For eight months, an HIV-positive patient in Mumbai has not been able to take any
medication. When he had tested positive, he had not told his family because of the stigma. The lockdown meant he had to be home. He could not step out and go to the local hospital without having a conversation he hoped to avoid.
“I met him last week. Many such cases are emerging as migrants who had gone home are getting back to the cities they worked in,” said Ganesh Acharya, a Mumbai-based HIV awareness activist and a patient himself. Antiretroviral therapy, or ART, is available only in big hospitals or at designated centres. The lockdown in March put the already distant access to treatment options further away for India’s 21 lakh HIV-positive patients.
In a survey by international biopharma company Gilead Sciences and the AIDS Society of India released this week, 47% of the respondents living with HIV said they worried about getting ART and preventive medication during the pandemic. Even physicians — half of those surveyed — said they saw a marked decline in prescription refills. Those surveyed in 10 Asia-Pacific countries, including India, attributed this primarily to two reasons — fear of
Covid-19 infection (62%) and travel restrictions (46%). A total of 1,265 respondents, comprising people living with HIV, at-risk population and physicians prescribing HIV medicine and care, participated in the survey, including 96 from India.
When the lockdown was imposed in March, India's 21 lakh HIV positive patients and those at-risk of HIV (having unsafe sex) faced difficulties in accessing medicines and getting tested because anti-retroviral therapy or ART is available only in big hospitals or at designated ART centres. “Interruptions to access and delivery of care can negatively impact people living with HIV, putting them at a higher risk of health complications,” said Dr IS Gilada, president of the AIDS Society of India. “If you do not take medicines for two months, you risk becoming resistant to the medication. Virus count in the body goes up and makes you vulnerable to comorbidities like tuberculosis.”
The survey also found that about 46% of the at-risk population reported a decrease in frequency of taking HIV tests during Covid-19. For India, the figure was 85%. The main reasons for reduced testing were concerns of getting infected with Covid-19 (62%) and travel restrictions imposed during the pandemic (46%).
Along with HIV testing, Acharya added that TB testing has also gone down which means that many HIV positive patients are living with undiagnosed TB. Almost all HIV patients get TB. “In Mumbai, before Covid we used to see some 5,000 new cases of TB every month. Now, the number hasn’t gone over 3,000 in the past few months. Which means, fewer people are being diagnosed. And leaving TB untreated for long makes it drug resistant,” said Acharya.
“Testing has been impacted. In future, if there’s another crisis like this, we need to figure out a way to take testing to the people instead of them coming out for it,” said Dr
Rahul Bargaje, medical director,
Gilead Sciences South Asia. He added that an important takeaway from the survey was the success of tele-health. In India, 85.3% physicians said they provided a phone consultation. Overall, almost 97% used telehealth to consult with patients via telephone (85%) or video (50%), or to provide refill prescriptions (67%). “Wherever care was possible it was made possible by tele-health. That’s the way to go ahead to maintain continuity of treatment,” Bargaje told TOI.