Physical barriers affect India's fight against HIV

Vast distances are a major hurdle to India's efforts to curb its soaring HIV rate.

India, which has the world's third largest HIV-positive caseload, gives drugs for free to HIV/AIDS patients. But doctors say this is not enough to stop the spread of HIV which is making inroads in rural India, especially among women infected by itinerant husbands, and also children.

For three days a month, Sambit squeezes into a crowded and often filthy train for a three hour journey to Delhi to receive HIV treatment.

"There's no seat and I am very weak," said the 30-year-old former tailor, who asked that his full name not be revealed. He can't afford lodging in Delhi and can barely afford the train tickets.

"I need to borrow money from my family for all these trips," he said.

Many patients in the same position simply give up treatment, an anathema in HIV therapy as it gives rise to drug resistance. These patients may then need more powerful second line treatment, which is not freely available in India.

"Travel can affect drug compliance. Patients who don't get family support, women who may not like to travel alone will just give up," said a doctor at a New Delhi hospital, who spoke on condition of anonymity because he did not have permission to speak to reporters.

There are 147 "antiretroviral therapy" or ART centers in the country, part of a government drive that has been encouraged by the World Health Organization in a bid to prevent HIV from becoming a major health problem.

Delhi has nine such centers and is far better served than many other states. Up to 6,000 patients receive treatment in Delhi, nearly half of these live outside the capital.

The government now plans to build "link centers", small facilities that are closer to where patients live so people like Sambit can obtain their medications more easily.

"They just come to pick up the drugs if they have no side effects and they go home ... that saves transport and other costs," Rao said, adding that the plan was to have as many as 500 such centers all over India.

INFECTION FIGURES AREN'T GOING DOWN

India has 2.47 million HIV cases, according to the latest figures, but health workers say the number is rising rapidly and spreading to new population groups.

"Our numbers are going up," said Loon Gangte, South Asia coordinator of the Collaborative Fund for HIV Treatment Preparedness.

"It's not confined to high risk groups, it's going into the general population. It's not a problem of sex workers, drug users or truck drivers. These people have wives and children at home and the disease is making its way into the general population."

Sujatha Rao, director-general of the government's National AIDS Control Organization, says doctors are increasingly seeing women infected by their husbands.

In some clinics, 1 out of 100 women who come for ante-natal care checkups are HIV positive, she said.

"It is a generalized epidemic," she said. "We have pockets where the prevalence is more than 1 percent among ante-natal care mothers, so we need to intensify our work."

Out of India's 611 districts, HIV prevalence is more than 1 percent of the population in 156 districts.

"The epidemic is getting deeper into (certain) rural, general areas of the country ... it is migrant-related. They go to work and then they take back the infection to their homes," she said.

Even though HIV drugs are free, only about 155,000 people have access to retroviral drugs, up from 20,000 just two years ago.

Health expert say there are many people who do not know they are infected or who do not know that treatment is available.

Some health professionals believe India's HIV problem is closely intertwined with poverty and that the government must tackle poverty if it seeks to curb the spread of HIV.

"Many of these people are very poor, they worry about food, shelter. So they may not think their HIV status is a problem because they don't even know where their next meal is coming from," said Errol Arnette of the help group Sahara.

"A lot of AIDS patients die of TB because it's hard for hospitals to keep them (in hospital). HIV patients are just thrown in a corner because of heavy stigma."

For more information visit http://www.jigfo.com, the no.1 source of information.

Inadequate TB treatment

In certain "hot zones" where multidrug-resistant tuberculosis is prevalent, patients treated with standard TB drugs have high rates of failure and relapse, new research indicates.

In countries where "drug sensitivity testing" is not performed routinely, the current standard anti-TB drug regimens "may be contributing to worsening drug resistance levels," a multinational research team warns in a report published Friday.

Dr. Dick Menzies, from McGill University in Montreal, and colleagues analyzed the association between drug resistance and treatment outcome in 103 countries, which were selected because their multidrug-resistant TB prevalences were known and because they had each reported on outcomes for more than 250 cases treated with standard treatment regimens in 2003 and/or 2004.

The researchers calculated that every 1 percent increase in the initial prevalence of multidrug-resistant TB was associated with a 0.3 percent increase in treatment failure among new cases, a 1.1 percent increase in failure among retreatment cases, and a 1 percent increase in relapse. The results are statistically significant, the researchers note.

Menzies and his team believe that in countries where initial multidrug-resistant TB prevalence is at least 3 percent, "it is urgent to strengthen capacity to perform drug sensitivity testing, or to reexamine standardized (initial treatment and retreatment) regimens."

In these countries, more than 20 percent of treated patients required retreatment, their report indicates. Moreover, in all countries, retreatment outcomes were generally poor, with high rates of default, failure, and death.

The investigators warn, "Failure to act now will mean far more resources will be needed in the long run to address global drug resistance."

Drs. Marcos Espinal and Mario C. Raviglione, with the World Health Organization in Geneva, Switzerland, agree, noting in an editorial that current tools for managing multidrug-resistant TB "are decades old, complex to use, time consuming, and more importantly, not designed for case management of multidrug-resistant TB."

"Unless those with the responsibility to boost control and research efforts increase their commitments and their financial investments by several fold, we may never see elimination of this major scourge in the decades to come," the editorial concludes.

For more information visit http://www.jigfo.com, the no.1 source of information.