HEALTH-INDIA: Anti-HIV Therapy Available, But Not Antenatal Care

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Mar 20 2002 (IPS) - Pregnant women in India may access anti-HIV therapy better than plain antenatal care, under a programme now being put in place at government hospitals across the country.

The programme, recently launched by the National AIDS Control Organisation (NACO), is aimed at Prevention of Mother to Child Transmission (PMTCT) of HIV by getting to expectant mothers.

According to NACO’s director J V Prasada Rao, the PMTCT programme using azidothymidine (AZT) or Nevirapine will be available nationally by the end of 2002 with support from the United Nations Children’s Fund (UNICEF).

Rao said PMTCT will be more than an HIV prevention programme and will stand to provide badly needed counselling on reproductive health matters to women at government centres.

But in spite of NACO’s professed good intentions, voluntary organisations are suspicious of a programme that sticks out like a sore thumb in an atmosphere of neglect evidenced by the high rate of infant mortality — 69 per thousand births.

Organisations such as the AIDS Anti-Discrimination Movement (ABVA) and the Joint Action Council (JAC) have argued that PMTCT completely ignores emerging evidence of the high toxicity of the drugs they propose to use for the programme.

For example, Nevirapine as post-exposure prophylaxis for health care workers was recently withdrawn in the United States after reports of severe liver toxicity.

Results from AZT drug trials carried out in this country on pregnant women have already shown a high incidence of birth defects among surviving children. These included holes in the chest, malformed hearts and brains and progressive blindness.

One area of concern is that government methods of testing and follow-up of children born to mothers who have been administered these drugs fall far short of accepted international guidelines, said Purushottaman Mulloli, campaigner for the JAC.

“To measure transmission — even if that were possible with current tests — at birth and two months unfairly biases towards the finding of positive testing infants and the limited two-month follow up does not cover the medical attention necessary to monitor infants for possible side effects they might have suffered,” Mulloli said.

For its part, NACO is satisified with the results of a pilot study conducted at the gynaecology and obstetric departments of 11 major medical institutions scattered across the country with the specific purpose of assessing the feasibility of administering AZT.

The pilot study, which completed one year in March 2001, established that administering short-term AZT intervention was a cost-effective PMTCT intervention and recommended that all of India’s 600 districts be covered in a phased manner.

But of the 751 women who accepted AZT, only 658 could be monitored and that alone, says Anju Singh of JAC, speaks volumes for the government’s thoroughness in an area which demands great care in administration and follow-up.

But NACO’s Rao estimates that an estimated six to seven million mothers could be covered in a year under the programme.

Of the some 25 million pregnancies a year, six to seven million are delivered at government hospitals and the majority of these are reckoned by NACO to be poor and vulnerable to HIV.

Questions such as who will bear the cost of expensive caesarian births and substitutes for breastfeeding, which are both discouraged to prevent mother-to-child transmission of HIV, remain unanswered.

Singh and Mulloli have also raised questions about the inadequate publicity given to the programme and point out that NACO literature does not even use the term “side effects” in its report on the use of AZT. Details on the Nevirapine trials are not being made available to voluntary agencies, they alleged.

“Given the state of India’s health care infrastructure and the high illiteracy levels of the patients, it is almost certain that these women are not going to get the required attention, guidance and care that add up to informed choice,” Singh said.

She said even within the far more capable medical and counselling infrastructure in Thailand, which served as a model for the PMTCT programme in India, 82 percent of seropositive women suffered major emotional and relationship problems.

“The situation in India is that asking a woman not to breastfeed her child is enough to create sever social and psychological problems, let alone depriving the child a chance at gaining natural immunity,” she said.

Singh and Mulloli alleged at a recent public discussion that programmes such as the PMTCT are actually a ploy by drug companies to get developing countries to pick up, even at reduced prices, medicines which are being junked in the West.

“This is nothing but genocidal dumping of failing medications on the world’s poor, which will have the bonus of gaining human guinea pigs for the new crop of untried and untested AIDS drugs,” they alleged.