Aids Spreads

There is a steady growth in the number of HIV Positive people in the State

By Alexandre M Barbosa

In June, a youth who learnt that the Human Immuno-deficiency Virus (HIV) was coursing through his blood decided that the best way out was death and committed suicide. Despite the big strides taken in enlightening society about the Acquired Immuno Deficiency Syndrome (AIDS) and the availability of pre-test and post-test counseling, cases such as this do take place even today. The shattering discovery that within one’s body lives a life-threatening incurable virus, can drive many to take the extreme step of killing oneself. Though one can lead a normal life with HIV, at times even 20 years, for many living with the fact that one is a victim of HIV could be torturous. Yet there are many who do accept this and pushing it to the back of their minds carry on as normal a life as possible.

Seven years back the World Health Organisation had estimated that by the beginning of the year 2000, Goa would have 8000 cases of HIV positives. This appears to have been grossly underestimated, as the current WHO estimate of HIV positives living in Goa is 15,000. This is rather alarming as it accounts for one percent of the total population of the State and if the estimates are correct, then on an average three to four people in Goa get infected everyday by the virus. For a non-contagious virus that first surfaced in Goa in 1987 when two German tourists tested positive to HIV, its infection rate is high.

As per figures available with the Department of Health’s Goa State AIDS Control Society (GSACS), 3110 individuals (upto May 31, 2000) have tested positive to HIV in Goa since 1987. Also according to them, 74 of these have expired. Both these figures are highly unreliable as both are culled only from those individuals who have tested positive from the tests conducted by the department of microbiology of the Goa Medical College and deaths in government hospitals. Individuals who have had tests at private pathological labs are not included as the labs are under no obligation to report their findings to the GSACS.

Examine this with figures available with Positive People, an NGO working in the field of AIDS. Since inception, they have counseled 477 individuals, of which 297 are still in touch with Positive People and 110 have backed out along the way. From among their cases, those who regularly visited the clinic for counseling and not counting those who have backed out, there have been 70 who have expired. Enumerating deaths due to AIDS related conditions is difficult. Few doctors, if any, in private practice will write AIDS against the column cause of death on their patient’s death certificate. For one the social stigma attached to the illness will reflect on the family and two nobody dies of AIDS, but of other illness, even minor ones, which the body is no longer capable of fighting due to the HIV virus in it.

It makes little sense to rely on figures where HIV and AIDS is concerned, as the estimates are just that – estimates – and there is no manner in which these can be confirmed. And statistics available are incomplete. For instance, the WHO has put the HIV figure in India at 4.1 million, but the National AIDS Control Organisation (NACO) can statistically prove just 0.1 million, 41 times less then the estimate. Yet statistics here can help in planning ahead for curbing the growth rate and Dr Prakash Nadkarni, director of GSACS, is of the opinion that the effort of the Society have helped in bringing down the rate of infection in the State.

Though the number of individuals who have tested positive to HIV has been going up every year since 1987, the percentage of those screened to those found infected by HIV has seen a drop in the last two years and the trend appears to hold good for this year too (see infection and growth graphs). “The rate of infection has come down. This means that our efforts have worked. If we had not created awareness about HIV and AIDS, then the rate of infection would have been even higher,” assesses Dr Nadkarni from the figures he provides. Goa has screened above five per cent of its population for HIV, which is the highest in India. And though one per cent have been found positive, this is not an indicator for the entire State as those screened are from the high category risk.

The main efforts of GSACS is towards educating on HIV and AIDS. That AIDS is preventable, not curable is the message that GSACS is desperately trying to get across. The society has concentrated its efforts on the high risk category groups that are the sex workers, truck drivers and tourism industry workers. Concerted efforts at Goa’s infamous red light area at Baina have paid dividends, as almost 85 to 90 per cent of the sex workers there now insist that their clients use condoms. “Though the girls insist, sometimes the gharwalis (madams) overrule them and force them to avoid condoms, but even then the number of those using condoms today is much higher than some years back. When we undertake free distribution drives of condoms there, they come to us and ask for it, when earlier they would not even accept them if given to them,” says Nadkarni.

GSACS pays more attention to the sex workers as it has been found that sexual contact is the main channel of transmitting the virus in Goa. Stringent measures on blood donation and transfusions have shut this route of transmitting the virus. Though the ELISA test done here in Goa on donor blood searches for antibodies created to fight the virus and these may take upto three months to appear, contaminated blood is almost ruled out as a means of transmission of HIV in the State. Similarly, the use of disposable syringes and mandatory sterilisation of intravenous needles has blocked this channel too. Despite the practice among drug users who share syringes without proper precautions, the number of those contracting HIV through this route is negligible. This leaves open two routes – sexual contact and an infected mother passing the virus to the child.

It is believed that today 95 per cent of HIV positive individuals contracted the virus through sexual contact. Another big percentage is from mother to child. It is disheartening to note that from among the known cases, there are 55 children in the age group of 0-5 who are HIV positive and 13 more in the age group of 6-15. Almost all these would have acquired the virus through infected mothers. Even a child breast fed by an infected mother is at risk to contracting the virus. Majority of the cases – 87 percent are in the age group of 16 to 45, with those in the age of 26 to 35 accounting for 44 per cent of the total. Somehow the youth has been the most vulnerable lot and 503 individuals between the ages of 16 to 25 have contracted the virus.

The campaign against AIDS in the State relies on education and surveying people in the high risk category. GSACS is now ably supported by NGOs in this. There are at the present moment seven NGOs working in the field, two are in Baina, one is working among the migrant population in Margao, one with tourism workers, one in counseling and two in a more general kind of way. NGO aid was called for only beginning last November and the on going projects will be completed this October, when they will be reviewed. However, based on periodic reports sent by the NGOs to GSACS, Mariatte Correa, NGO advisor to GSACS says that the experiment in involving the NGOs is paying dividends.

The major player among the NGOs is Positive People, the brainchild of Domnic de Souza, himself HIV positive who expired of AIDS related symptoms. The NGO has been doing a lot of good work in the field with HIV positive victims. Under a project financed by GSACS, Positive People has placed counselors in all the major government hospitals in the State. Under the programme, if the doctor suspects HIV and sends a patient for the ELISA test, the patient has to agree to the test and has to undergo pretest counseling. If the result of the test is positive, then again the counselors of Positive People come into the picture with post test counseling. Says Elizabeth Sivakumar, executive director of Positive People, “A lot of rapport is built between our counselors and the patient. They find that there are people who are supportive of them.” Realising this, HIV positive individuals who frequented the offices of Positive People in Panjim have now themselves started a self-help group called Goan Community of Positive Persons. 

There is, however, much remaining to be done for AIDS victims. A relative of a victim who passed away some months backs tells of how his family member was left in the GMC with the workers even refusing to sweep the room where he was. “I went to so many NGOs and asked if they could direct me to any institution that cared for such cases in their final stages. Nobody could help me, each NGO and the GSACS claimed that they had a specific duty only. In the end another friend, who is HIV positive himself offered to help at the hospital.”

Most HIV positive individuals will tell of being socially ostracized. There is sympathy for HIV victims, but when it comes to actually relating to one on a social basis, even educated persons will hesitate to shake hands with a known HIV positive person. 

As the virus spreads in the State – Goa is 7^th State wise for prevalance of HIV in the country – the rural areas have now turned susceptible to the virus. Mormugao still has the highest incidence of HIV, but all eleven talukas now have the dubious distinction of housing HIV positive individuals and the virus is spreading