As India stumbles on the threshold of the 21 st century - even as it is yet
to come to terms with the basic needs of its billion people - the human
immunodeficiency virus continues its spread causing as many as 16,000 new
infections a day worldwide. Most of these new infections occur in the developing
world; eighty- nine per cent of people with HIV live in SubSaharan Africa and
the developing countries of‘ Asia (I).
In India, the HIV/ AIDS epidemic has reached frightening proportions since
the first case of AIDS was identified in 1986. Even those who once dismissed it
as a fashionable topic of conversation, or a 'fund- raiser’ have had to sit up
and take notice. Current projections estimate that by the year 2000, annual HIV-
related deaths in India will be between 100,000 and 300,000 annually ( l0- 15 %
of all deaths in the age group of 15- 45 years. (2)
Testing Patients
The epidemic has led to stigmatisation
of’ HIV- positive persons, in their workplace, and even more shockingly, by the
health services. Instances are reported every day, of doctors denying medical
treatment to people testing HIV positive, of testing incoming patients for the
virus - often even without their knowledge. Small efforts have been made to
counter such practices. Recently, at a medical staff’ meeting in a major
hospital in Mumbai, a proposal for universal testing of incoming patients was
abandoned when a doctor insisted that all doctors be tested as well.
On the other hand, the acknowledgement of HIV and AIDS has had several
consequences in the fields of health and development both positive and negative.
Long neglected subjects such as hospital waste management, standard of blood
banks, implementation of universal safety precautions, sex and sexuality
education, and terminal care have come into focus.
The first cases of HIV/ AIDS in India were reported amongst commercial sex
workers in Mumbai and Chennai and injecting drug users in Manipur, more than a
decade ago. Such economically deprived groups remain most vulnerable to
acquiring HIV, likely to fall ill earlier, and die earlier. For this reason,
such populations are generally the focus of preventive health interventions.
Last month, some members of the Forum for Medical Ethics Society were invited
by a voluntary organisation which is active in the red light area of Mumbai, to
address doctors who have been practising in the area for several years. The
meeting’s revelations were shocking.
Too many celebrity rallies
According to the doctors, as
many as 30- 40 per cent of the patients who seek their treatment are HIV
positive. It therefore came as a great surprise that not a single organisation
governmental or non- governmental - had till date made any organised effort to
educate this group of doctors in matters concerning HIV and AIDS, or to involve
them in their activities in this field. Some organisations have been in this
area for many years, organising well publicised celebrity rallies but they seem
to have kept the local doctors out of the picture. How can any HIV/ AIDS control
programme be effective without educating and involving the local general
practitioner, especially in such sensitive and vulnerable localities?
HIV and AIDS have raised these and many other ethical issues: the maternal-
foetal conflict, the need for patient confidentiality versus the rights of the
spouse, the question of whether HIV- positive mothers should breastfeed, the
AIDS vaccine and its trials - especially in third world countries, antiviral
drugs, discrimination by employers etc. Some of these have been discussed in
earlier issues of IME but with each passing day as HIV- AIDS insinuates itself
into the community, more and more questions demand our attention.
Finally, for those who might believe that, with all the billions of dollars
that are being spent on AIDS research, a cure for the scourge of this century is
just around the corner, a note of caution. Professor Michio Kaku, a renowned
theoretical physicist also known internationally for his futuristic vision,
recently said in an interview published in The Times of India, “HIV in just two
years mutates as much as humanity in two million years. Unlike cancers, which
are mutated human cells, HIV mutates at such an incredible rate that a cure may
or may not be on the cards .” (3) There is certainly no ground for apathy. The
medical profession must accept the challenge. Let HIV/ AIDS not be the last
straw on the Indian health system’s feeble back.
References :
1. Joshi PL., Rao J. V. R. Prasada;
Changing epidemiology of HIV/ AIDS in India; AIDS Research and Review; 1999,
Vo1.2, No. 1,7 (published by National AIDS Research Institute, Pune -Indian
Council of Medical Research)
2. Godwin Peter: The looming epidemic; The
impact of HIV and AIDS in India. Mosaic Books, Delhi 1998.
3. Gangakhedkar
R. R.; Editorial; AIDS Research & Review; 1999, Vol. 2, NO. 1, 1 (published
by National AIDS Research Institute, Pune -Indian Council of Medical Research)
Santosh Karmarkar,associate professor and unit in charge, department of
paediatric surgery, B. J. Wadia Hospital for Children, Parel, Mumbai
400012
