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Story Publication logo April 2, 2014

AIDS Patients in Andhra Pradesh Find Fear at State Hospitals


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Doctors have demanded fixes to India's public hospitals for years, but have been stifled by...

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WARANGAL, India — As M. Balakrishna, a 38-year-old AIDS patient, pushed his gaunt body out of bed with his skinny arms, his knees wobbled as his feet hit the floor. His apartment was covered with spare motorbike parts, relics of a time when he was still able to work as a mechanic.

In December, he entered Mahatma Gandhi Memorial, the largest government hospital in Warangal, a district 90 miles northeast of Hyderabad, to have an abscess removed from his neck. But he left the building untreated because of the results of a routine blood test taken before his surgery.

"They said that that they could not help me because I have AIDS," Mr. Balakrishna said.

Officials from Mahatma Gandhi Memorial declined to comment on Mr. Balakrishna's case, but his complaints have been echoed by many others with H.I.V. and AIDS in Andhra Pradesh, which has the highest prevalence in India with 500,000 cases in a population of 85 million, according to a 2012 survey by the World Bank.

Places like Warangal, where truck stops are commonplace and prostitution plays a significant but undocumented role in the local economy, are contributing to the epidemic in the state.

Dr. B. Ranjith, a leading H.I.V. and AIDS researcher in Andhra Pradesh who founded the International AIDS Prevention and Research Organization in 1995, said that the Internet had helped disseminate information about the disease to younger people, helping stem the spread of the disease in Indian cities, but that ignorance still contributed to the high number of new infections in the state.

"I get unbelievable phone calls from people who get my number off the Internet," Dr. Ranjith said.
"'Hey, I'm getting married next week, but I had unprotected sex with a prostitute last night. Can you check me?'"

That ignorance is also displayed among medical professionals in government hospitals, who are sometimes afraid to touch patients with AIDS and H.I.V. for fear of infection, Dr. Ranjith said, even though the virus that causes AIDS can be transmitted only through unprotected sex, blood transfusions, the sharing of hypodermic needles or from mother to child.

He also said that some state health care plans like arogyasri yojana, which insures lower-income patients for major operations, have clauses that disqualify people with AIDS and H.I.V., making such discrimination part of state policy.

Dr. Achanta Vivekanand, an AIDS specialist in Warangal who treated Mr. Balakrishna at his clinic, said the denial of care to AIDS patients at government hospitals was an underreported scandal of large proportions, infused with frightening life-and-death consequences. He estimated that the majority of patients with H.I.V. and AIDS in the state avoid government hospitals because they fear being treated as pariahs.

"Doctors take a Hippocratic oath," Dr. Vivekanand said. "And this issue represents a compromise of ethics that should leave people outraged."

His criticism of government hospitals carries some weight, as he was the recipient of a World AIDS Day award issued by Andhra Pradesh's government in 2011 for his work in reducing prenatal transmission of the disease.

"We are talking about doctors who have the ability and knowledge to treat patients," Dr. Vivekanand said, "but then lack the will to help the ones who need it most."

However, officials with Andhra Pradesh's State AIDS Control Society, more commonly known as A.P. SACS, and the state's health ministry denied that AIDS patients encountered discrimination at government hospitals, with Dr. B. Kishore, the head of A.P. SACS, asserting that there was a "zero percent rate of occurrence."

Dr. Vivekanand scoffed at their denials. "Of course government agencies don't want to admit that discrimination happens, because it's an unambiguous sign of failure," he said.

When government hospitals refuse to treat these patients, the poor ones turn to nongovernment organizations and religious charities like Karunalayam, a Roman Catholic mission in Warangal. Run by the Rev. Joseph Jyotish, a group of nuns and social workers, the rural center is devoted to caring for people with H.I.V. and AIDS.

Dr. Vivekanand volunteers at Karunalayam frequently, providing medical advice to patients free of charge. Among the patients living there full-time are 94 children, many of whom have been abandoned by their families for having H.I.V. or AIDS, despite having been born with the disease through prenatal transmission.

"There is so much stigma related to being born H.I.V.-positive," Father Jyotish said. "And this is true despite the commonality of the disease in this area."

People with H.I.V. and AIDS also find that private practices, which often have more experienced, better-trained physicians who know how H.I.V. is transmitted, are more likely to accept them as patients.

Some private doctors, like Dr. Ranjith, will work at a reduced rate for lower-income patients because of this very need. He runs a private clinic in Hyderabad that was the first of its kind in Andhra Pradesh. On a visit one afternoon in February, Dr. Ranjith's clinic was full of patients, many of whom either did not trust government hospitals or had been rejected by them.

One woman, Shoma, who requested that her last name not be used, is the sole survivor of what was once a family of five.

Married at 18, she tested positive for H.I.V. during a routine exam at the start of her third pregnancy 12 years ago. Since then, her husband and all three of her children have died of AIDS-related complications at government hospitals in rural Andhra Pradesh, where her family did not receive the urgent care that they needed, she said.

Today, she is cared for by her nephew, an app developer working in Hyderabad's bustling technology center, and seeks treatment only from Dr. Ranjith's clinic.

When asked about the public health care her family received as AIDS patients, Ms. Shoma spoke bluntly and without pause: "The hospitals here failed my family."



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