By Tan Ee Lyn
NEW DELHI (Reuters) - Vast distances are a major hurdle toIndia's efforts to curb its soaring HIV rate.
India, which has the world's third largest HIV-positivecaseload, gives drugs for free to HIV/AIDS patients. Butdoctors say this is not enough to stop the spread of HIV whichis making inroads in rural India, especially among womeninfected by itinerant husbands, and also children.
For three days a month, Sambit squeezes into a crowded andoften filthy train for a three hour journey to Delhi to receiveHIV treatment.
"There's no seat and I am very weak," said the 30-year-oldformer tailor, who asked that his full name not be revealed. Hecan't afford lodging in Delhi and can barely afford the traintickets.
"I need to borrow money from my family for all thesetrips," he said.
Many patients in the same position simply give uptreatment, an anathema in HIV therapy as it gives rise to drugresistance. These patients may then need more powerful secondline treatment, which is not freely available in India.
"Travel can affect drug compliance. Patients who don't getfamily support, women who may not like to travel alone willjust give up," said a doctor at a New Delhi hospital, who spokeon condition of anonymity because he did not have permission tospeak to reporters.
There are 147 "antiretroviral therapy" or ART centres inthe country, part of a government drive that has beenencouraged by the World Health Organisation in a bid to preventHIV from becoming a major health problem.
Delhi has nine such centres and is far better served thanmany other states. Up to 6,000 patients receive treatment inDelhi, nearly half of these live outside the capital.
The government now plans to build "link centres", smallfacilities that are closer to where patients live so peoplelike Sambit can obtain their medications more easily.
"They just come to pick up the drugs if they have no sideeffects and they go home ... that saves transport and othercosts," Rao said, adding that the plan was to have as many as500 such centres all over India.
INFECTION FIGURES AREN'T GOING DOWN
India has 2.47 million HIV cases, according to the latestfigures, but health workers say the number is rising rapidlyand spreading to new population groups.
"Our numbers are going up," said Loon Gangte, South Asiacoordinator of the Collaborative Fund for HIV TreatmentPreparedness.
"It's not confined to high risk groups, it's going into thegeneral population. It's not a problem of sex workers, drugusers or truck drivers. These people have wives and children athome and the disease is making its way into the generalpopulation."
Sujatha Rao, director-general of the government's NationalAIDS Control Organisation, says doctors are increasingly seeingwomen infected by their husbands.
In some clinics, 1 out of 100 women who come for ante-natalcare checkups are HIV positive, she said.
"It is a generalised epidemic," she said. "We have pocketswhere the prevalence is more than 1 percent among ante-natalcare mothers, so we need to intensify our work."
Out of India's 611 districts, HIV prevalence is more than 1percent of the population in 156 districts.
"The epidemic is getting deeper into (certain) rural,general areas of the country ... it is migrant-related. They goto work and then they take back the infection to their homes,"she said.
Even though HIV drugs are free, only about 155,000 peoplehave access to retroviral drugs, up from 20,000 just two yearsago.
Health expert say there are many people who do not knowthey are infected or who do not know that treatment isavailable.
Some health professionals believe India's HIV problem isclosely intertwined with poverty and that the government musttackle poverty if it seeks to curb the spread of HIV.
"Many of these people are very poor, they worry about food,shelter. So they may not think their HIV status is a problembecause they don't even know where their next meal is comingfrom," said Errol Arnette of the help group Sahara.
"A lot of AIDS patients die of TB because it's hard forhospitals to keep them (in hospital). HIV patients are justthrown in a corner because of heavy stigma."
(Editing by Megan Goldin)
