OUR car swings past
the gates of India’s biggest HIV hospital. Throngs of
men, women and children are heading up the driveway for appointments
or to visit relatives receiving treatment in the single- storey
brick buildings in the grounds of Thambaram hospital in the
southern city of Chennai.
The government-run hospital was set up as a tuberculosis
sanatorium in 1937, but since 1993 it has been treating people
with HIV as well. Up to 800 people are seen a day, with many
travelling from as far as 200 kilometres away.
“People come from across the state of Tamil Nadu as
well as from the neighbouring states of Andhra Pradesh and
Karnataka. We don’t turn anyone away. If there is no
hospital bed, we let them sleep on the floor,” says
the deputy superintendent, Dr Chandra Sekaran of Thambaram
hospital.
Such tolerant attitudes, even among the medical profession,
are rare in India’s socially conservative society where
stigma and discrimination are rife. As we get out of the car
in front of the Indian Red Cross Society centre, its project
coordinator, Shanta Diaz, a vibrant woman in her late 40s,
tells me that she has even had problems getting drivers to
work for her.
“Two refused because they didn’t want to take
me to the hospital every day and an autorickshaw driver was
convinced that he would catch HIV as soon as he came through
the gates.”
Care and nutrition
Diaz is a dietician by profession and her all-female team
of seven is responsible for serving up to 200 meals a day,
providing a third of the patients’ daily nutritional
requirements. The specially made pongal, a mixture of rice
and dhal seasoned with cumin and cashew nuts, is a big hit
on the wards, and queues form for this tasty supplement to
the ordinary hospital fare.
Every month the women give new arrivals up to 400 hygiene
kits of soap, towels and toothpaste. But the Red Cross service
is about far more than just distributing food and toiletries.
Emotional support and counselling are seen as key to helping
patients rebuild their lives. “People always ask me,
‘How long have I got to live?’,” says Diaz.
I ask, ‘How long do you want to live?’ I tell
them that if they continue taking their antiretroviral treatment,
eat well and take care of themselves, then their CD4 count
will increase and they can continue to live life to the full.”
But she says that it is much harder for women. For 90 per
cent of women, the only risk factor is that they are married.
As soon as they are diagnosed, many are dumped by their husbands,
who infected them, and shunned by their families.
Stigma
Malti, a frail woman of 25 who looks 10 years younger, has
just learned that she has HIV. She sits motionless, her eyes
downcast as her daughter, Vidhya, plays with the Red Cross
counsellors. They managed to persuade her husband to have
Vidhya tested, but he has now stormed off and it is unclear
if he will return for the results due the next day. Malti
will join the other women on the ward, where visitors are
rare and the sense of despair acute.
Another woman, 24-year-old Lalitha, plays nervously with
her faded green sari as she sits cross-legged on her bed.
Her husband is alcoholic, regularly beat her and spent the
little money he earned as a labourer on drink and sex.
Fighting back the tears she says that she feels like committing
suicide and taking the lives of her children too.
“My husband has gone back to the village and told
everyone that we have HIV. If I go back, I shall be an outcast.
No one will speak to me or play with my children, and I am
scared that when I have my period or cut myself I could infect
them,” she says.
Many of the women have unwittingly passed on their infection
to their children while pregnant or breastfeeding.
At the nearby children’s ward, Vasanti has sunk into
a deep depression. Her 10-year-old son, Ravi, was diagnosed
a week ago. She and her husband have been HIV positive for
several years. He is now suffering from chronic diarrhoea
and she has stomach pains. She says that the doctors in her
home state of Andhra Pradesh had refused to give them antiretroviral
treatment so she has come to Thambaram.
Medical wall of silence
In India, hospitals and doctors are sometimes reluctant to
treat people with HIV. Stigma crosses class boundaries.
Bala comes from a solidly middle class background and holds
a business degree in finance. He never thought he would be
affected by HIV. However, he ended up on the palliative ward
at Thambaram after a private hospital in Chennai refused to
treat him. Suffering from stomach ulcers and severe weight
loss, he now keeps a holy book under his pillow and says he
will tell his friends to practise safe sex.
According to Dr Chandra Sekaran, many hospitals palm off
their HIV cases here as they either don’t want to or
don’t know how to treat them. He says stigma and discrimination
in the family, at the workplace and among the medical profession
are the biggest obstacles to curbing the spread of HIV.
With the epidemic yet to peak in India, Thambaram has started
to run residential internships for doctors from across the
country so that they will be better equipped to treat a rising
number of patients in their hospitals and surgeries.
Scaling up
More than 2.5 million people live with HIV in India. The
country is home to one in 16 people living with HIV worldwide.
“It won’t be possible to control the global epidemic
if it is out of control in India,” warns Mukesh Kapila,
the International Federation’s special representative
for HIV/AIDS.
On 1 December 2006, World AIDS Day, the International Federation
launched a Global Alliance to scale up efforts to double the
number of direct participants and beneficiaries in Red Cross
Red Crescent HIV programmes in low- and middle-income countries.
HIV has risen to the top of the Indian Red Cross Society’s
public health agenda. Care and support programmes such as
the one in Thambaram are, however, the exception not the rule,
with most of its work focused on prevention through youth
peer education.
The Indian Red Cross currently trains young people in 520
schools and colleges in 13 of the country’s 600 districts
in four high-prevalence states, Karnataka, Andhra Pradesh,
Maharashtra, Tamil Nadu and the highly vulnerable state of
Uttar Pradesh, to recommend abstinence, being faithful and
using condoms as part of a general life skills course. Education
programmes also reach factory workers and prison inmates.
Other National Societies in the region have increased the
scope of their peer education programmes to include key vulnerable
populations — the drivers of the epidemic — such
as drug users, sex workers and migrant workers.
It is an approach that Kapila and many in the International
Federation believe is the way forward. “If prevention
work is to be effective,” he says, “it has to
be about actively seeking out people before they get infected.”
“We have to move away from our innate conservatism
and remember that dealing with the marginalized and stigmatized
is part of our universal values. It is vital that National
Societies become more proactive and start to address those
groups that are driving the epidemic.”
On a recent visit to Thambaram, he suggested the Red Cross
follow up more closely with people living with HIV after they
leave the sanctuary of the hospital. Volunteers with legal
expertise could, for example, help take on cases of unfair
dismissal and discrimination in the workplace, while partnerships
with non-governmental organizations representing people with
HIV could increase the impact of the organization’s
work.
“Thambaram,” says Kapila, “is a flagship
project, but if the Red Cross is to be truly effective in
India, it has to not only do more and better prevention and
support work, but also find new innovative ways to fight the
scourge of HIV.”
Indian Red Cross Secretary General Dr S. P. Agarwal says,
“With greater resources, we could increase the number
of schools and states we work in. This is where we can make
a difference and we need to play to our strength, which is
our large network of young volunteers.”
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