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When 'prevalence' Makes for Disparity in AIDS Care

The third phase of the National AIDS Control Program (NACP), set to kick-start this month, will see care and control strategies vary widely from state to state. States// are classified as "high prevalence" and "low prevalence", based on declared numbers of the HIV/AIDS infected. But there is a difference in attitude towards AIDS control from state to state.

The budgetary allocation also differs, affecting awareness campaigns in north Indian states, with declarations and testing low. Health activists say that this is like "sitting on top of a volcano and waiting for it to start spewing".

Tamil Nadu, which has topped the list of high prevalence states since 1986, tested 100,000 people in 2006 - one of the highest numbers of tests done in the country.

This would be expanded further by taking the services to the community level, said Supriya Sahu, chairperson of the Tamil Nadu State Aids Control Society (TANSACS). "Efforts in NACP III would be to bring the prevalence down to 0.1 percent by 2012."

The prevalence in this southern Indian state is calculated to be at 0.5 percent in 2007. "Reaching out to the infected and affected children will be a priority as they are the most vulnerable," she added.

"Steps are being taken to ensure that no new infections happen among newborns through a comprehensive outreach program where we are tracking each and every HIV positive pregnant woman for Nevrapine administration," Sahu told IANS.

"We are also mobilising NGOs, health service providers and the local community to find every child infected with HIV who needs care and support.

"At present we have 1,124 children on anti-retroviral treatments (ART) - the largest number of children on ART in the country in any one state. The target is to enrol 2000 children on ART by the end of July," she added.

Matters of concern for HIV positive widows and destitute women like "denial of property and oth er legal rights" would be addressed on a priority basis, Sahu said.

TANSACS has joined hands with the Legal Services Authority to reach out to destitute HIV positive women for free legal aid.

"We plan to involve the private sector in a big way in this endeavour. IT companies, automobile and other heavy industries and the plantation sector would be made partners in Tamil Nadu's campaign," she said.

In stark contrast is the way AIDS control is steered in the small town of Gwalior in Madhya Pradesh that the government still considers a low prevalence area.

Doctors at the Gwalior Children's Hospital, supported by British charities, say their small hospital has three infected children but no government intervention.

"I believe the reason for government non-interest is that our region is currently low prevalence. Probably they are waiting for it to become high prevalence before they wake up. By then it may be too late and beyond control", says B.K. Sharma, who set up the hospital.

The hospital attempted to survey 59 existing laboratories and blood banks, including government ones, in this town for HIV findings, "but could not get any information in writing for confidentiality reasons", he added.

"As many as 39 laboratories have confirmed on personal communication that they re testing two HIV positive people every month on an average," said Sharma.

He added: "We could trace seven people with HIV positive status by personal contacts but they refused to come openly or take treatment for fear of stigma and dislocation.

"From the infectious unit of the Government Medical College Hospital, we learnt that two or three patients are admitted in a terminal stage every month. They belong to the poor community, and many more may be dying undiagnosed at home or other places."

Sharma estimated that within this semi-rural town at least 100 new HIV positive people are being diagnosed every month in private laboratories.

Only 30 percent of the local urban and rural population of 1.1 million can afford private tests, he added.


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