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HIV NUTRITION UPDATE
VOLUME 9, ISSUE 3
HIV Nutrition Crisis in New Delhi

 

(Continued from page 3)
HIV nutritional services including the most basic education on nutrients and food safety are a rarity in New Delhi despite the dire need for them. A few organizations are doing a limited job of providing food to some of the patients. In this area of the world, patients have so many needs that it is impossible for physicians to meet them all. Basic survival needs such as securing access to safe water and meager amounts of basic foods take priority and quite often are a challenge to fulfill.

Formal nutrition assessment is usually not done but advice on proper nutrition is often given. Hand washing before eating is emphasized. Despite recent data on the important role of micronutrients, few patients actually secure prescriptions for them. Current economic and political conditions in New Delhi make it literally impossible for patients to secure adequate HIV-specific nutritional services.
 
There are few doctors in New Delhi willing to treat HIV infected patients. Many private and government laboratories perform the ELISA test but CD4 T-cell testing is done only in a couple of laboratories in Delhi. Western Blot and viral load tests are completed at a few laboratories across the country and cost a lot by Indian standards. In many cases physicians in India are happy to accept a positive ELISA report done twice (by different kits) as confirmatory evidence of a positive HIV status. Viral load testing is often not done or done only about once every 1-2 years. Antiretroviral resistance tests have begun to be done only recently. A combination of two nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor (NNRTI) is the most common prescription. Zidovudine, Lamivudine and Nevirapine are available as a combination pill. Efavirenz is often used especially since many patients have co-existent TB. Many doctors are not aware of the fact that drugs for post exposure prophylaxis or prevention of vertical TB are available.

There is some concern that the new patent laws will make medicines more expensive. A few pharmaceutical companies in India are making antiretrovirals at more reasonable rates. A combination of Stavudine, Lamivudine and Nevirapine can be bought for about $30 per month in New Delhi.

 

 
 


 
"There are few doctors in New Delhi willing to treat HIV infected patients."

 

 
 
 

 
The Prime Minister is now the head of the Nation Council on AIDS, the highest policy making body in India. The fact that the Delhi State government has decided to distribute free antiretrovirals is commendable for a resource poor country. What is important, however, is that free distribution of just antiretrovirals is not going to make that much of a difference for people with HIV. There is widespread skepticism that the program may not be sustained and many doctors do not even understand the full meaning of HIV disease. Considering the magnitude of the problem, it is imperative to educate the entire medical community starting with the simple message that "HIV is treatable". Countrywide doctor education is necessary and has to be more of a priority than it is now. There are many funding agencies including those from the U.S. but these funds are very often not used appropriately. The problems can not be tackled by charity. Delhi needs to make some major policy decisions concerning HIV disease. There is optimism now, especially with the Prime Minister directly heading the Nation Council.
 
 
(Forward to page 5)

 


 
 
 
 
 
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2/15/2005