Tyranny of distance a barrier to combating HIV/AIDS in India
Vast distances are a major hurdle to India's efforts to curb its soaring HIV rate.
India, which has the world's third largest HIV-positive caseload, gives drugs for free to HIV/AIDS patients. But doctors say this is not enough to stop the spread of HIV which is making inroads in rural India, especially among women infected by itinerant husbands, and also children.
For three days a month, Sambit squeezes into a crowded and often filthy train for a three-hour journey to Delhi to receive HIV treatment.
"There's no seat and I am very weak," said the 30-year-old former tailor, who asked that his full name not be revealed.
He cannot afford lodging in Delhi and can barely afford the train tickets.
"I need to borrow money from my family for all these trips," he said.
Many patients in the same position simply give up treatment, an anathema in HIV therapy as it gives rise to drug resistance. These patients may then need more powerful second line treatment, which is not freely available in India.
"Travel can affect drug compliance. Patients who don't get family support, women who may not like to travel alone, will just give up," said a doctor at a New Delhi hospital, who spoke on condition of anonymity because he did not have permission to speak to reporters.
There are 147 "antiretroviral therapy" or ART centres in the country, part of a government drive that has been encouraged by the World Health Organisation in a bid to prevent HIV from becoming a major health problem.
Delhi has nine such centres and is far better served than many other states. Up to 6,000 patients receive treatment in Delhi, nearly half of these live outside the capital.
The Government now plans to build "link centres", small facilities that are closer to where patients live so people like Sambit can obtain their medications more easily.
"They just come to pick up the drugs if they have no side effects and they go home ... that saves transport and other costs," the doctor said, adding that the plan was to have as many as 500 such centres all over India.
India has 2.47 million HIV cases, according to the latest figures, but health workers say the number is rising rapidly and spreading to new population groups.
"Our numbers are going up," said Loon Gangte, South Asia coordinator of the Collaborative Fund for HIV Treatment Preparedness.
"It's not confined to high risk groups, it's going into the general population. It's not a problem of sex workers, drug users or truck drivers. These people have wives and children at home and the disease is making its way into the general population."
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