01 December 2010
By Umesh Isalkar
As India makes steady progress in its battle against HIV, it comes as a setback of sorts that a sizeable chunk of AIDS patients in Maharashtra have given up on treatment after the initial few doses of medication. The state government says that despite its best efforts, these patients – numbering 4,478 at last count – have remained untraced, many of them for years.
Labelled as "lost to follow–up" (LFU) cases, these patients carry a mortality risk that is five times higher than patients who have been taking regular anti–retroviral therapy (ART). Side–effects of the medicines, lack of family support and social stigma are the main reasons why these patients have abandoned the treatment.
"These 4,478 AIDS patients from 48 ART centres across the state, who have a CD–4 count less than 250, have been untraceable since 2008," Santosh Wani, assistant director of the Maharashtra State AIDS Control Society (MSACS), told TOI on Tuesday.
"The list of LFU cases is generated every month," Wani said. "Our outreach workers attached to the district community care centres make home visits to convince these patients and their family members about the need to resume treatment. However, in many cases, the patients change their place of residence, which makes it difficult for us to reach out to them."
A L Kakrani, professor and head of the department of medicine at D Y Patil medical college, says there is an urgent need to identify critical issues in patient registration and follow–up, and formulate strategies to improve patient retention.
Kakrani, who was formerly a member of the technical resource group of the Indian government on ART, says the main reason for patients dropping out of the ART programme was the side–effects of the medicines. "However, the sideeffects, which include jaundice, anaemia and neuropathy, are seen only in the initial period of medication and are very minimal later. Patients are counselled about the side–effects before the start of the ART treament," he said.
Other reasons for LFU cases are poor family support, social stigma, logistic problems and economic reasons, which include the cost of travelling to the ART centres.
The movement to give free treatment to AIDS patients started back in 2005 with the opening of the first ART centre at J J Hospital in Mumbai. In the same year, eight more ART centres were started in government hospitals. Five centres were opened in 2006, 14 in 2007, two in 2008, 25 in 2009 and four in 2010.
Besides this, 32 link centres were started in 2008, 63 in 2009 and nine in 2010. The idea behind starting link centres at rural hospitals was to ensure that patients did not have to spend much on travelling to avail of medication.
What The Recent UN Aids Report Says
- India is on course to reverse the spread of HIV in the country
- In India, there has been an almost 50% decline in new HIV infections over the last decade. The numbers have fallen from 2.4 lakh in 2001 to 1.2 lakh in 2009
- HIV prevalence rate has fallen from 0.4% in 2001 to 0.3% in 2009
- Globally, new HIV infections fell by nearly 20% in the past decade while AIDS–related deaths were down by around 20% in the last five years
- India was among the 32 countries which reported 60% greater Condom use among men who had sex with more than one partner in the past 12 months
- India was among the 69 countries where more than 60% sex workers used a Condom with their last client
- India was among the countries with the largest number of pregnant women living with HIV in 2009
In the cramped, often unhygienic conditions of the 29 central and district jails in the state where medical care is down to the basics, 467 inmates have tested positive for HIV infection in the last two years. The Yerawada Central Prison in Pune has 120 HIV positive inmates, the highest in the state.