Access

My aunt is a retired women’s health specialist, but still maintains a part-time practice at a small, nearby hospital (“nursing home”; not in the American sense). She has only been there a few weeks, and prior to this, she worked at a charity hospital. She told me an interested story about HIV and access to care.

She was visited by a couple from Nizamabad, some 200km away from Hyderabad, after they both tested positive for HIV. The woman seemed, clinically, in early stage disease, but the man was clearly wasted and probably needed antiretroviral therapy on that basis. I am not clear on their socioeconomic background, but is likely that they do not have many resources, as the story involves seeking care at government hospitals. They came to see her because they had made multiple attempts at getting ART at various facilities both in their hometown and here in the capital, but met with no success. They first tried to get care at Nizamabad, where they were told that the ART centre did not have the proper kits (I presume this means CD4 count kits). Per NACO guidelines, there needs to be a documented CD4 count less than 200 for a person to qualify for free medications. They came to Hyderabad to see the larger clinics here. Apparently, they were turned away at two of them because of the large waiting lines. I believe this readily, since I have spoken to the man who essentially runs the largest clinic in town (and in AP) and have seen that he often sees 150 patients a day.

So it is nice that first line regimens are available for free for persons with AIDS. It is unfortunate that the available regimens are fairly toxic and have a low threshold for the development of drug resistance. It is really terrible that access to care is so bad, if this anecdote is accurate and happens with any frequency. Clearly, there needs to be an increase in the number of places equipped to care for person living with HIV/AIDS. It is not reasonable to expect that a place like Osmania will be able to physically handle 150 patients a day. According to my reckoning, there are some 8 to 10 million persons living in Hyderabad. If there is a prevalence in the general population of 0.7% (this is the prevalence in antenatal clinics here and it is felt that the prevalence in AP is definitely over 0.5%, if not 1%) then we are looking at up to 70,000 persons in the city that are HIV infected. The only reason that the system has not been overwhelmed is the fact that the vast majority of these persons do not know their status. Hopefully, the rumors of the epidemic slowing down in India are true (not the opinion of HIV providers I have spoken to here), or there is going to be big trouble.