The occurrence of cases of Human Immunodeficiency Virus (HIV) have seen a slight dip of prevalence in Maharashtra in 2014-15 amidst all categories except drug addicts. While health officials may take pride in this, experts say several issues including irregular supply of drugs, condoms, HIV testing kits and delay in funding has hampered the intervention programme.
The prevalence rate of HIV, according to Maharashtra State AIDS Control Society (MSACS), stands at 3.58% in intravenous drug users (IDU). Last year, only 0.90% drug users who were tested, were found to be positive. In general population, while last year 1.78% tested were infected with HIV, this year it has reduced to 1.46%. The high risk categories including female sex workers, homosexuals, migrants and truckers too have seen a marginal dip in prevalence.
While on one hand the number of cases is decreasing, on the other the health officials and NGOs are struggling to continue with the ongoing work. Five months back, the National Aids Control Organisation was merged with the National Rural Health Mission after central government felt that HIV prevalence rate has come down drastically. However, the merger has led to red-tapism and delay in funds and medicines supply. Activists fear that the HIV programme is going the TB way where government woke up only after the drug resistance form of TB became a problem.
Dr Alaka Deshpande, an HIV expert and pioneer of the Anti-retroviral therapy (ART) programme in state-run JJ Hospital told dna, "Irregular supply of drugs is a major concern as it can lead to drug resistance in patients. The virus is fast mutating. Over the past three years, 5% persons in the state who are on ART have been found to not respond to treatment. Shortage of drug supply and patient's non-compliance could add up the drug resistance burden in HIV. "
Ideally, drugs for one month should be given to the HIV patients. If not, he will have to visit the hospital frequently to collect it. India is facing a shortage of HIV/AIDS drugs provided under the government's free medicine programme after some drug-makers halted supplies due to delayed payments. While the HIV drug shortage is a problem across the country, it is acute in Mumbai, say experts.
Explaining how shortage of medicines have impacted the life of people living with HIV (PLHIV), Vijay Nair of Udaan Trust, NGO said PLHIV have discontinued medicines for the sake of their jobs. "People who come from afar have to take leave frequently. Many of PLHIV have told us they would prefer not to take medicines and save their jobs," said Nair.
Dr Deshpande agrees that HIV/AIDS patients avoid visiting ART centres frequently because of the stigma attached to the ailment. Acknowledging the problem, a senior MSACS official said, "According to the protocol, each ART centre should have a drug stock of three months and a 10% additional buffer stock. Shortage of supply of drugs has led to a situation where the centres do not have even a month's stock currently," said the official.
Also, delay of funds has hit the execution of state programme. Rs59 crore were disbursed by the central government to MSACS for expenditure in the first three months of 2014. In the second quarter, the funds were reduced to Rs41 crore. Also, MSACS received the funds only in November instead of April. "Unlike past where the funds were directly sent to MSACS by the NACO, it is now sending funds to the state department of finance. Later, it is disbursed to the MSACS which leads to a delay in receiving funds," said Khushalsinh Pardeshi, project director of MSACS.
MSACS has partnered with close to 200 NGOs and community based officers all across the state that form the backbone of the community education and awareness programme. Due to non-payment of salaries on time, close to 50% of experienced community workers are quitting their jobs.
According to a MSACS officer, funds allocated to each of the targeted intervention projects vary from Rs8 lakh to Rs20 lakh. Eldred Tellis, head of Sankalp, an HIV/AIDS NGO in the city said, "Old hands are leaving us because of job insecurity. We don't have money to train people. For the time being, we have decided to postpone the project for intervention to prevent HIV in IDU women population as we will need more staff for it," said Tellis.
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