Antiretroviral therapy (ART) is made accessible to all and is now available free to all those who need it. All public health facilities are mandated to ensure that ART is provided to people living with HIV/AIDS (PLWHA / PLHIV). Special emphasis is given to the treatment of sero-positive women and infected children, as per the Manipur AIDS Control Society (MACS). However, amid the unrelenting second wave of the COVID-19 pandemic and curfew, people living with HIV (PLHIV) in Manipur are faced with the problem of getting ART. COVID restrictions and increasing fare in public transportation have added to the difficulty in accessing treatment.
Speaking to the Imphal Free Press over the phone, a minor girl from Pishum in Imphal West district of Manipur shared her woeful story in accessing ART and requested this IFP reporter to help her get the treatment.
The girl, living with HIV and coming from a poor family, lost both parents to HIV/AIDS and has since been living with her uncle’s family. In mid June, she visited JNIMS to get the therapy but the auto driver charged her a hiked fare of Rs 300 from her home to the hospital, which she is not able to afford.
Faced with social stigma, the minor girl also faced the problem of stepping out of the house. Although she is not infected by Coronavirus, neighbours told her not to step out of her house as she poses the risk of spreading the infection to others.
Financial woes and difficulty in accessing ART amid the pandemic is posing a major problem for PLHIV.
Another woman from Pishum Ningom Leirak, N Manbi said that many people living with HIV, including widows and children, are struggling to get ART. She said some PLHIV stock up ART for a few months. But when the stock gets depleted, it is difficult to get it. She went for ART by paying Rs 600 to an auto driver during curfew time, and got an extra amount of ART and gave them to some PLHIV known to her.
Apart from the problem of accessing ART, several PLHIV includes widows, who are facing a traumatic time in running a family. They are struggling for food amid the challenges posed by the COVID-19 pandemic.
“It is hard to run the family and feed my children without any source of income,” Manbi said, adding that she would do anything to prevent her children from facing starvation.
She said she often goes to buy vegetables from Khoijuman and other places during midnight but police detained her and fined Rs 100. She also borrows money from her friend to buy and sell vegetables in the locality.
“Why is the government not considering the actual ground situation,” she asked, and said that the state government should think about every section of society. Providing just five kilograms of rice to a household by the government is not enough to run a family, she said.
Manbi also pointed out that orphans with HIV are not getting ART and food is inadequate. If the situation continues, one-day poor people will start dying of hunger, she said.
Curfew has been relaxed in the state and is imposed only during the night but relaxation given to vegetable sellers is very limited – from 7 am to 10 am on Wednesday, Friday and Sunday. It is tough to sell vegetables. In urban areas, people come out after 10 am to buy vegetables but police stop the sale by 10 am.
“I as PLHIV is facing a hard time in paying transportation fare as it has increased due to high petrol price,” Manbi said and urged the state government to supply ART to PLWH door-to-door.
While there is no cure for HIV, it can be controlled with proper medical care. ART is an essential, life-saving treatment that can keep the HIV virus under control for most people within six months, she said.
MACS, with the help of ASHA or Anganwadi, could supply ART for PLHIV in all districts, she suggests.
A new WHO report confirms that HIV infection is a significant independent risk factor for both severe/ critical COVID-19 presentation at hospital admission and in-hospital mortality. Overall, nearly 23.1% of all people living with HIV, who were hospitalised with COVID-19, died.
The report is based on clinical surveillance data from 37 countries regarding the risk of poor COVID-19 outcomes in people living with HIV (PLHIV) admitted to hospital for COVID-19.
Studies found that the risk of developing severe or fatal COVID-19 was 30 per cent greater in PLHIV compared to people without HIV infection. Underlying conditions such as diabetes and hypertension are common among PLHIV. Among male PLHIV over the age of 65 years, diabetes and hypertension were associated with an increased risk of more severe and fatal COVID-19. These conditions are known to put people at increased risk of severe disease and death.
Therefore, all people living with HIV should be prioritised for early vaccination. And people living with HIV with co-morbidities (such as chronic pulmonary disease, diabetes, hypertension, obesity, kidney disease, liver disease, Parkinson’s disease, multiple cases of sclerosis, motor-neuron disease) should be prioritized for early vaccination and management of their co-morbidities. People living with HIV should not be excluded from COVID-19 vaccine access plans regardless of their immune status, and countries should include people living with HIV as a priority group for COVID-19 vaccination according to their epidemiological context.
Although people living with HIV face high risk of getting COVID-19, ensuring they have access to effective ART and other healthcare facilities will help to minimize the risk, a WHO report states.
It may be mentioned that ART is initiated depending upon the stage of infection. PLHA with less than 200 CD4 (while blood cells/ mm3) require treatment irrespective of the clinical stage. For PLHA with 200-350 CD4, ART is offered to symptomatic patients. Among those with CD4 of more than 350, treatment is deferred for asymptomatic persons, MACS stated.
According to MACS, in order to make treatment more accessible ART centres are located in medical colleges, district hospitals and non-profit charitable institutions providing care, support and treatment services to PLHA. A PLHA network person at each of the ART centre facilitates access to care and treatment services at these centres. ART centres also provide counseling and follow up on treatment adherence and support through community care centres.
In view of the prevailing COVID-19 situation in the state, Manbi along with her friends who declined to disclose their names opined that authorities should make rules or issue notice to security personnel to ease the situation for PLHIV to get timely treatment.