New Delhi: All roads lead to state clinics and hospitals when it comes to HIV/AIDS, even as lack of experts and fears on safety seem to constrain most private establishments.
“I would always recommend a (HIV) positive person to visit a government hospital. They are well trained...and there is a clear standard operating procedure... More importantly, first line medication is free of cost,” says Loon Gangte of the Delhi Network of Positive People. “In private clinics, they will prescribe you expensive drugs, or at times even give wrong prescription, or put you straight on second-line treatment.”
The government has been steadily bolstering its support for HIV/AIDS. The National AIDS Control Organisation (Naco) raised its budget to Rs1,100 crore for this fiscal year from Rs860 crore in the last fiscal year, under the third National AIDS Control Programme (NACP-III) that runs through March 2012.
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NACP’s outreach is expanding fast. From 127 antiretroviral therapy (ART) centres in June 2007, there are 190 centres today.
According to NACP-III, 2.8 million people are living with HIV/AIDS, of which roughly 500,000 need first-line ART. It says 180,000 people are receiving free ART in government and semi-government institutions, compared with just 35,000 people receiving care at private or trust-owned establishments.
Securing access for patients or safety for doctors in states has been a challenge. “We don’t control state hospitals. We can only intervene in terms of guidelines,” says B.B. Rewari, national programme officer for ART at Naco.
Naco recently obtained the Supreme Court’s approval for a note directing all states to provide adequate precautionary equipment to health care workers. It suggests stringent action against doctors or nurses who refuse to treat those infected.
To be sure, the memorandum also stresses on care givers’ safety. “You should assume every patient to be postitive, and hence, take whatever precautions are demanded in your procedure,” says Rewari.
This is in line with the government’s requirement of universal work precautions for all medical procedures since HIV testing is to be voluntary.
Testing a patient for HIV requires informed consent. “Informed consent means the patient must be willing to be tested for HIV after knowing and understanding its repercussions. This testing is...not mandatory... The private sector, however, does not follow rules,” says Anand Grover, project director at Lawyers Collective.
He adds that a lot of private hospitals and clinics have misinterpreted the World Health Organization’s guidance on this matter and made HIV testing mandatory by disguising it as a routine test.
At Fortis Healthcare’s La Femme Hospital in New Delhi—a unit especially for women—HIV testing is recommended for everyone. “If someone insists they don’t want it, we send them for counselling. If they still refuse, we don’t...test,” says gynaecologist Shivani Sachdev.
But Dr Sachdev, who was earlier with Mumbai’s JJ Hospital, one of the country’s largest health care providers for HIV/AIDS, admits patients are not asked to sign consent forms and are merely informed that blood tests would include HIV. “There is no pre-test counselling as a routine (at La Femme),” she says.
There are other problems.
“Sometimes private hospitals prescribe unncessary drugs...that may not be in accordance with the (government) protocol,” says K.K. Abraham, president, Indian Network for People Living with HIV/AIDS.
Private hospitals are also known to have turned away HIV-positive people. “More than 80% (private) doctors refer positive patients to other doctors even though they may be well equipped to handle the case,” says Shomasree Dey, programme manager for the Wockhardt-Harvard Medical International AIDS Research and Education Foundation.
Wockhardt Hospitals, which follow universal precautions, accept positive patients for surgeries and ensure their surgeons are well protected. But this is not the case everywhere.
“When at a private hospital a person is found to be positive, 95% of the time he is turned away and sent to a government hospital. Here, we doctors follow all necessary precautions, so our own safety is not at stake while dealing with positive people,” says Harshal Gawai, casualty medical officer at JJ Hospital.
Nalin Nag, a senior consultant for internal medicine at Apollo Hospital in New Delhi, is one such doctor who often attends to patients who are turned away by other private hospitals.
“At Apollo, we practice informed consent by way of getting it signed. We try to motivate patients to know their HIV status.” He agrees that at many private hospitals across the country, HIV testing is marked as a routine test and people are not counselled properly.
“Private health care providers have the choice of turning people back and so, for their own protection, they do just that. The problem is also that there are only a handful of doctors who know how to handle HIV,” Nag adds.
Graphics by Ahmed Raza Khan / Mint