Post Mortem

Deadly HIV thriving unabated in the shadow of Covid-19 pandemic

By Nagaland Post | Publish Date: 1/17/2021 12:41:43 PM IST

 (From previous issue)

Nagaland State AIDS Control Society (NSACS), on the line with NACO and WHO as well as with close coordination and collaboration with International and National Government agencies and development partners through different capacities has been implementing robustly at every possible step to ensure that HIV pandemic is contained and the curve is reversed. For example, under the State AIDS Control Society, awareness about HIV has reached the saturation point, every high risk or key population as well as suspected group/individuals have been screened and tested and still counting. On the treatment aspects, in order to minimize the chances of discrimination and stigmatization while coming to avail the facilities for HIV treatment, multiple ART centers have already opened across the state districts so that facilities are made available closer to their home. Again, another pertinent issue like distance travelling across difficult topographical mountainous terrains and travelling through bad roads and difficulty to attend regularly to the facility points have been addressed through innovative patient-friendly mechanisms like creation of Differentiated Service Delivery Model (DSDM) that includes Multi Month Dispensation (MMD) for 3 months so that patient can take drugs home for 3 months instead of coming to ARTC on daily basis. Community ART Refill Groups (CARG) are being created so that Drug delivery point is brought nearer to the patients’ locality. 

Advantages of such innovative policies are :- a) To improve treatment adherence: Good adherence of ART intake is essential in order to suppress viral load consistently so that HIV individual becomes non-infective to partners. b) To minimize the Lost to Follow Up (LFU): LFU issue for those people who had initiated ART but failed to keep the pace due to excuses such as distance travelling, poverty, sickness and feeling of discrimination and stigmatization are to some extent solved. These are the potential group of people who would spread and create an artificial epidemic of HIV. c) To minimize the financial and economic burden of the family of people living with HIV (PLHIVs) and also to maximize the savings for livelihoods.

As mentioned above, Nagaland state being a small state with very less population unfortunately, for the wrong reason, tops nationally in overall HIV prevalence rate in the country. Now we have entered into multipronged real-time warfare with so many pandemics among which HIV remains as formidable above all other pandemics as its causation involves not only the virus but also involves social evil behaviours and social diseases inflicting huge impact on national economic as well as family economy and also heavily impacting on deprivation of one’s lifetime’s dreams. 

No single entity or body or community can change the real time situation that is threatening our very existence. No games of magic will do the miracle or be able to reverse the pandemic or automatically eliminate HIV from our state. It is our collective responsibility as well as individual responsibility to correct the wrong to right and change our society to a disease free society. Owning self responsibilities and obliging to responsibility by stake holders and individuals are the need of the hour now.

There are two possibilities that has potential to prevent HIV transmission in the community and if played well by the concerned stakeholders shall surely yield dividend in terms of human development and overall quality of living standard of the state in particular and also have positive contribution to the national interest in a big way.

First possibility and foremost responsibility is the role of HIV positive people themselves to act and behave responsibly as how to lead a healthy living and catch up with other non HIV infected healthy person in all respects, be it longevity, quality life, achieving dreams just as all others do. More importantly, to develop healthy attitude and concern for dear ones and society that HIV should not spread to others through them. Healthy attitude and willpower of the infected individual and also healthy support from family and community are necessary to overcome stressful lifestyle habits and behaviors of the unfortunate patients. It will be prudent on the part of the individuals who are suffering from HIV to understand certain instructions given in the guidelines and why discipline is vital because it is after all for their own interest and benefit only. 

For instances, 

a) Anti Retroviral (ARV) Drugs: These drugs are the only hope for HIV infected individuals to get life back. There is no alternative. There is no cure. If treatment protocol is followed properly and treatment adherence is good then viral suppression will achieve the stage of Target Not Detected (TND) and also U=U (Un-detectable is equal to un-transmissible) which means even HIV positive people will not transmit HIV to others anymore. This stage should be the target and aim for all concern PLHIVs. There is no point of living in hiding or in denial. The only option and choice for survival is to come forward and avail available facilities. 

b) Viral Load Testing (VLT): The same objective as mentioned above also stands true for regular viral load testing. VLT is advised before initiating ART and then once in 6 months. If viral load reading in the host blood is less than 1000 copies then viral testing will be advised on yearly basis. Such advice is not at all burdensome but very convenient and easy to follow. 

c) Other routine tests such as CD4 (Clusters of Differentiation of T lymphocytes-4) every 6 months will determine the status of host immunity and response of treatment. Kidney Function Test (KFT) every 6 months will determine the condition of renal status as many ART drugs has side effect for renal damage so that changing of drugs regime is decided based on that report, so likewise Liver Function Test (LFT) as well as haemoglobin estimation. 

 Only appealing is this: just come forward. Never live in hiding or in denying life anymore. It only hurts you and dear ones more. Help yourself and let not the HIV go out to others from you.

 The second possibility of controlling HIV pandemic and elimination of HIV calls for all the HIV free people in the state to play a very proactive role and respond positively to the collective call to prevent HIV transmission in the state and to keep up prevention efforts consistently till total elimination stage is achieved. There is no room for complacency or negligence. Either prevent yourselves from HIV or suffer the consequences of HIV. Choice is yours.

The household topic for the control of Covid-19 pandemic such as social distancing and mouth masking can also be applied for HIV pandemic control program simultaneously. For example, the Covid-19, an airborne disease which can be largely contained through consistent practices of social distancing from suspected individuals as well as regular use of mouth masking to filter out dreaded virus, this same principle and methodology can also be true for HIV prevention. 

For instance, HIV, being a behavioral or lifestyle disease, can be controlled through consistent practice of social distancing from sexual immoralities and drug injecting habits while mouth masking for Covid-19 can be compared with consistent use of condom to prevent HIV through sexual contacts if self-restrain from sexual immoralities become a burden for weak individuals. 

Last but not the least, the prime stakeholder is the family. Family values have to be revived and re-focused and re-strategized in the Naga society. The vicious cycle of all anti-social elements, social evils and this dreaded HIV more or less is directly linked to the family upbringing and family environment that nurtured the kids. 

Another very important stakeholder is the Church. Church ministries need to prepare in-depth and strategize and gear up to focus deeper for real time spiritual counselling as well as teaching particularly to youths and children. Church needs to do more in spiritual investments such as Youth ministries, Children ministries and family ministries. Sexual immoralities, drug abuse and alcoholics are all spiritual things and evil things that can be directly countered and resisted by the church ministries and family ministry. Every effort should be pooled together to conduct internal researches so as to analyze why youths today are in the first place taking up risky and harmful life style and behaviors rather than choosing something positive, healthy life style and behaviors and more productive way of life. These are the things for which resources are worth investing.

Third and most indispensable stake holder of any state’s health affairs is naturally the Government of the state. Be it of normal situations or for emergencies, be it state health affairs or central flagship programs such as NACO or NHM or any other vertical programs. All execution as well as effective implementations of any given health programs are by default accountable to state government only. State government are expected to own the responsibility for the welfare of the citizens of the state. All the government machineries (law enforcing agencies included) are to ensure smooth functioning and flawless implementation of all health programs in the state and do away all the protocol’s bottle-necking system that might cause hurdles or failure of program implementation. Government is also expected to look into the factors that are creating un-healthy vicious cycle in the society and address systematically. All roots causes or triggering factors need to be plugged out from its point of sources. All the possible reasons for disease spread should be deliberated thoroughly and addressed firmly and deal accordingly in steady and consistent manner. All the stop gaps are expected to be taken care by the government.

Another concern and known reason of rise of HIV prevalence rate in our state points directly and is naturally linking to open unrestricted alcohol abuses and drugs abuses in the Naga society which in turn connects with all kind of crimes and social evils activities such as sexual immoralities and injecting drugs being indulged mainly by the educated youths out of desperation mostly. Latest observations through index testing (snowballing study to contact tracing of the partners of HIV positive individuals), it is found that there are some pockets in the high placed society where tracing partners are not possible to access, to cut the story short. State government are expected to enforce firmly about the HIV/AIDS prevention acts or under pandemic prevention acts for all kind of defaulters of the act, big or small to be accounted as criminal so as to ensure that all responsible HIV positive individuals don’t hide or deny their status anymore so that potential reservoir of epidemic issue is checked before it is too late. Let the wisdom prevail in our society and together we’ll achieve the very pressing urgent call for the elimination of HIV/AIDS from our state and be a model state for all others to follow our footstep. Let the history be only repeated for the right reason. 

(Concluded)

Dr. Nitovi Shikhu, Nagaland AIDS Control Society, 

Kohima: Nagaland

 

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