A couple from Surat was not so lucky. Both positive, they put their nine-month-old son on ART because “a well-known paediatrician” had tested and found him to be HIV positive. A chance test later showed the kid wasn’t. “They spent five years after that, agonising over which of the tests was wrong, and brought him to Mumbai every six months for a re-check,” says the doctor who attended to them. The ART has left the youngster, now six, severely anaemic and with liver problems.
Risks of wrong negatives
The reverse — of telling a person he is negative when he actually isn’t — is, in some ways, more serious. “It encourages him to be reckless, and he may pass it to many others,” says Dr Alaka Deshpande of JJ Hospital. “Also, having once tested negative, the person will be reluctant to test again, despite risky behaviour.”
Ram Niwas, a fruit-seller from UP who lives in Grant Road, is an exception. He tested negative the first time. But he opted for a second test because he knew multiple sexual partners put him in the high-risk group. This time around, he found that he was positive. “You could end up infecting members of your own family, if you don’t know you have the virus,” says Dr Jehangir Sorabjee of Bombay Hospital. “Your wife, and through her, your child can get it, and containing it becomes a problem.”
Although both the WHO and NACO recommend three tests to detect HIV, most hospitals carry out only one if the result is negative. “If it’s negative, doctors feel there’s no need for a second test,” admits Dr Deshpande. “But this is a missed opportunity to set right a dangerous mistake.”
Ill-equipped private clinics
Besides, WHO and NACO guidelines are not binding on the hundreds of private testing centres that have mushroomed all over Mumbai. Second, the most basic test (the cheapest and therefore the most widely used) is the Rapid Test where a change in colour indicates infection. The fact that this is checked with the naked eye — as opposed to machines in the more advanced Elisa or Western Blot tests — makes the result suspect. But these centres brush this off as fairly foolproof. Perhaps they don’t know the case, from a few years ago, of an intern at a testing centre who passed a result as negative because she did not even know about a less common strain of HIV called HIV2. (The test was later found to be wrong).
Apart from the lack of adequate expertise and equipment at testing centres, the sale and use of testing kits is also mired in malpractices, since private clinics charge whatever they want. Besides, poor documentation where — as Kudalkar alleges — patients give false identities or incomplete addresses makes it hard to trace the people tested, and rectify mistakes.
“Now that the incidence of HIV has gone up, all these things will happen more and more,” says Dr Gilada. “The MDACS admission is long overdue, but it’s only the tip of the iceberg.”
(Names of patients have been changed on request)
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