Bihar State AIDS Control Society doesn't give a damn about Mothers!

It’s Mothers’ Day today.

And what does a poor, sick mother in the boondocks of Bihar, desperately trying to ensure that her HIV positive orphaned child gets his essential daily dose of life-saving meds get? Insensitivity, buck-passing and indolence by the government medical fraternity and the Bihar State AIDS Control Society!

 On Thursday May 7, [incidentally observed as AIDS Orphans Day, part of the annual global aids awareness week], a desperate 25 year old widow in Chapra (Bihar state)was running from pillar to post in a frantic bid to obtain the next dose of ART for her 8 year old son. An HIV positive person needs to take the prescribed medicine daily, just like a daily insulin dose for diabetics. If the dose is missed, even for a day, the immune system of the patient starts deteriorating. The people at the ART dispensing centre were helpless, stocks were over. (The special ART formulation for children is given in a syrup form.) When the woman, in desperation went to submit a written intimation to the Nodal Medical Officer, pleading that the medicine be made available, she was brushed aside. The doctor refused to accept her application!

 The woman, a widow on her own, who somehow ekes out a living working in one of those hole-in-the wall ‘ private schools’, is distraught. For the past five days, she has abandoned her work, running to and from the dispensing centre. The irony is that the medication can only be obtained from the government centre and no private chemist shops in Chapra stock the medicine, which is very expensive.

 “I went to get the medicines on the 4th, a day before the last dose ran out. (This is the practice. Patients are given medicines for a month only, and they can’t ask for any advance stocks). There was no medicine available. My child is on ART since 2011. What’s worrying me is that in January, when a CD-4 count was done, his platelet count had dropped to 311 from 1100. I’m desperate,” she said over the phone.

 Exactly 14 days ago, I happened to visit the Chapra ART centre with RTI activist Sanjeet Singh, where the personnel us that stocks were low. “We are just not receiving adequate stocks from BSACS, and we struggle to do what we can,” they said.

 “The High Court has decreed that every ART centre should have a two month stock of ART medicines and medicines for opportunistic infections, but despite assurances from BSACS officials, see the situation!” says Sanjeet.

 In Chapra, the situation is overwhelming. 4200 registrations, ART 2,900 total counting. Last month 1748 patients received ART. There are about 150 children on ART. NACO guidelines are not met. BSACS has not appointed the required staff. Only 4 posts out of 14 are filled. No Medical Officer for the ART and ICTC centre, so obviously, no ‘accountable’ official! There is no CD4 testing machine, even though NACO funds were there for one unit in each district, it is said.


How does the State, and BSACS, which gets funding from the Centre ensure safe motherhood? Probably by twiddling their thumbs and looking the other way!

this is NOT a photo of the widow.... for representation only

BSACS is supposed to provide ‘safe delivery kits’ at all its PPTCT centres. Reality check: That doesn’t happen. Pregnant women have to buy their own ‘safe delivery kits’ from private stores in Patna because the hospital has no stock. “We advise them to take precautions, because many of them end up having home deliveries. Even when they have go to the government hospitals, if they bring along their own kits, it can pre-empt any refusal by the nurses not to deliver the babies for lack of safety kits,” said PPTCT Counsellor Sadhna. A kit costs about Rs 750, and add on the cost of a trip to the state capital, just to buy the kit!

HIV positive pregnant women are denied surgery at Chapra. This was told to me by the PPCTC counsellor. She said that because there is only one OT for caesarean sections in the district hospital, there would be ‘complications’ if an HIV positive C-section was performed. So the pregnant woman is told to be prepared to make the long trip to the Patna Medical College Hospital, over 120 kilometres away, in case a C-section is called for. When we asked the resident gynaecologist at the district hospital about this, all she said was, “I am aware that we have delivered babies from HIV positive mothers, and as for C-sections, so far, no such case has been brought to my notice.”

The woman says “My child is the only reason I am living, if he dies, I am nothing, I might as well destroy myself.”

Just as I was putting the finishing touches to this article, I received a phone call from Sanjeet Singh, the activist. The ART medicines have finally arrived at the Chapra centre on Friday. The 25 year old widow can breathe easy, for one more month… Happy Mothers’ Day!


But, for how long will the State Government and BSACS flout the orders of the High Court? Instead of getting on with the procurement of medicines, will they try to pass the buck if summoned to court once again?









Author: Frank Krishner

Bihar SACS: bouquet of broken promises?

You just can’t beat the ingenuity of low-level government functionaries in Bihar who want to shirk responsibility and foil attempts to bring them to book. No matter what promises and undertakings the Bihar Government has made to the Patna High Court, people living with HIV are still at the receiving end of discrimination, abuse and neglect, caused by the very people being paid to assist them.

In 2010, the then health minister of Bihar had told them ‘why should we bother about you’? Left with no other option, Sanjeet Singh and other doughty HIV positive people, with the help of public spirited lawyers, moved the High Court at Patna. Hearing after hearing, and one by one, each judgement brought some relief, as the Bihar government and BSACS acknowledged their responsibility to provide treatment and relief to people living with HIV [PLHA], especially those from the labouring classes.



Sanjeet Singh: soldiering on...

The State government committed that the supply of life-saving ART drugs would be maintained faithfully, that the ART centres for HIV positive people would be made hygienic and equipped with toilets, that special schemes for children living with HIV would be formulated. Four years on, with the assurances given to the High court remaining largely on paper, with HIV positive patients still being ridiculed, discriminated against and even refused treatment by government medical service providers, activists are wondering whether the fight would have top be taken to the Supreme Court.

“What does one do when the entire establishment is in some sort of a conspiracy?”  asks Singh. “Refer to the High court judgement where the  BSACS project director  and principal secretary Health assured the court that the government  would supply  ART (anti-retrovral treatment) 365 days and they were to  ensure stocks of  two months’ advance supply to avoid shortages. The reality is that for the past one month the essential drugs in the ART regime are not being dispensed and the patients are frantic. The government ART centres run short of the drugs. The situation is such that there is a tacit understanding within the department that no correspondence should be generated on the matter so that there is no paper trail, in order to duck accountability and escape ‘action’ later.”

Singh, a member of Bihar Network of Positive people and attached to CHMU (Community Health Medicinal Unit) alleges that  BSACS functionaries are refusing to register more HIV positive persons for ART, in order to avoid ‘complications’. The logic being ‘There’s no stock, if we register them, from where will we get the medicines?’ These unfortunates are running from pillar to post.  

Functionaries at the government ART centres hand out  ‘prescriptions’  on scraps of paper and the patients are  told to buy the drugs elsewhere. There is a provision that in the case of shortage, the patient may be directed to buy ART medicine from a private pharmacy, and the record is kept in the ART book, so that the registered patient be reimbursed. (These drugs are available at very high rates in the open market). BSACS had given an undertaking to this effect in the court. The ART functionaries in gross violation, merely give the patients a scrap of paper with the name of the drug written on it. Evidently, this scrap of paper is not valid for reimbursement.

The situation is such that, even those patients who were lucky to have their purchases recorded in the ART book previous months, have not been reimbursed. Daily wage earners with a hand to mouth existence can’t afford to cough up for medicine that costs in the range of a thousand rupees every time, says Singh.

Singh’s own commitment to the cause has been the loss of his infant son to AIDS related complications largely brought on due to the negligence, apathy and dysfunctional State Aids Control Society services.

“What’s to be done? Do we have to start another agitation? Do we once again knock at the doors of the Court?” This is a question that a coalition of NGOs may soon be taking up. Watch this space.

Author: Frank Krishner