Old data hides spurt in HIV positive cases, say NGOs

Here’s a paradox: The government of Bihar has the most schemes for persons with HIV/AIDS, and at the same time apathy, inefficient reporting, gaps in the health delivery system and red tape are pushing the state towards an HIV epidemic. Even as the spread of HIV seems to have been brought under control in the southern states, Bihar, once known as a ‘low prevalence’ state, has over a lakh of HIV positive persons, with new detections happening practically every day.
The issue was brought up on Friday, during discussions on the release of a study of ‘Issues affecting PLHA’ (People Living with HIV/AIDS) in Patna district attended by NGO representatives, doctors from primary health centres of two blocks, ICDS functionaries and Women’s Development Corporation (WDC) representatives.
The questions being asked were: “Why doesn’t Bihar State AIDS Control Society (BSACS) update its obsolete data? Why is the procurement and dispensing of ART medicines inconsistent? Why is there no reporting on indents? Why is BSACS reluctant to engage with NGOs and networks of people with HIV and AIDS?” These questions just hung in the air. No representatives from BSACS were present. They ignored the invitation, it seemed.
“BSACS hasn’t updated its data base for ages. In the absence of current data, we are forced to use 2011 data. Yet, ART centres and ICTC centres are updating their records on a monthly basis. If BSACS Patna cannot afford a data entry person, may be the NGOs should offer some technical assistance,” said Dr Diwakar Tejaswi. The old figures do not give the true picture of the HIV incidence in the state.
One of the key findings is that the number of PLHA who have actual access to the government schemes for PLHA is very small (so far about one per cent for Antyodaya and two per cent for Parvarish). PLHA may have heard of some schemes (such as the Shatabdi AIDS Yojana) but are clueless about how to go about applying for the benefits in the absence of proper guidelines and procedures laid down and publicized by the government. “I am happy to say that in spite of the bottlenecks, the Parvarish Yojana (which is a stipend for HIV positive and affected kids) has finally kicked in, and some 24 beneficiaries in two blocks will soon receive their allowances,” said Sanjit Singh, a representative of CHMU, the organization that released the report of the study.
“Every month, we come across at least two more people with HIV,” said a PHC staff from Maner block. A WDC official called for greater coordination and synergy between NGO networks and government so that they could address the issues of women with HIV in certain short stay homes, citing a case from Vaishali district.
Women with HIV have the heaviest burdens to bear. “Women with HIV continue to face multiple threats such as physical and emotional violence, especially from the husband’s family, and widowhood often means that the woman loses the support of in-laws. In many cases, the woman either returns to the parents’ home or lives on her own with her dependants,” read the document.
The ART delivery system remains problematic. Essential tests such as the CD4 count are often not conducted either due to non-availability of kits or for some other ‘technical’ reasons. One of the recommendations from the survey, readily endorsed by the primary health centre personnel, was that medication for opportunistic infections could be made available to the PHC, so that it could be readily available to PLHA, rather than have them travelling several kilometres to the government hospitals.
“HIV testing kits should be given to PHCs. After all, it is at the PHC where antenatal care is given. If the HIV test can be done as well, it would further help in detecting prenatal HIV cases and ensuring proper PPTC and safe delivery of the child,” said a doctor.
“Copies of the study and the recommendations from the conference will be presented to government departments concerned as well as BSACS. NGOs are not here to confront BSACS or government, but to work together with them to improve the system,” CHMU coordinator Chandy told the delegates.