INDIA: People with HIV Get Dose of Discrimination from Hospitals

by Ranjit Devraj

NEW DELHI, Dec 1 (IPS) - Lalitha's pregnancy was cause for joy in the affluent Arora family, which quickly resolved to get her the best private pre-natal care that money could buy in India's capital.

The obstetrician at the large and well-appointed private nursing home, located in the middle of a posh residential area, was charm itself. That is, until she informed the Aroras that 'routine' blood tests carried out on Lalitha (not her real name) showed her positive for HIV.

''She told me that they simply did not have staff suitably trained to take on an HIV-infected person,'' recalled Lalitha, who in June gave birth to a healthy baby boy at her residence with the assistance of a medically qualified cousin.

''I wanted to sue the nursing home but was dissuaded by other members of the family because of the stigma involved,'' said Lalitha's father, an influential businessman who confessed to feeling helpless for once in his successful life.

''All kinds of questions popped up. How did she contract the virus? Was my son-in-law infected?'' he said. In the end, the Aroras did nothing and did not even care to go in for further tests. ''Let the gods have their way,'' Lalitha's father said resignedly.

Even the knowledge that private nursing homes are not legally allowed to test for HIV without a patient's consent, let alone refuse treatment or care, was of no help.

''There is very little regulation on private nursing homes, which make a killing because government facilities are badly overcrowded,'' said Lalitha's father, asking not to be named.

But chances are that Lalitha would have been rejected even by the government hospitals. Earlier this month, the Delhi High Court issued notice to the prestigious All-India Institute of Medical Sciences (AIIMS) and other major government-run medical facilities to ensure that HIV-positive patients are not denied treatment.

Taking notice of newspaper reports of yet another HIV-positive patient being refused treatment, the court ruled: ''Prima facie we come to the conclusion that the manner in which the patient had been treated on the grounds that he was HIV-positive amounts to violation of human rights as well as fundamental rights guaranteed in the Constitution.''

Raj Bahadur, a government employee, had knocked on the doors of several hospitals to seek continued treatment for urinary blockage. But after blood tests showed that he was HIV-positive, Bahadur was thrown out of St. Stephen's hospital in August, with a catheter sticking out of his side to drain out urine.

''They told us they did not have the facilities to handle his case,'' said Bahadur's wife Raj Kumari.

It took the personal intervention of Delhi's Health Minister A K Walia before Bahadur, his surgical wounds oozing pus, was admitted to the LNJP hospital, a major government hospital, on Nov 12.

Bahadur was lucky because his case received massive newspaper publicity at a time when Microsoft Corp's philanthropist chairman, Bill Gates, was in town with a 100 million U.S. dollar cheque for anti-HIV/AIDS projects.

Unlike Lalitha and the Arora family, Bahadur and his wife had no problem being identified by name. ''If it were not for publicity he may have been dead by now. We just don't want anyone else to go through what we experienced,'' Raj Kumari said.

Hundreds of other cases of rejection by hospitals go unnoticed. A handful end up at the all too few hospices in the capital -- themselves at the receiving end of prejudice and hostility from local residents.

Said Richard Francis, a volunteer at Michael's Care Home, a 35-bed hospice for HIV/AIDS sufferers: ''There are problemsà people don't take kindly to the idea of living near a hospice like this.''

But Francis says attitudes are improving, though far more slowly than the rate at which the virus was reported to be spreading. By conservative estimates, India could have 10 million people living with HIV by 2010 compared to the four million it is estimated to have at present.

Anjali Gopalan, who runs the voluntary agency Naz Foundation (India), whose 12-bed care centre was honoured with a visit by Gates on Nov. 12, said the facility faced resistance from neighbours who for instance boycotted the washerman who did their linen.

Those living in the centre have taken to washing and ironing their own linen because the neighbours fear that the virus could spread through the washerman's hot iron.

Such ignorance is not confined to lay people -- even medically trained professionals seem to have a need for specialised instruction on the handling and care of people with HIV.

At an April meeting,. a group of leading volunteer agencies including CEHAT (health), the Association of Medical Consultants, the Forum for Medical Ethics and Women's Centre called for amendments to laws that govern to private nursing homes and hospitals in order to make it difficult to reject HIV-positive people.

But the group also recognised the need for the government to conduct courses on the care of HIV-positive people for different types of medical care workers, ranging form doctors to attendants. These courses, the participants agreed, should include social aspects, universal precautions and the basic duty of doctors and other professionals to people living with HIV.

Said Samiran Nundy, former head of gastrointestinal surgery at the AIIMS: ''Doctors should know better and it is terrible that they reject HIV-positive patients especially when they know that ordinary precautions are sufficient.''

Nundy says doctors are in fact at far greater risk of contracting Hepatitis-B than HIV in India, but seem generally unaware of this fact.

''In any case, rejecting a patient is completely unethical and goes against the oath of Hippocrates if not the laws of the country,'' Nundy said. ''Doctors who do that should have their licenses cancelled as also nursing homes.''