Going beyond prevention

Print edition : December 17, 2004

A counselling session for an AIDS patient at a government hospital in Chennai. - MANISH SWARUP/AP

THE incidence of HIV is rising in Tamil Nadu and the disease is manifesting itself in the form of various opportunistic infections. As the number of persons infected with HIV increases, it is vital to expand care and support services. The services range from medication, psycho-social support, clinical care, human rights education and legal support to helping the HIV-positive people create a network for themselves.

The awareness generated about HIV/AIDS by various APAC-affiliated non-governmental organisations plays a vital role in disseminating the messages. For instance, the target-population groups are beginning to accept the realities of the problem, shedding the stigma attached to the disease and are breaking their silence. There has thus been a rise in the reporting of HIV/AIDS cases in Tamil Nadu.

APAC has started community-based care and support projects in six high-prevalence districts of Tamil Nadu. This project is aimed at improving the quality of life of those tested positive by providing them with psycho-social support such as counselling and reducing the stigma attached to HIV/AIDS. Under the project, each person living with HIV/AIDS (PLHA) and his/her family is visited by an out-reach worker, a counsellor and an auxiliary nurse, who identify their health problems, stress levels and psychological needs and help them cope. They are also trained in self-care and are made aware of their rights. Linkages are established to various government and non-governmental agencies to provide economic support to the PLHAs.

The Tamil Nadu State AIDS Control Society (TNSACS), the first State AIDS society in the country, which was set up in 1991, supports institutions in providing clinical care to HIV-positive people. This is done through four NGOs in government and 12 private hospitals across the State. At these institutions the treatment for opportunistic infections is provided free.

In line with the World Health Organisation policy of providing anti-retroviral therapy (ART) to three million PLHAs by 2005, the TNSACS provides free ART at the Government Hospital for Thoracic Medicine, Tambaram (near Chennai) on a pilot basis. This is to be expanded to other hospitals soon. The TNSACS also sells ART at a subsidised rate at its pharmacy and provides free legal support to PLHAs.

The voluntary testing and counselling centres (VCTC) are the entry point of care and support services. Besides information about HIV/AIDS and HIV testing, the VCTCs also provide pre- and post-test counselling. The entire process of VCTC is confidential. No information about the client is shared with anyone. The TNSACS operates 44 VCTCs from government medical college hospitals and district headquarters hospitals. The Chennai Corporation AIDS Prevention and Control Society (CAPACS) operates 12 VCTCs in the Chennai Corporation city limits. APAC plans to establish 30 mobile VCTCs all over the State, to be managed by the NGOs.

Most infections in children less than 15 years are transmitted from their mothers. Medical interventions during and after pregnancy can effectively prevent such transmissions. APAC has launched a programme to prevent mother-to-child transmission of the virus. Its objectives include preventing infections among women in the reproductive age, avoiding unnecessary pregnancy among HIV-positive women, and providing care and support to the mother and family. This programme is implemented in 65 centres in both government and private institutions, offering pre- and post-test counselling, free HIV testing, providing Nevirepine (a drug which prevents transmission) during delivery, and post-natal counselling and care. This programme, initiated in 2002, has counselled and tested over 6.25 lakh pregnant mothers, of whom 0.75 per cent tested positive for HIV.

With increasing awareness about HIV/AIDS, more HIV-positive people are coming into the open, forming networks and raising their voice for their rights. There are 30 such networks in Tamil Nadu. While 17 are registered and three are unregistered, 13 are supported by the TNSACS.

Over 20 medications have been approved by the United States Food Drug Administration to be used as anti-retrovirals in HIV medication. They are available in the market at varying costs. Although anti-retroviral drugs inhibit the multiplication of virus inside the human cell, they do not, irrespective of the dosage or the period of use, remove the virus from the human body.

The anti-retroviral is a double-edged weapon. If used correctly, it will reduce the viral load and hence lower the chances of opportunistic infections, and thereby raise the quality of life of the patient. But if it is or is used indiscriminately, it can lead to the development of drug-resistant strains that will not respond to the usual therapy.

Every infected person does not need ART. It is started only when the T4 lymphocyte count is below 200 or the viral load rises to more than 100,000 per ml of blood; only a qualified physician can decide on which patients need ART. The starting of ART could be delayed if the patient leads a healthy lifestyle - such as drinking boiled water, eating well boiled/cooked food and good nutritional supplements, and so on.

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