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Right HIV, Wrong HIV

Telegraph india
18 December 2011

Chandreyee Ghose reports on the discrimination within the community of patients
Anjan Sil (name changed) is just another "bad HIV" from the city. It does not mean that his life is in greater danger. It means that he faces more discrimination than other HIV–positive patients.

HIV Drug Skeleton in India's Closet

The 30–year–old resident of Serampore is gay. He had been working with MSM (men having sex with men) since he was a student. When he tested positive in 2006 at 25, he thought he knew how to handle the trauma. He was wrong.

He was not prepared for the attitude of the health workers who he would have to deal with for years. Same for the counsellors who were appointed in government health centres to make the lives of people living with HIV/AIDS easier. They were not only outright rude and sarcastic; they also distinguished between MSM and "normal" people — pregnant women, children or those who had contracted the virus through blood transfusion.

Anjan would often receive cold stares and snide remarks from other patients as well. "You are so young and you already have the virus," a staff member remarked at an Integrated Counselling and Testing Centre (ICTC). Government hospitals house these centres. Another asked him viciously why he preferred men.

"The very people who have been appointed to sensitise us about AIDS were making us more uncomfortable from the minute we entered an ICTC to get tested," he said.

Anjan was required to go to an Antiretroviral Therapy Treatment (ART) centre — also part of some government hospitals — for further tests, counselling and treatment. More rudeness, sarcasm and humiliation waited for him there. "I felt hesitant to continue the treatment," he added.

HIV Drug Skeleton in India's Closet

The National AIDS Control Organisation (NACO) lists MSM, female sex–workers and injected–drug users as high–risk categories. The latter two categories are the other "bad HIVs".

A homosexual man committed suicide in 2006 after the staff of a government hospital and doctors allegedly neglected him despite severe anal pain and bleeding. Many MSM go without treatment for months, after which NGOs or peer groups are forced to intervene.

N. Ravi Kumar, zonal (Baruipur) head of Manas Bangla, an NGO that works with the MSM community, says things have improved now, with government counsellors more sensitive to the needs of MSM. Yet, not many MSMs or transgendered individuals feel tempted to go to hospitals on their own.

"There is always a resistance among the transgendered and MSM to go to an ART centre for treatment, especially if the patient is 'feminine' in his ways. Transgendered people don't know which queue to join, male or female, and whichever one they choose, they are bound to face abuse and sarcastic remarks," says Pawan Dhall, country director (programmes and development) and the Calcutta head of Saathii, a Mumbai–based organisation that works with MSM and HIV–positive persons.

"Most don't go in for treatment and prefer to obtain medicine from quacks or health centres. Many homosexuals would rather go to private hospitals that have no counselling system at all. That leads to more risky behaviour. So we tell them to stick to government ones for whatever counselling they get," he adds.

Government hospitals in the city have cleaned their act up considerably now. A visit to one such hospital revealed that counsellors were willing to talk and deal with the problem objectively. The district health centres, however, leave much to be desired.

NGOs claim that there is another form of discrimination that has been introduced by NACO's categorisation. West Bengal is a "low–prevalence" zone in India. A total of 1,29,452 infected persons were identified in a 2009–10 survey. Based on the prevalence, the state has been divided into three categories — A, B and C. Eleven districts, Cooch Behar, South Dinajpur, Malda, Birbhum, Nadia, Bankura, Hooghly, North and South 24–Parganas, West Midnapore and Howrah, where the prevalence is the lowest, fall under category C.

Each district under category A and B get initial funds of Rs 5,33,000 from NACO. Those under category C are to get a similar amount from the state government.

Sheikh Sajahan, the vice–president of Hooghly Positive Network, a network of HIV–positive people in the district, complains of irregular funding. "We have not received any funds since July. Hooghly has around 700 infected people who are registered with the positive network," he says.

"There are many more unregistered patients. We cannot provide them with any nutritional support or carry out any beneficial projects. The ART centres in our district refer most patients to Calcutta hospitals," Sajahan adds.

"Should I ask members of my community to spread the virus to get noticed?" asks an activist.

Not that the situation is much better for "good HIVs", either. In early November, in a government hospital in Chandernagore, Anita Sarkar (name changed), an HIV–positive woman whose labour pains had started, had to go without treatment for over four hours before help came her way.

"At the government hospital in Chandernagore, the wailing woman was left lying in a corner from 4pm to 8.30pm, after which we approached the district magistrate," said a member of the Hooghly Positive Network who was present at the hospital at that time.

Doctors have their set of problems. An SSKM Hospital doctor, not willing to be named, says discrimination against HIV patients will continue till government hospitals offered doctors enough protection against infection.

Gloves are often a scarcity here as also the post–exposure prophylaxis (PEP) treatment that should be started immediately if a doctor is at high risk of getting infected by accident.

The government is found lacking in a basic ways. The HIV/AIDS bill is facing much delay. An all–India meet on November 23 was organised by the NGO World Vision to pressure decision–makers to table the bill in Parliament's winter session.

"Things have not changed much even today," says Dhall. He says Saathii had held a training for 10 male health professionals in Konark a few years ago. At the end of the session two of the counsellors were adamant that MSM were "dirty".

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