after the company selected failed to supply. Retendering had to be done, leading to a three-four month delay. But there is no shortage now. Local issues are holding up supplies,” he said.

Drugs being sent through speed posts, made locally after NACO sent the packages over to the state authorities, are taking some time.

Subrata Dutta, the lone medical officer at the ART centre in Burdwan, said the supplies, sent by speed post, were yet to reach.

“I have to see up to 200 patients from five districts every day, and many of them are not getting treatment they are supposed to,” he said, pointing out that the post of the second medical officer has been vacant for long.

Activists have said they may launch protests. “Prior to World AIDS Day, we had issued a plea to NACO and the West Bengal SACS to regularise treatment services, which includes ART medicine, other medication as well as diagnostic tests. If the situation does not improve, we will be forced to sit on dharna outside Swasthya Bhavan, and maybe even block roads,” Shau said.

Specialists treating HIV/AIDS patients agree that a break in ART can lead to complications.

“The CD4 count, which indicates the body’s capability to fight infections, goes down. If the breaks are repeated, it could lead to drug resistance, necessitating the patient to move onto second line drugs, which are more expensive,” pointed out S.K. Guha, who is in charge of the AIDS centre of excellence at the Calcutta School of Tropical Medicine.

Meanwhile, Osman Ali of Basanti in South 24 Parganas has had to skip a week’s medication.

The farm labourer cannot spend up to Rs 80 per visit to his closest ART centre at M.R. Bangur Hospital ever since the once-a-month trip became a weekly affair.