Steps to curb Covid add to woes of PLHIVs on ART drugs
Source: Chronicle News Service / Niranjan Oinam

Imphal, May 22 2021: People from different walks of life are facing hardships due to the second wave of Covid-19 pandemic and related restrictions imposed by the government and People living with HIV/AIDS (PLHIVs) are also among the group of people, who are facing serious inconveniences.

As this group of people needs Antiretroviral Therapy, they are facing hardships in trying to get the ART drugs, especially those living in remote areas of the state.

Meanwhile, Manipur State AIDS Control Society (MSACS) joint director Dr Lucy said that they are aware of the situation and patients can contact their respective ART centres or their counsellors for availing delivery service for ART drugs even if not at their home but at a convenient location where the patients can come to collect.

Speaking to The People's Chronicle in this regard, Yaima (name changed), a PLHIV activist, informed that as of now there is no issue of shortage of ART drugs.

Some NGOs are also distributing ART drugs to several clients.

Though there are ART centres in almost all the districts, the recently created districts do not have these centres and PLHIVs in these districts have to go to ART centres of other districts to get their drugs.

On the other hand, there are still several PLHIVs, who out of fear of social stigma come to either RIMS or JNIMS to get their ART drugs instead of visiting the ART centres in their respective districts and these patients are now facing inconveniences in visiting RIMS or JNIMS during the curfew.

At the same time, a patient from Noney finds it more convenient to visit Imphal instead of Tamenglong, he said.

Though there are instructions to arrange adequate seating facilities, drinking water and waiting sheds at the ART centres of RIMS and JNIMS, there inadequate seat arrangements and these centres are not hygienic.

This situation has made the PLHIVs more vulnerable to Covid-19 during the pandemic.

At times, the ART centres at RIMS and JNIMS have around 200-300 clients per day but there is not adequate manpower to cater to the need of the clients which leads to occasional altercation between clients and staff.

During the pandemic, the clients are facing severe hardships due to logistic as well as space problem in the ART centres, he contended.

Occasionally, some clients would come to collect ART drugs without conducting tests for viral load and blood sugar level.

The officials seem to be unaware of the reason for such negligence on the part of the clients.

Now the ART drug has been replaced with a new drug and the clients will need regular tests for liver function and blood sugar, he said, while suggesting regular announcement on the benefits of viral load and blood sugar level tests by using PA system at the ART centre and creating awareness among the clients.

On the other hand, the official could also distribute pamphlets, he said.

On the other hand, most of the clients are from poor families and they want to conduct the tests at RIMS or JNIMS free of cost.

However, the long queue makes it impossible for them to get the test done and take ART drug on the same day.

In this situation, clients from far flung places face difficulties in visiting the next day or staying the night in Imphal.

Making separate arrangement for ART clients at the centre would make it easy for the clients to carry out the required tests, he suggested.

Another PLHIV activist Rex (name changed) from Churachandpur, told TPC that clients from the district can get the ART drug from three centres -Churachandpur district hospital, National Strategic Framework and SHALOM.

Delivery service is being offered for clients in interior areas during the pandemic.

Police as well as CSOs enforcing Covid-19 related restrictions allow free passage to clients visiting ART Centres.

However, there is no counselling or consultation service available in the ART centres of the district, he said.

PLHIV activists Romeo and Rose (name changed for both) from Ukhrul district, said that village authorities in the district are taking up stringent measures to check the transmission of Covid-19.People exiting their respective villages need to bring a Covid negative certificate while returning home and they are made to stay in isolation for seven to 10 days.

Any person violating these restrictions is made to pay fine.

In order to visit ART centre, one needs to get a pass from the village chief or from the village volunteers.

The client will then need to spend Rs 2000 to Rs 4000 to hire a vehicle to visit the ART centre.

The ART centre staff are also not in a position to introduce delivery service due to lack of vehicle.

Getting delivery at home is pure luck and is possible only when the ART centre staff come across a vehicle reaching the particular village of the client.

The district has around 1200 ART clients and they get their drugs from the ART centres located at the district hospital and Rihan Centre.

Staff of Rihan are offering delivery service of ART drugs as of now, they said.

On the other hand, MSACS joint director Dr Lucy said that annual infection rate was more than 2000 people some five to 10 years ago but the rate has dropped to a little more than 1000 in 2017-18 and below 1000 in the past couple of years.

As per report of National AIDS Control Organisation (NACO) under its 'Know Your Status' campaign, only 53 per cent of the population of the state know their status while the remaining 47 per cent do not know their status as they do not want to undergo HIV test out of fearing stigma and social discrimination.

From February 2020 onwards, index testing programme was taken up under which contact tracing of sexual partners and injecting drug user partners of known positive cases were carried out and counselling were given to them for conducting HIV test.

In the process, around 15 to 20 per cent of the contacts were found to be HIV positive.

However, the exercise had been halted due to Covid-19, she said while stressing the need for tracing these group of people and encouraging them to undergo test in order to prevent further transmission of the virus.

A HIV positive person without ART has high chances of transmitting the virus to others.

Regular ART significantly suppresses the virus and no viral load is detected in 96 per cent of the regular ART clients.

As such, possibility of transmission to another person is very low and it also increases the survival duration to a great extent.

There are several cases in which the HIV positive husband is on regular ART and the wife is still HIV negative, the doctor said.

She further said that there are 13 ART centres in the state and they are providing services to over 13,200 clients.

Considering the hardships besetting the clients in getting ART drugs, MSACS along with its partner NGOs and bilateral partners have been delivering these drugs to the clients since last year.

Under these initiatives, a client from Ukhrul, who used to get ART from JNIMS, can get his ART drug from the centre located in Ukhrul district after establishing a communication between the centres in JNIMS and Ukhrul.

Like any other medicines, the dose for ART has also its limit.

Any client, who is facing logistic issue in visiting the ART centre can communicate with the centre or their respective counsellors for availing delivery service, she continued.

Considering the hardships facing by the clients, most of whom are from poor families, the ART centres have been instructed to enquire the issues if any client is not showing up to take his drugs.

Similarly, the clients can also contact their respective centres or the head office as per their need.

Recently, the head office sent ART drugs for two months for seven clients from Jiribam, who used to get their drugs from Silchar, Dr Lucy informed.

RIMS and JNIMS have around 7300 clients and there is a problem of overcrowd in these centres.

In order to reduce the crowd, healthy clients are provided drugs for two or three months after assessing their conditions.

Earlier TLE drugs were provided to the clients and now it has been replaced with TLD drugs.

As the new drug has some adverse effect, it requires some prior testing before administering the drug.

There are separate test facilities for viral load but other tests are combined with the general public, she said.

She further appealed to the clients to strictly follow the Covid relevant SOPs and continue their therapy regularly.

She also appealed to the general public to know their HIV status and help in eliminating the virus from the society.

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