FEATURES NEWS THE RISING NEPAL (DAILY)

Aids Epidemic Paradigm Shift Necessary

By P.Gopakumar

IN Nepal, people living with AIDS are often ostracised by their communities. It is high time to enact policy to uphold their rights and dignity. It is important to dispel the ignorance about HIV and AIDS. Ignorance and fear lies at the root of discrimination and stigma. It is important to cultivate scientific temper and help people comprehend the medical reality of AIDS. The time has come to articulate a paradigm shift in our perception of AIDS. HIV and AIDS are chronic manageable conditions that need acceptance, care, support and compassion like chronic diseases. For, if HIV and AIDS do not kill, the stigma, discrimination, exclusion and isolation will.

Care

Several years may pass before a person living with HIV falls ill. Until then, people living with HIV can lead a relatively normal productive life by taking good care of their health through regular medical check ups and anti-retroviral therapy if necessary, and taking care not to donate blood, share needles or indulge in sex without condoms. HIV is not transmitted via skin -to -skin contact and there is no reason to isolate someone living with HIV due to fear of causal contagion. The unfortunate tendency to keep linking HIV transmission to unlawful for amoral activities has resulted in the general population mentally distancing themselves as being beyond the reach of the virus.

Changing popular perceptions about AIDS requires massive inputs of information, education and communication, sensitisation of opinion makers and political leaders at all levels, and maybe some modification in legislation. Of course, we have made a beginning. These efforts need to be given more momentum.

Nearly two million children in Asia have lost one or both of their parents due to AIDS. But Nepal did not furnish its count of AIDS orphans. This may be because of the less seriousness in the approach or it might have felt 'too uncomfortable". This is where a second paradigm shift is necessary. We need to educate the community not to forsake the responsibility of caring for children because their parents perished in an epidemic. I strongly believe the joint family system will continue the tradition of caring for orphans in the family. There is also need for an effective mechanism to estimate the number of AIDS orphans. However, the survival of the parents is equally important. Therefore, we should work towards a combination of institutional and home-based care initiatives to ensure the long-term survival of both mother and child. As Nepal has about 1-2 million deliveries a year, mother to child HIV prevention is critical.

The Long-term survival of people living with HIV is dependant on anti-retroviral therapy. But the majority of the patients find patented drugs and even generics unaffordable. We are depending upon the import of medicines and drugs from the neighbouring countries, mainly from our southern neighbour, as it is the largest producers and exporters of low-cost generic drugs. Ironically, excise duty on pharmaceutical products' export to Nepal is waived off by the government of India; still medicines are not affordable in this country. There is a need to deliberate with representatives from the pharmaceutical industry and traders, donor agencies and health service providers.

A rational policy of standard treatment regimens for HIV and AIDS need to be adopted. Such a policy should detail modalities for expanding access to these regimens and consider social marketing and franchising to enhance the availability of HIV-related products and services. There should not be failure to link HIV prevention with care and support.

Evolving special methods and means to counter impact of the fearsome disease has now become critical in the fight against AIDS.AIDS researchers intrigued that 1 to 5 per cent of the people infected by HIV can live for 10 or 15 years or even more, with apparently no damage to their immune systems. The scientists call these untreated people long-term non-progressors. Using defensins as a medicine might be difficult, in part because they are hard to manufacture. But clues to treat AIDS might come from understanding how the defensins work, which is unknown. Dr. Bruce walker, director of the AIDS division at the Harvard medical school, said defensins might not be that useful therapeutically because they appear to have only fairly modest effect in suppressing the virus. Some people might withstand the virus because of genetic variations or because a weak virus might have infected them.
Skeptics say the data on HIV/AIDS in Nepal is neither comprehensive nor accurate. There is a need to work towards increasing the number of sites, to refine modalities for estimation with a view to enhancing coverage and accuracy.

A comprehensive package of services for vulnerable segments and also refining strategies for HIV prevention should be evolved and also work on providing support and care for people living with HIV and AIDS. The focus on identifying gaps in the existing systems and strategies with regard to the geographical heterogeneity of the spread of the epidemic is needed and should work towards upgrading community level HIV surveillance. There is also need to work towards professionalising health delivery systems that deal with the logistics, management and delivery of safe blood. The specifications and standards for drugs, instruments, equipments and accessories that are utilised in the national AIDS program need to be better articulated.

Cooperation

All this can only be accomplished through multi-sectoral cooperation, community awareness and participation, initiatives from the private and the non-governmental agencies and explicit political will and commitment.

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