The gender face of HIV/AIDS The divide runs deep Neo, natty, unhealthy Something to talk about Promises to keep Looking at life positively Healthy option The bone crusher

T here is a joke that if the Domjur local train does not reach on time, the hospital wards for the sexually transmitted diseases in Kolkata remain empty. Every morning, crowds of patients from the districts arrive at Howrah and Sealdah stations on the way to Calcutta Medical College , a premier government hospital in the heart of the city. Jyoti, an HIV patient, visits the hospital even for diarrhoea or fever, common recurring ailments among HIV/AIDS patients. “I do not know which is worse, my illness or the journey and wait for treatment,” says Jyoti.

Parvati, Jyoti's neighbour at Parbatipur village, Domjur, claims she knows better. She and her two young children were diagnosed with HIV/AIDS following her husband's death yet refuses treatment in the city. “I'd rather spend the time to earn a few rupees to feed my children,” she says without lifting her eyes from gluing paper packets. “Will I spend Rs 40 to travel to the hospital or should I buy rice? I'd be a fool,” she mutters. Parvati prefers the neighbourhood private doctor, who gives her cord blood transfusion to “cure” her disease.

In the next few days, world leaders will meet in New York between May 29 and June 2 for the second round of United Nations General Assembly Special Session (UNGASS) on HIV/AIDS to appraise w hether specific commitments, including prevention campaigns, ensuring treatment, care and respect for people living with HIV/ AIDS have been met. In the 2001 UNGASS, when India along with other countries adopted the Declaration of Commitment, it brought hope to the 5.13 million HIV/AIDS affected people, estimated to be the largest population of people living with the disease next to South Africa . “Many viewed it as a roadmap to halt and reverse by 2015 one of the most challenging pandemics,” s aid Dr S Jana, HIV programme advisor of CARE International, an NGO . “For UNGASS not to be reduced to a jamboree, specific commitments were made for sustained action.”

Most important, governments had pledged to incorporate lessons learned from local communities. If so, does the India Progress Report (IPR) for UNGASS 2006 reflect the concerns of people like Jyoti and Parvati caught between an overcrowded, uncaring public health system and mavericks who value profits more than life? Does the IPR spell out a strategy to introduce a nti-retroviral ( ARV) therapy and comprehensive health care in an organised and regulated manner?

There are lessons the HIV/AIDS epidemic in the country can learn from old diseases that have refused to die . Even today, tuberculosis, malaria, acute respiratory infections including pneumonia and influenza and diarrhoeal diseases remain the leading infectious killers in the Indian sub continent. Despite government commitments to eradicate the killer diseases and the gigantic strides in modern medicine, it is significant that more people are dying of these diseases than in any other period of history, said neurosurgeon Dr Ekbal, convenor, People's Health Assembly.   “Never have so many people had such broad and advanced access to healthcare. But never have so many been denied access to health,” said an international health expert. With majority of Indians earning less than Rs 100 a day having to meet 80 percent of cost of health care, in reality patients either forego treatment or run up huge debts.

Undoubtedly, the diseases are inextricably linked to poverty, malnourishment, impoverished dwellings and poor sanitation that weaken immune systems. Similarly, HIV/AIDS patients urgently and immediately require comprehensive care to boost their immune system and limit the impact of HIV infection, said Dr Jana. This would mean nutrition to build on a truant immune system to prevent catching other infections. It's no surprise that Parvati prioritises her dwindling resources to buy food for the children over spending time and money on travel to the city.

Unfortunately, the popular perception of HIV/AIDS is of a disease for which ‘nothing can be done'. Said Ritu Priya, Centre of Social Medicine and Community Health, Jawaharlal Nehru University , “Doctors have reinforced the view that ARV drugs is the only treatment. National AIDS Control Organisation (NACO) has also strengthened this view by barely mentioning comprehensive care in the guidelines on ARV”. According to the IPR only 10 percent of HIV/AIDS patients in the country require drug therapy; if so why has it not emphasized on comprehensive care and support for all the affected, including adequate nutrition?

The IPR proposes to provide ARV therapy initially to 180,000 HIV/AIDS patients by 2010 and drugs to prevent parent-to -child transmission through community and primary health centres. Yet, the IPR makes only token mention of improving the crumbling health care infrastructure, the backbone to operationalise health services and care. Currently, there are only less than half the requirement of 7, 415 community health centres (CHCs) in India and only 38 percent of the primary health centres have all health personnel. In the absence of health care services, it has forced patients like Jyoti to crowd city hospitals for treatment.

Some problems are too big to be handled alone. Disease control is one of them. The large, public health infrastructure was initially planned to be an integrated, comprehensive one. Today, it has become a donor trap for vertical, single disease control programmes, like malaria and TB – and now HIV/AIDS - leading to escalating costs and ineffective implementation. The eruption and rapid spread of the HIV epidemic is a clarion call to re-examine and co nfront these issues. Otherwise, like poll rhetorics, UNGASS will become another 5-yearly global jamboree.