“One of the positive developments since the 10th ICAAP (held in Busan, South Korea in 2011) is that national governments have put more money into HIV/AIDS programmes - be it India, Indonesia or China. It is the national governments’ input and acceptance of the responsibility to finance the domestic HIV programme that has become more of a reality now than it ever was. Money from external donors for financing HIV programmes has dropped significantly so this positive change of upping domestic funding is important. We can of course argue that the money is not enough and we need more investment in HIV programmes” said Dr NM Samuel, President, of AIDS Society of Asia and the Pacific (ASAP) and former Professor of Experimental Medicine, Dr MGR Medical University. “The negative aspect since last ICAAP is that we have to put more money as current investment in HIV programmes is not enough.”
PROGRAMMING BEYOND HIV SPECIFIC CARE
Added Dr Samuel: “HIV response in the Asia Pacific region has been very diverse - just like the epidemic itself. For example, we are not preparing the agenda on how to handle the care needs of people living with HIV (PLHIV) who are living longer now-- such as cardiovascular diseases (CVDs), lipid metabolism disorders, diabetes, cancers, among other co-morbidities. Are we looking at this?”
PREVENTING CERVIAL CANCER IN HIV POSITIVE WOMEN
Namakkal is amongst the worst HIV affected districts in India both in terms of prevalence and impact. The high prevalence rate among antenatal clinic attendees highlights the extent of vulnerability among women of child-bearing age and general community at large. Dr Samuel led an initiative to not only strengthen HIV programmes in Namakkal but also screened women living with HIV by offering them pap smears (to rule out cervical cancer).
“In Nammakal we screen every woman living with HIV who comes to our clinics by offering pap smears. This small initiative has helped prevent at least 25% of them from developing cervical cancers by screening them early on. We need a comprehensive agenda for broader healthcare needs of PLHIV in the country,” said Dr Samuel.
MENTAL HEALTH
“Mental health needs of women living with HIV have long been ignored. Loneliness is a huge issue for HIV positive women. How many helplines are there functional in the night where women can call for help?” asked Dr Samuel.
MORE COMMUNITY AT 11th ICAAP
“Every ICAAP local organizing committee puts aside certain amount of money and numbers to bring representatives of affected communities from the Asia Pacific region. ICAAP is about the affected communities and often, it may not be as much as we would like to do. It is a question of resource constraints too despite which a significant number of delegates from affected communities are brought in. We also see apathy to conferencing, people do not like to put their money in conferences, despite that we have such a large gathering here (at 11th ICAAP held last month in Bangkok).”
Apart from supporting more than 300 International delegates from key populations, this ICAAP also covered registration fees for additional 20. Also, special provisions were made to encourage participation of representatives from key populations from Thailand. “Thai government had organized a separate workshop to train the community to write an abstract, present an abstract, and 30-40 abstracts submitted from that workshop alone had been accepted at this conference. It is important to support community members to put their work into words. We need to do these workshops in other countries too” added Dr Samuel.
WHAT THE ASAP PRESIDENT DOES BACK HOME
Dr NM Samuel currently leads Concern for AIDS Research and Education (C.A.R.E.) which manages two important HIV care programmes in Namakkal. One programme addresses the needs of HIV positive pregnant women and the other programme engages tribal populations where HIV related stigma and discrimination is far more. “Children living with HIV get a priority at our centres. Since the intervention has been in place for more than a decade, we are now dealing with other issues apart from HIV care. For example, children of 10-12 years of age, are asking questions such as 'Why am I infected?' or 'Who is responsible for giving me this infection?' or 'You never told me I have HIV infection?' These children are taking medicines, including antiretroviral therapy (ART). At times parents tell these children that they are giving these medicines for better immunity, to become stronger, or for TB but not telling them that they have HIV. The issues, such as disclosure, preparing the mother and father for answering such questions, and not to feel burdened or responsible that they have infected these children, were not the issues that were talked upon earlier on in Prevention of Parent to Child Transmission Programmes,” said Dr Samuel.
CHILDHOOD TB-HIV: DOUBLE STIGMA
“Colour of urine in children co-infected with TB and HIV might be red due to anti-TB drug rifampicin. People who use the toilet after them and find the red urine, often confront these children on why they have blood in their urine. These are some of the important issues we have not dovetailed into our regular counselling. In our clinics children and their caregivers such as parents, grandparents or guardians are counselled together. Currently, an HIV positive woman who was a school teacher earlier and mother of two children (both living with HIV) leads our intervention to talk with other caregivers of positive children” said Dr Samuel.
Bobby Ramakant, Citizen News Service - CNS
November 2013
Note: This article was first published in 11th ICAAP INSIGHT, the official daily conference newspaper of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) in Bangkok, Thailand. This newspaper was managed by Inis Communication and CNS.
