Denied rights and treatment, HIV patients still fight stigma

On October 5, a 27-year-old HIV positive woman hanged herself from a pipe in Hyderabad’s Osmania General Hospital after being denied admission, which is given free under India’s National AIDS Control Programme (NACO).

In another incident last month, doctors declared a 24-year-old pregnant woman admitted to Tikamgarh district hospital in Madhya Pradesh a ‘human bomb’ after she tested positive for HIV, the virus that causes AIDS.

The confidential pathology report was leaked by the lab technician, and within hours, everybody from the doctor to the nurse and the ward boy refused to treat her. She finally delivered twins, who died within 30 minutes of birth, unattended on the ward floor.

Following media reports, a staff nurse and the lab technician were suspended and a show-cause notice was issued to the civil surgeon.

“It’s really unfortunate that doctors and supporting staff shy away from their duties. We will ensure that incidents like Tikamgarh are not repeated. Hospitals are provided enough resources for treatment, such as protection gear,” said Pallavi Jain Govil, health mission commissioner, Madhya Pradesh.

But providing protective gear is clearly not enough. “We have a (monitoring) committee in every district headed by the district collector but I haven’t noticed a proactive behaviour by anybody, including hospital administration, on how to train staff to treat people living with HIV,” said Madhya Pradesh AIDS control society joint director Savita Thakur.

Deja vu

Free counselling, testing and treatment has helped India lower new infections to 80,000 a year, which have stabilised HIV numbers at 2.1 million, shows UNAIDS Report 2016, yet ignorance around this once feared infection persists.

Over the past three years, at least a dozen people living with HIV have been denied treatment at government hospitals in Madhya Pradesh, and hundreds more across the country.

In Uttar Pradesh’s Bareilly district last year, an HIV positive woman delivered a stillborn after a hospital in neighbouring Badaun refused to treat her because she didn’t have Rs 2,000 to buy gloves for the hospital staff.

Discrimination in both government and private health centres and hospitals is rife across states, say people living with HIV and AIDS (PLHA). “Paramedics and nursing staff and in some cases even doctors often refuse to take care of HIV+ patients,” said Swapan Mallick (name changed), who has HIV and works with Bengal Network of PLHAs.

Sensitisation affects quality, which varies widely across government hospitals in the same city, with those with NACO’s voluntary counselling and testing centres (VCTC) usually better equipped to treat PLHAs.

“For example, even within Kolkata, patients feel at ease in N R S Medical College and Hospital that has a VCTC centre, but face stigma from a section of nursing staffs and paramedical staff in other teaching hospitals like R G Kar Medical College and National Medical College,” said Kallol Ghosh, founder-director of OFFER, an NGO that works with children with HIV.

Legal situation

In April this year, the Parliament passed the HIV and AIDS (Prevention and Control) Bill, 2017, that guarantees equal rights in medical treatment, admission to educational institutions and jobs to people living with HIV/AIDS, but the Act is yet to be notified.

If an HIV positive patient is refused treatment at a government health facility, then the patient can move court, but the same doesn’t hold true for private hospitals till the Act is notified.

“Under Aarticle 14 of the Constitution people have right to equality and health, and the person can move court if treatment is refused in a government hospital,” said Raman Chawla, lawyer and HIV-activist.

“Nothing much can be done if a private hospital refuses treatment, till the HIV law comes into force. Once the law is implemented, it will also cover private health facilities,” said Chawla.

“Rules and regulations are to be drafted before it gets notified. The process is on,” said a senior Union health ministry official, who did not want to be named.

Filing complaints is a must. In the case of the Telangana woman hanging herself, for example, the sister told the media that the woman was denied hospital admission but did not file a police complaint. Police registered a case under Section 174 of the CrPC (suspicious death).

The hospital has denied the charge. “There is no question of denying treatment to the patient, even if a person is in advanced stage of HIV infection. The investigation will reveal the truth,” said Osmania General Hospital superintendent Dr GVS Murthy.

But errant doctors seem to be a step ahead. An officer in MP State AIDS Control Society who looks into complaints against doctors and para-medical staff said on the condition of anonymity, “I have seen that doctors prepare their reports so smartly that it’s difficult to fix responsibility on them.”

Along with the law, what are needed are sensitisation workshops for medical staff. “Instead of mass media campaigns, what is needed is intensive sensitisation campaign among health professionals in government hospitals,’ said Mallik.

(With inputs from Snigdhendu Bhattacharya in Kolkata and Srinivasa Rao Apparasu in Hyderabad)