Pregnant but HIV positive

 The other day I received a call from a Gynaecologist of a nearby Hospital.


'I have an ante-natal [pregnancy] patient who is HIV positive. Should I send her to you now or after delivery?'

The doctor was asking me.

I was happy that she called to inform me, but was disappointed with her question. I had spend some effort as an HIV/AIDS trainer to make doctors aware that pregnant women need anti-HIV treatment to prevent the birth of a 'positive' child. I am not sure whether the above-mentioned doctor attended the training, but I expected her to know the importance of ART [anti HIV treatment] in pregnancy.

'You should send her to me immediately. She needs treatment to prevent the birth of a 'positive' child.' I replied.

The next day the patient came with her husband. I explained the situation to them in detail and asked them to attend the Govt ART center as early as possible. I telephoned the ART Medical Officer about this patient and fixed a suitable time for the patient to reach the center.

That lady will get the treatment, which will greatly reduce the chance of the birth of a 'positive' child from about 40% to less than 5%.

All pregnant females should be tested for HIV and if found positive should immediately receive treatment so that we can eliminate the chance of birth an HIV positive child

A very 'Positive' news from Pakistan

Cricket is the national sport in Pakistan as it is in India, but what makes the First Positive Cricket Team stand out from all the other Karachi-based clubs is that its members are all HIV positive.


The team was put together a year ago by the Pakistan Society, an NGO working for the rights of people living with HIV. They played -- and won -- their first match in August, and haven't looked back.

Dr. Saleem Azam, president of the Pakistan Society, told CNN, "Every time they play the players have a boost physically, emotionally and psychologically, and they feel a lot better."

Azam says that there is a considerable stigma in Pakistan surrounding HIV/AIDS and he hopes the team can help combat discrimination towards HIV sufferers.

"People assume the team must be very sick-looking, like walking skeletons, but when they see them playing and winning matches they have to think again," said Azam.

"We've given them a very strong message that having HIV does not mean you must retire from life and become helpless. You can have HIV and live a very happy life if you take your antiretroviral treatment regularly.
 When the team won handsomely, leaving their opponents and the fans amazed that HIV-positive players could be so active - one of the team members was asked whether antiretroviral medication was also a form of performance-enhancing drugs.



"The stigma is the worst consequence of this illness, so it will be the greatest service to people with HIV if we are able to help them overcome this stigma. The change is coming, but it's very, very slow."

While changing attitudes takes time, Azam says the team has already built bridges between the players and their estranged families. He told CNN that some players who had been ostracized by their families were now back in contact with them, with one family requesting to travel to matches with the team.




First Positive has already played a match in Hyderabad, about 200 km (125 miles) from Karachi, and next month they will take to the road for two more matches, which will see them spread their message elsewhere in the country.

"This is how the team will be known the country over," said Azam.

"People will come to know more and more about the team, and I hope eventually they will be successful in combating this stigma and discrimination."

Abdul Lateef is captain of the FPCT. He contracted HIV six years ago and told CNN that the team is helping to change others' attitudes towards people with HIV.

"We are reaching the minds of the people," he said.

"Everybody thinks there are things that HIV positive people cannot do. We have shown we can play and we have proved to everybody we can do anything they can do."

We are thankful that the authorities were so cooperative with us, and provided us with the space that was needed for the match without any discriminatory attitude. Rather, their attitude was positive and encouraging," said Azhar Hussain Magsi, a manager at the Pakistan Society.


"More matches are scheduled to take place all over Pakistan in the coming weeks ... We are also having talks with other NGOs in India, and look forward to having an international HIV-positive cricket match.

Having personally witnessed the wonders that anti retro viral therapy can produce in many patients, I cannot think a better way of illustrating the fact that HIV/AIDS is treatable and HIV positive patients are as human as we all are than the site of a 'Positive' cricket team winning a match against the 'negative' team on the cricket field.


An India-Pakistan cricket match between HIV positive players!!!

That will be a great event.

adapted from
CNN
AIDS Portal

What is the cause of his respiratory distress?

                     He was admitted sometime late in the night. The doctor on night duty had called me and told me about this patient. He said that a patient with no history of asthma has come with severe respiratory difficulty. The pulse oximeter showed unusually low value of oxygen level in blood. ECG showed only an increased heart rate and X-ray Chest was hazy on either side.


" Sir, What could it be?"

'Let the blood results come and let me see the patient in the morning”. I replied.



The patient was 46 years old, working in one of the Metro Cities. He came to his hometown here 5 days ago. He was having cough and breathing difficulty for about 2 weeks now and was getting some treatment with mild relief. There was on and off fever and severe fatigue. He was suffering from Diabetes for last 2 years, but not on any regular medication nor was doing frequent blood sugar tests. He had lost weight considerably in last few months.

His clinical examination showed white patches on his tongue with chest showing features of pneumonia. With Oxygen administration in high pressure he was much better than the time of admission.

His blood sugar was high and Liver function Tests were slightly deranged. The WBC count was low with lymphocytes predominating suggesting a non-bacterial cause for pneumonia..X ray Chest showed ground glass like haziness.



What is this?.............

Sub acute onset of illness, severe breathlessness and low Oxygen level, fungal patch on the tongue, low WBC count, ground glass haziness on Chest X ray............

Yes, I want to test his HIV status.

He has features of Pneumocystis Pneumonia, caused by a fungus found in patients with very low level of immunity, mostly HIV positive patients.

Patient was drowsy and was not in a state to give his consent for the test. I talked to his wife and got an oral consent. Did she want to say something? Or was I imagining?



The rapid test for HIV antibody was positive. I called the wife again and told her about the result. Then she told me everything. Yes they know he was 'positive’. She was also 'positive' too. He was seriously ill 2 years ago and was found to 'positive'. He took medications for about a year and was much better. Against doctor's advice he suddenly stopped the Anti retro-viral medicines and started some alternative system of medicine with the hope [that someone gave him] that he will be completely cured. He slowly became ill again and is now in this state.



I have heard this story many times. Modern medicine being based on scientific evidence based medicine will not claim cure for conditions, which has no cure. But most of the illnesses can be well controlled with continuous medications. This is true not only for HIV/AIDS but also for other chronic illnesses like Diabetes, Hypertension, Coronary Heart Disease etc.

After taking modern medicine treatment for some time many people try to experiment other systems of medicines/practitioners because they falsely claim complete cure. Finally after worsening of their condition and realizing there is no permanent cure they come back to modern medicine. By this time much damage to the body would have been incurred.



He is critically ill now. If he had continued on medicines advised for him under modern medicine treatment he would not have been fighting for his life like this.

Who should be blamed here?

Discrimination against 'positive' persons.Another shocking story

Authorities at the Guru Govind Singh Government Hospital in Jamnagar,Gujarat,India labelled a 25-year-old pregnant woman as ‘HIV positive’ with a sticker on her forehead and paraded her in the hospital in the presence of her six-month-old daughter and mother-in-law, on Saturday June 20, 2009.

Yes, news report of yet another inhuman and cruel discrimination against HIV positive persons. This is depressing reading. I watched the news report in NDTV too and was shocked to see the video clip showing the woman's full face.How can the TV channels be so in-sensitive!!!

I had posted about stigma and discrimination against HIV positive persons before, especially about that I encountered in my clinical practise. Read some of them here.

Why there is Stigma and Discrimination against HIV positive persons?

1. Fear of contagion,ie the irrational fear that going near a 'positive' person will make you 'positive'.

2.HIV/AIDS is still considered by many as a death warrant.

3. Being 'positive' is considered 'immoral' by many people.It is considered to be a result of sins committed or due to Personal irresponsibility and deserve to be punished.

4, Many believe that HIV positive persons are vengeful and try their best to transmit the disease.

Why there should not be any Stigma or discrimination against HIV positive persons?

1. HIV is not transmitted from person to person by social or even intimate contacts. Read here how HIV is not transmitted.

2.HIV/AIDS is not a Death Warrant. It is a chronic manageable disease like Diabetes and Hypertension.

3. HIV/AIDS is just like any other disease.There is nothing immoral about it.More than 70 percent of positive persons in the World are those who never had sex outside marriage and had never abused IV drugs.

4. Discrimination against HIV positive persons will increase the transmission of the virus and epidemic will explode further. Seeing the discrimination in the Society a 'positive' person [who fears he/she is positive but has not tested] will be reluctant to test for HIV. They will continue to transmit the disease. If one knows he/she is 'positive' they will not reveal it, fearing stigma.Thus they will not get counselling and treatment which will reduce transmission. A pregnant 'positive' woman,like the one who was discriminated in Jamnagar should take medicines to prevent transmission of the virus to her child. Stigma will prevent her doing that and she may get a 'positive' child.

I can add on many more points,but the message remains the same.

A society that discriminates against HIV positive persons is fuelling the epidemic in its midst.

"I cannot tell this to my wife doctor".

" I cannot tell this to my wife doctor.She will explode and may even take her own life".
A 43 year old man was telling this to me in my clinic.
He is HIV positive.He know about this for last 3 years.
I was asking him if he had tested his wife for HIV.
No he had not tested his wife.He had not told his wife yet. He is working in a far away place and visits his family only occasionally.

Are you using condom when you are with your wife? I asked.
'No' was his answer.

I did not know what to say.I had seen him 3 years ago when he was first found 'positive'.I had given a detailed lecture to him about what to do and what not to do.I had asked him to tell his wife about his 'positive' state.I had stressed on use of Condoms.
He had neither told his wife nor used condoms while having sex with her.

I was angry. "I can't treat you if you do not follow my advise". I threw his papers on the table. He and his friend who accompanied him started pleading.

" I cannot tell this to my wife doctor.She will explode and may even take her own life".

"What are you doing? You are now giving her infection and killing her.And you still say you are afraid she will commit suicide?"
I cannot ethically decline treating him. So what should I do?

I was confused. His CD4 cell counts are low and he should be started on ART. He is so afraid of stigma and discrimination that he is not willing to go to Government ART centre.

There is a law that says the doctor have to reveal the result to the spouse if she/he asks. I told him about it. From his face I could make out that he is mentally resolving never to bring his wife to me.

I had an idea.I should make him realise that telling his wife and testing her is also important for his health.

"I have to start you on anti viral medicines now.With in few months the number of viruses in your body will become very small.But if your wife is positive and you are having sex with her without condom the viral load will not decrease as your wife will transmit the virus to you."

He was confused first, I explained again to make him understand. Slowly he realised that it is important for his health that his wife is tested and given treatment if needed.Also the fact that having unsafe sex is unsafe not only for his wife but also for him.

He agreed to take his wife for testing. I gave prescription for 2 weeks and asked him to come back with the result of his wife's test. Will he do as I advised? I do not know.
But what a selfish man?

It seemed they all wanted her to die.Part 3

Yes, they all wanted her to die,may be even myself.And she died.
The girl I mentioned in 2 of my earlier posts [November,December]died few days ago. Not seeing her come for review for last 2 months, I called the cell number I had obtained from Hospital records again.The person who answered immediately gave it to the girl's mother.
Why you are not bringing her to me?How is she? I asked in an accusing tone.
She is no more,died few days ago', was the matter of fact reply.
I was shocked.
' Did you take her to any doctor?'
'No, She was better with your medicines'.
'Did she die in a hospital or home?'
'She died at home'.
I held the line for a few seconds not knowing what to do.Then I disconnected.
Sense of depression engulfed me.And guilt.May be I should have been more pro-active.Should have telephoned that number more regularly and threatened them of action if they did not bring the girl to me.Or I should have asked one of my acquaintance in the District Positive network[an NGO of Positive ppl] to go and find out where she lived and try to interact with the family.
I hid an important fact in my first posting about that girl.The fact was her father died few years ago due to HIV/AIDS and she might have been a victim of incestuous relationship[.Her mother was negative.]This was one of the most important factor that made her family want her to die.For them her death means an end to their humiliating secret.
She was severely ill,with her CD 4 count 20[indicating very advanced AIDS] at the time of diagnosis.Still with proper care there was a 40/60 or on the pessimistic side 20/80 chance that she will recover.
But they never wanted her to recover.Should I blame them? For them she was a dirty stain on the family,someone they wanted to forget fast.
May be I should have been able to ask some NGOs to take her under their wings.Take her out of the house where she is not wanted.If she was an orphan I might have done that before discharge from the hospital.But she was not an Orphan.She had a mother,sister and brother, and Uncles.
I wish she was an Orphan.Then she might have survived.

It seemed they all wanted her to die -Part 2

You may remember the post with above title few days ago.As a follow up I have both good and bad news.
Good news first.
The 'Positive' girl slowly improved. I took her out of ICU after 4 days and by 6th day she was insisting on going home. But she was very weak and taking very little food. I delayed for a day and then discharged her giving a prescription for 7 days. Before discharge I had a long talk with her mother and one her uncles.I told them that she is still not out of danger.I told them the plan of treatment.I told them if we do all we can for her she can be saved.I reassured that there is no threat of any one of the family members getting infected.They listened to me seriously asking me to clarify if they could not understand.Over all I thought they are coping well and have a genuine interest in the welfare of the girl.I told them to come to the hospital with her on the 8 th day of discharge.

Now the bad news.

Now it is the 15th day of her discharge. They have not brought her to me on the 8th day as per my advise. What might be the reason? Had they taken her to another doctor? If it is so, it is OK.Had they lost interest in her and is not continuing the treatment? That is unpardonable negligence.Or ......had she died?
I don't know what to do. Should I try to trace her?

Questions and answers about HIV transmission

What are the main routes of HIV transmission?
These are the main ways in which someone can become infected with HIV:
1.Unprotected penetrative sex with someone who is infected.

2.Injection or transfusion of contaminated blood or blood products, donations of semen (artificial insemination), skin grafts or organ transplants taken from someone who is infected.

3.From a mother who is infected to her baby; this can occur during pregnancy, at birth and through breastfeeding.

4.Sharing unsterilised injection equipment that has previously been used by someone who is infected.

Can I become infected with HIV through normal social contact/activities such as shaking hands/toilet seats/swimming pools/sharing cutlery/kissing/sneezes and coughs?

No. HIV is not an airborne, water-borne or food-borne virus, and does not survive for very long outside the human body. Therefore ordinary social contact such as kissing, shaking hands, coughing and sharing cutlery does not result in the virus being passed from one person to another.
Can I become infected with HIV from needles on movie/cinema seats?

There have been a number of stories circulating via the Internet and e-mail, about people becoming infected from needles left on cinema seats and in coin return slots. These rumours appear to have no factual basis.
For HIV infection to take place in this way the needle would need to contain infected blood with a high level of infectious virus. If a person was then pricked with an infected needle, they could become infected, but there is still only a 0.4% chance of this happening.
Although discarded needles can transfer blood and blood-borne illnesses such as Hepatitis B, Hepatitis C and HIV, the risk of infection taking place in this way is extremely low.
There is a wide spread belief among 'negative' people that HIV positive persons will try deliberately to spread the disease.There is no factual basis for this belief.

Is there a risk of HIV transmission when having a tattoo, body piercing or visiting the barbers?
If instruments contaminated with blood are not sterilised between clients then there is a risk of HIV transmission. However, people who carry out body piercing or tattooing should follow procedures called 'universal precautions', which are designed to prevent the transmission of blood borne infections such as HIV and Hepatitis B.
When visiting the barbers there is no risk of infection unless the skin is cut and infected blood gets into the wound. Traditional 'cut-throat' razors used by barbers now have disposable blades, which should only be used once, thus eliminating the risk from blood-borne infections such as Hepatitis and HIV.

Am I at risk of becoming infected with HIV when visiting the doctor or dentist?
Transmission of HIV in a healthcare setting is extremely rare. All health professionals are required to follow infection control procedures when caring for any patient. These procedures are called universal precautions for infection control. They are designed to protect both patients and healthcare professionals from the transmission of blood-borne diseases such as Hepatitis B and HIV.

Can I get HIV from a mosquito?
No, it is not possible to get HIV from mosquitoes. When taking blood from someone, mosquitoes do not inject blood from any previous person. The only thing that a mosquito injects is saliva, which acts as a lubricant and enables it to feed more efficiently.

Can I become infected with HIV through biting?
Infection with HIV in this way is unusual. There have only been a couple of documented cases of HIV transmission resulting from biting. In these particular cases, severe tissue tearing and damage were reported in addition to the presence of blood.

Can HIV be transmitted outside of the body?
Whilst HIV may live for a short while outside of the body, HIV transmission has not been reported as a result of contact with spillages or small traces of blood, semen or other bodily fluids. This is partly because HIV dies quite quickly once exposed to the air, and also because spilled fluids would have to get into a person's bloodstream to infect them.
Scientists agree that HIV does not survive well in the environment, making the chance of environmental transmission remote. To obtain data on the survival of HIV, laboratory studies usually use artificially high concentrations of laboratory-grown virus. Although these concentrations of HIV can be kept alive for days or even weeks under controlled conditions, studies have shown that drying of these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within a few hours.
Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, the real risk of HIV infection from dried bodily fluids is probably close to zero.

Does circumcision protect against HIV?
There is very strong evidence showing that circumcised men are about half as likely as uncircumcised men to acquire HIV through heterosexual sex. However, circumcision does not make a man immune to HIV infection, it just means that it's less likely to happen. Male circumcision probably has little or no preventive benefit for women.

If I am taking antiretroviral drugs and have an 'undetectable' viral load, am I still infectious?
Even if your tests show that you have very low levels of HIV in your blood, the virus will not have been totally eradicated and you will still be capable of infecting others. Some drugs do not penetrate the genitals very well and so do not disable HIV as effectively there as they do in the blood. This means that while you may have little active virus showing up on blood tests, there may still be quite a lot of HIV in your semen or vaginal fluids. Transmission may be less likely when you have a low viral load, but it is still possible so you should always take appropriate precautions.
Courtesy- Avert.org
Click here if you want to know more

It seemed they all want her to die

She is 21 years old.She is my patient for the last few days.She is sick, really sick, probably spending her last days under my care.
The family is around her.Her widowed mother,her Uncles,her grand mother etc.They are taking care of her in the usual loving and caring way as any other family will do. But some how for me it seemed they all want her to die.

Why? Because she is an HIV positive person.After being treated for various illnesses symptomatically the real reason for her problem, her positive status was revealed only few days ago.She was immediately referred to the nearest Government facility treating such patients.
The family took her home instead.After 2 days her Uncles came to me.They wanted some treatment but did not want hospital admission.

'Let me first see her condition and decide I said.
They brought her soon.Her condition was really poor.I explained to the relatives. I told them it may be better to take her to a Higher centre with better facilities.They flatly refused. I realised then that I am her last hope.
It seemed they all wanted her to die.

I am trying my level best.But she may be fighting a losing battle.

The follow up of this patient can be read in my posts in December and January

How I got interested in HIV/AIDS?

In the late 1990s, I was working in a small [Government] Taluk Hopsital. HIV 'Positive' persons I saw in my practise were few and I was happy to refer them to higher centres.

Then I got transferred to a busy District Headquarters Hospital in 2001. There I could not escape dealing with 'positive' persons.
Every week the infectious disease ward will see a new 'positive' patient coming to die.
Most of them by then might have spend a fortune on magical remedies. The most infamous among them was the medicines of Fair Pharma from Kochi. For more detailed information about how one Majeed cheated poor patients and build the costliest house in Kerala click here. Now fortunately the 'medicine' is banned in Kerala by the Court after a longstanding legal battle with 'Positive' people and PUCL.

The patients in my hospital were given symptomatic treatment and left to die. Some come and die alone while the more lucky ones have a wife or mother to be with them during their last days.
I was depressed seeing all these deaths.
What can I do for them? I asked myself.
I had no experience in treating HIV/AIDS patients. In the medical college where I studied in early and mid 1990s, 'positive' persons were rarely seen. I knew a lot from the text books but practical knowledge was nil.
Those days the Government was giving lot of training in HIV/AIDS for doctors and other health care workers, but it was only about prevention.
HIV/AIDS is a death sentence. So train yourself and others how not to get it.
This was the message of such trainings. Nobody mentioned treatment. We were not trained to cope with these dying 'positive' patients.
In the developed world by the year 2000, more than 10 drugs were available effective in treating HIV/AIDS. Few were available in India too at that time. They were expensive and somewhat toxic but still they worked. And they were cheaper than the Fake medicines of Fair Pharma.
More over, HIV/AIDS patients need treatment for opportunistic infections that attack them as their immunity is low.
So when a 'positive' patient is sick, first we have to find out which opportunistic organism or organisms have infected him/her. Then give the proper treatment so that he/she becomes better. Later, ART [anti retro viral therapy] was started. Some time in severely sick patient we may have to start both treatments together.

Training myself in HIV/AIDS management, I started treating these patients in earnest. I procured medicines from drug companies directly and thus was able to give it to patients much below market rates. The stigma of buying such medicines from Drug Store was circumvented as I myself provided the medicines.

The results were dramatic. Patients in death bed about to say their final prayers were able to look after themselves with in months. Those who sticked on to the medication schedule for more than a year began working and earn for themselves.

I lost many patients too, but I tried my level best. Some came to me at a very late stage. Many could not continue the medicines because of the high cost of ART. Many by then had become social outcasts and committed suicide.

I urged other Physicians to take up the challenge of HIV. I conducted lectures in the IMA[Indian Medical Association]. I told them that it was ,we the modern medicine doctors, who are making the 'positive' persons go to Quacks like Majeed [Fair Pharma]. As we are not ready to take care of them, they are helpless. Unscrupulous persons squeeze out the last penny from them giving false hopes.

That made some difference. Few of my colleagues started taking up such cases.

By 2003-2004, things started changing in a positive direction for 'positives'. ART drugs became cheaper. India became one of the biggest manufacturer and exporter of cheap generic HIV drugs. Govt of India started giving ART drugs free of cost at selected centres. Kerala Government followed suit.
The emphasis in training of health care workers shifted from prevention to treatment. From a 'death sentence' HIV/AIDS became projected as a chronic manageable disease needing lifelong medication like Diabetes.

Now a 'Positive' person comes to my clinic every other day. Most of them are old patients coming for follow up. A newly detected 'positive' person is seen once or twice a month. Most of them are taking the free ART drugs from Medical Colleges. Some who can afford [and is afraid of perceived stigma at Govt centres] take medicines from me.
Deaths occur but only rarely.

I cherish the sight of happy faces and healthy bodies of all those positive persons. That sight make my life meaningful.

What to do if an HIV positive person comes to you for help?

This post is for all health care providers and Social workers in India.
You know an HIV positive person who needs medical help.What to do?
First thing you have to make sure is whether he/she is really 'positive'. Three positive rapid tests detecting antibody is considered confirmatory. These tests are done virtually free of cost at all major Government Hospitals. The person can go directly there to the testing centre and get tested.No need for a doctor to order the test.
If he/she do not want to test in a Government testing centre you can ask him/her to get tested in a good private lab. There the more costly Western Blot test is usually done to confirm the diagnosis.
If the diagnosis is confirmed the most important thing is to reassure the patient that HIV/AIDS is a treatable condition now and the treatment is available free of cost at ART Centres attached to certain major Hospitals. Before starting treatment few other blood tests also have to be done to assess the immune status and overall health of the patient.
It is important to note that all positive persons do not need treatment.If there are no illness and if the person's immunity status is good[meaning the CD4 count is more than 200], treatment is not started immediately.The person needs to follow up regularly to check his immune status.
What do you mean by Immune status?
It is a measure of the ability of the person's body to fight against infections. HIV virus slowly destroys the ability of the body to fight against infections.Such an immune compromised individual can get infections easily.
Why treatment is delayed till the immunity is destroyed?
In early stages of infection especially the first 5 years the body partially win the battle against HIV. Slowly but surely the virus get the upper hand [in most of the positive persons] and the body's immune system gets destroyed. Only at this stage the person becomes ill. We start anti HIV treatment at that time so that we can prevent the person falling ill due to various infections.
Starting treatment before that do not give much benefit.As of now we can only reduce the multiplication of the virus to a minimum.We cannot eradicate the virus. Also the anti HIV medicines have many side effects.There is also chance of drug resistance if the dosages are missed. Considering all this treatment initiation early in the course of HIV infection is not very useful.
It is also important to test the spouse of the person.If the mother is positive the children if any also have to be tested.
If there is a pregnant positive woman, she needs treatment to prevent her child getting infected. This also is provided at ART centres.
Compassion and good advise is what that is needed for a newly detected 'positive' person.

Is it AIDS doctor?

A 48 year old man came to my clinic with his brother. The man is working in one of the Persian Gulf Countries. He was in Persian Gulf for the last few years but was not regularly employed.He was staying with and was dependent on his friends and relatives most of the time. 5 months ago he was fortunate enough to get a good job. Finally he started sending money to his family in India.

His illness also started 5 months ago.He began getting loose stools. Some times there was blood in the stools.He lost all his appetite and became thin.His friends asked him to see a doctor. He did not had a health insurance or other benefits.He knew that seeing a doctor there means lot of money.He applied for leave to come to India for treatment,but it was rejected. He continued to suffer and lost around 20 kilograms in weight. Sensing something wrong his boss gave him leave.Thus he presented before me.

He was extremely ill looking, thin and emaciated. He said he is having frequent tummy pain along with loose stools.Some times it is mixed with blood, which he attributed to Piles. He was pale and his blood pressure was on the lower side.I asked him to lie down. I examined his abdomen. He had a fairly large and hard palpable Liver.He also had pain on pressing his lower abdomen on the left side.For me the diagnosis was obvious.

I asked him to do some blood tests and an Ultra sonogram of his abdomen and come back to me with the reports in 2 hours.
Both of them went out but the patient's brother returned immediately, came close to me and asked
'Is it AIDS doctor?
I wish it was AIDS. I replied.
His face showed his confusion.I explained. Probably it is advanced Colonic cancer which had spread to Liver. If in operable the chances of survival are very slim.
If it is AIDS I can offer a lot and he will live healthy for long.But......
The Ultrasound scan suggested my impression was correct.He was referred to higher centre. Subsequent CT Scan and a colonoscopic biopsy confirmed the diagnosis.

Yesterday was his day of surgery.It was planned to remove the colonic tumour and to give chemotherapy later for the Liver lesion. His brother called me in the afternoon.He was crying when he said that the colon tumour was in operable as there was adherence to Urinary bladder. They just did a diversion of bowel to abdominal wall so that he wont have obstruction to bowel movements. His days are numbered.

Colonic cancers especially on the left side are slow growing and are diagnosed early because of alteration in bowel habits and bloody stools. When diagnosed early it is a curable cancer.
This patient because of his circumstances delayed seeking medical help which now proved was suicidal.

'Positive' Grand mother

When we think of HIV positive people, we imagine some one in their 20s or 30s, but there are a few 'positive' women (and men) who are in their 50s and having grand children. HIV testing may be delayed because of the age as the treating doctor may not consider this possibility.

She came with her husband 7 years ago. He was very sick having all the features of defective immunity. His test proved he is 'positive'. She was also found to be positive but with a near normal immunity. She had 3 children all in their 20s. They were all tested and found negative.
At that time, there was no free Government supply of medicines [ART] for HIV/AIDS. I prescribed medicines to prevent opportunistic infections. ART was too costly and he could not afford to take it continuously. He died within 2 years.

Last month she came to me again. She is 52 now and is living with her son. She is the proud grandmother of 3 kids. She came with recurrent fever and weight loss. She had fungal infection in her mouth, and I could make out that her immunity is low. Lab tests confirmed it, and I referred her to Govt ART Centre where she will get free anti HIV medicines. If everything goes well, she will be able to live a near normal life for a long time.

She is grateful for this opportunity to live well because of free ART, but laments the fact that her husband did not get such a chance.

When I started practising Medicine, I had helplessly seen scores of patients with advanced HIV/AIDS dying in my hospital. ART was unavailable or unaffordable. Now the availability of free ART has dramatically changed the situation.
A scientific discovery in health, whether it is a new technology or a drug , should be made available to whole mankind as soon as possible, otherwise such discovery only adds to the pain of the poor.

Doctor,please give me your cellphone number

Doctor, please give me your cellphone number.Then in case of an emergency we can contact you directly.
I receive such request very frequently. How should I respond?

You will think that this is a reasonable request. Each and every patient should be able to contact the treating doctor directly in an emergency. You wont have any second thoughts about how I should respond. But.............
I am sure if each and every patient I treat get my cellphone number, I wont have a single minute of peaceful living. I will be deluged with calls while sleeping, eating, bathing, driving, when seeing patients in my Consultation room, while taking rounds etc etc. Sense of propriety and ethics are forgotten. The facility will be misused [as some already do who have somehow got my cell number.]
I am available in the daytime at my land phone numbers. At night in case of an emergency, the patient have to approach the hospital were I work. The staff at the hospital can contact me 24 hours a day.

For some of my patients, I give my cellphone number without hesitation. They are
1. HIV positive persons
2. Type 1 diabetes patients
I don't hesitate for HIV positive persons, because I feel with all the stigma and discrimination they face, they should at least be positively discriminated by me. They should be able to talk to me anytime they want.
Type 1 diabetes patients need constant communication with the treating doctor as they have to self manage a lot and may need physician guidance in management.
Another reason for lack of hesitation is that 'positive' persons and type 1 diabetics under my care constitute less than 1 percentage of total number of patients. So, I need not loose sleep giving away cellphone numbers to them.
Do you think of me as a selfish and uncaring doc?

Another sad 'positive' story

He was working in one of the Persian Gulf countries, and was one among the millions of Indians who went there to work for those oil rich economies, so that they can earn some decent wages.

There came a routine medical exam for migrant workers. He was put in a jail after the result of a Lab test. When asked what is wrong, there was no answer. Within days he was deported to India.

Utterly clueless to the reason for his deportation, he approached a local doctor. A panel of blood tests was done. He was found to be HIV positive. A second confirmatory test gave the same result. The doctor referred him to a Govt facility. Fearing stigma he never went there.

This happened 10 years ago. He never told anybody about this. He told his family that he came back because he cannot tolerate the weather there. Even his wife did not know the exact reason. He began working near his native place as a driver. His wife gave birth to 2 kids. He never had any major health problem until now.

For the last few months, he started losing weight and getting recurrent fever. After a detailed evaluation, he was diagnosed to have Lung Tuberculosis. The Chest Physician suspecting something more, asked for an HIV test. Then he revealed his 'positive' status to the doctor. The doctor promptly referred him to me.

I gave my positive talk [that I usually give to the 'positives']. I told him there is nothing to worry,I will take care of him. First we will treat and cure the Tuberculosis. Then we will attack the HIV virus. I emphasised the importance of compliance with treatment.

I was afraid for the wife, but he said she was tested negative before both her deliveries. I asked him to test her again. He came with his brother-in-law and a cousin. Both knew the truth and was supportive. I asked him to come back after few more lab tests, so that we can start anti-TB treatment. He seemed relieved and hopeful of future when he left my consulting room.

Deportation of migrant workers as if they are criminals as soon they are found to be HIV positive, is a common practise in Persian Gulf countries. The person concerned are never given a proper explanation of the test result. According to WHO/UN AIDS HIV testing guidelines , there should be a pre-test counselling and also a post-test counselling. If these guidelines were followed, after a positive test result the person will be able to understand the implication of the result and he will be guided to the proper health care facility for further management of his condition. The testing and deportation with out any explanation are clear violations of these guidelines.

Can anyone intervene to stop this inhuman testing and deportation of hapless migrant workers from Persian Gulf countries?

A happy family

Two days ago a family came to meet me. A 32- year-old husband with his wife and 3 year old son. They came to see me regarding a minor fever for the wife. They seemed to be happy, especially the kid who kept on exploring my consultation room for treasures. My thoughts went back to the time they visited me the first time.

They were referred to me by a Gynecologist when a routine HIV screening on the pregnant woman was found to be 'positive'. They were in tears, the husband and wife. They did not want the baby but it was too late to abort. They wanted to end their lives as the husband also turned out to be 'positive'. I tried to talk to them in a positive way. I assured them that with proper treatment for the mother and the newborn, the baby will be negative. I also told them that HIV/AIDS is now a well treatable condition, and they will be able to continue living with a good quality of life indefinitely. They did not want any of their family members to know. I promised that I wont tell anybody.

Next day itself I started Mother to Child infection prevention medicines. Her pregnancy period was uneventful, and she delivered a normal boy by Cesarean section. In case of a 'positive' mother, it is always better to avoid breast feeding if the parents could afford formula feeding. So the paediatrician while giving the newborn the medicines for prevention of infection asked them not to give breast milk. This advice produced a commotion among women members of the family. The guy (new father)called me frantically warning me that both Grand mothers are coming to me to ask me about breast feeding. He pleaded with me not to say anything about HIV.

Meanwhile I called the Gynecologist and pediatrician and discussed with them what to reveal and what not to reveal. We decided that we will tell a lie as per the wishes of the couple. The Grand-mothers arrived in front of me. I told them that a virus that can cause jaundice is there in the mother's blood. If she breast feed, the newborn will get infected with dire consequences. So, it is better to give formula feeding. If they have any doubt they can ask the other 2 doctors. Some how or other, I was able to convince the two women. Later I learned that they did not go to other 2 doctors.

All was seemingly well for a few days when suddenly I heard that the guy was hospitalised for attempted suicide. The young mother one day told her mother all the truth. On hearing that, the husband not able to bear the thought of stigma tried to kill himself but fortunately was unsuccessful.

After 18 months, the couple came to me with the kid. They were very happy. They just got the result showing that their boy is HIV Negative. I asked them how is it with their families. They told me that both parents know the truth and they are very supportive.

Later last year, I referred the guy to the ART centre as his CD4 count was below 200. Now he is on ART for last 9 months. His last CD4 count showed steady improvement.

All these I remembered as I watched the son happily playing with a paper weight on my table.
Then the mother said, 'He has not been given any shots'.
I was shocked. The 3-year-old child has not been given any vaccines for immunisation. How could it be like that?
She said that when they went to the nearest Govt Health Centre for immunisation, they saw the HIV positive status written on the mother's medical record. The doctor there was confused which all vaccines to be given. So he referred the child to a Higher Centre some distance away, but the couple fearing stigma never went there.

I asked them to get the child vaccinated immediately, told them to take ART regularly, also reminded them about measures to prevent further pregnancy and said goodbye.
It was a pleasantly satisfying interview for me.

A Story of Discrimination

The day after I wrote about Stigma and Discrimination I had to listen to a tale full of that.
She was working in a Government run rural pre-school centre. Her 4 year old son [who was always sick] was diagnosed to have AIDS. He succumbed to his disease.Both she and her husband were tested 'positive'.The news got around and the parents of the kids under her care and even some of her co-workers began whispering. Finally they told her not to come for her job.
The District Health authorities intervened and tried to pacify the parents.After few months She went back to work but still had to face lot of problems. So she stopped going though
she continued to be employed there officially.
Now she is sick and came to see me.She first saw me few months ago at the Positive Network's office where I was there for my health class. There she saw me sharing food with the 'positives'.So she had confidence in me.As soon as she settled in her chair in my room she revealed that she is 'positive'.Then she told her story.
Her immunity was low for quite some time and she should have started ART[Anti HIV treatment] a year ago. But psychologically down due to her troubles in her work place she did not go to the ART centre.
She was really ill,most probably suffering from multiple infections due to her low immunity. She wanted some immediate relief but again refused to go to ART Centre. After listening to her whole story I talked to her explaining that there is no short cuts.She will get relief only if she start the correct treatment. I reassured her that there wont be any discrimination at the ART centre. At the end she promised me she will go and get the treatment.
I hope she will.Otherwise I don't think she can survive another year.

Stigma and Discrimination

Why there is so much fear,stigma and discrimination among some health care professionals towards HIV Positive persons?
You may think the main reason is fear of getting the infection.But there are other serious infectious diseases which are much more easily transmitted to health care workers like Hepatitis B, Hepatitis C and Open Tuberculosis.Patients suffering from these diseases are usually not stigmatised or discriminated. Then why against HIV/AIDS?
This website summarises the reasons well.If you have any views or comment please be free to express it here.

Negative thoughts about 'Positives'

Recently I was attending a dinner and having small talk with my doctor friends. A doctor was talking about how lucky he was in finding out one of his patient was HIV positive just in time to refer him to a Government Medical College without causing any 'damage' to his nursing home. He was patting himself in the policy of his Nursing Home to screen all patients for HIV and to refer all patients who were found 'positive'. At the same time he was lamenting that these 'positive brutes' always hide their 'Positive' status.
Why do they hide the 'positive' status?Especially why do they hide in front of that doctor?
None of them hide their 'positive' status from me.Because they knew from their friends or relatives or other doctors that I never discriminate. So why they hide their status elsewhere? Because they fear stigma and discrimination. They know that the moment the 'positive' status is known they will be discriminated and stigmatised.If there is so much stigma and discrimination among medical community what can you expect from common people?

Being positive with 'Positives'

Today I was invited to be with some of the 'Positive' people in my district.I am referring to a meeting organised by the local Network of HIV positive persons.


When I reached there, the meeting had already begun. It was held in a Hall in a house which also houses the office of the network. There were around 50 adults, women almost equalling men. Around 10 kids were also there playing in the next room.Most women were sitting on the floor while men had chairs and few benches to sit. Most of them were poor, some may be in lower middle class. Most are Hindus, some Muslims and a few Christians. They include Manual labourers, Drivers, House wives, Sex workers and many are currently unemployed. The only thing common about them was that they were all 'positive' persons.

Today was their monthly meeting day. They come here to discuss their health, about Stigma and discrimination they face, about the difficulties they face in getting employment and sending their kids to school, and about the ways to get more benefits from the Government etc.

When I came in their faces lit up. I know many of them. I am a regular visitor there. I usually take Health classes for them. I give them hope and so they like me.

Today also I stressed the importance of taking medicines regularly in the correct dosage at the correct time. I told them not to worry about side-effects of medicines. It can be managed. I told them the importance of healthy food and asked them to abstain from tobacco and alcohol.

They listened intently and in the end when I asked if they have any questions, many stood up but they were not asking questions. They wanted to consult me. They wanted solutions for their personal health problems, not a health lecture. Such lectures they are hearing regularly.

I saw some of them. A 10 year old kid taking ART [ anti retro viral therapy] had Scabies. A 45- year- old man's cough was persisting even after completing anti tuberculous therapy. Many had general medical complaints not related to their 'positive' status. They were not keen on relieving their status to other doctors. They also complained that when they reveal their 'positive' status, many doctors ask them to get treatment from the ART Centre [which is 2 hours away]itself.

I did not had time to see all of them as I had planned only a class. The organisers were embarrassed.They started shooing away those crowding around me. I went promising to come again to them another day.

The Government and many NGOs are helping them.Even then their plight is miserable. It is a big fight for them every day to keep their body and soul in good spirits.I try to do my bit by being positive with 'Positives'.