Over 6,000 positive cases drop out of surveillance radar

The latest report prepared by the district officials of the Tamil Nadu State AIDS Control Society (TANSACS) is a wake-up call for Madurai.

The district is on the HIV watch list after 6,539 HIV positive patients have gone “missing” and cannot be traced despite a sprawling network of voluntary organisations and heavy fund flow from Government and private agencies.

An alert has been sounded for fear that these missing patients could be silently spreading HIV among the population in and around Madurai.

Not undergoing treatment, these HIV patients remain at large and have dropped out of the surveillance radar.

“Tracking them is a challenge for us and I have already alerted the higher-ups at TANSACS headquarters in Chennai,” said Dr. M. Kalirajan, District Programme Manager, Madurai District AIDS Prevention and Control unit, while presenting the HIV prevalence report on July 2.

Every year, more than 1,000 new cases are added to the ‘positive’ list in the district. From January to December 2012, the data points to 1,048 confirmed HIV cases, while 1,217 persons tested positive in 2011. In 2010, Madurai district had 1,374 HIV positive cases.

Madurai district occupies the fifth place in the overall prevalence of HIV/AIDS in Tamil Nadu, according to the 2011-12 survey, after Salem, Namakkal, Vellore and Chennai.

As per last year’s records, the total number of patients in two categories — HIV positive and those who require Anti Retroviral Therapy (ART) — was 16,225 in Madurai district.

Of these 1,406 died in the last few years, bringing the number down to 10,939. Among these patients, 4,400 positive cases have shifted to other districts.

“Currently 3,880 are on ART and the whereabouts of 6,539 patients have to be established. Wrong address, door locked and transfer were cited as reasons by our field staff,” Dr. Kalirajan said.

Prevention, counselling and treatment activities are carried out through 28 Integrated Counselling and Testing Centres in the district, apart from government hospitals at the taluk level and the Government Rajaji Hospital here. The focus is on high risk groups — female sex workers, homosexuals, transgenders and migrants.

Voluntary organisations such as Pache Trust at K. Pudur have also reported “missing” patients.

“Fearing stigma and discrimination, some are giving us false addresses and that makes it difficult for us to keep track of them,” says G.S. Sujatha, project manager.

A few “hotspots” from where HIV cases are detected in Madurai district are Melur, Karungalagudi, Kottampatti, Alagarkoil, Anaiyur, Alanganallur, Thirumangalam and Usilampatti. The combination of HIV with tuberculosis (358 persons have both as per the latest figures) is proving deadly and there are fears that the general population is at risk when detected patients do not go for follow-up treatment.

Mother-to-child transmission is another major challenge. From 1998 to 2012, the district had 896 HIV positive cases among children in the age group of 2 to 17 years. The whereabouts of 697 children are not known, according to Dr. Kalirajan. Last year, 49 pregnant women tested HIV positive in the district.

The report pointed out that 35 per cent of those (general category) who were detected with HIV are not going for treatment.

Inadequate staff and the lack of job security in the District AIDS Prevention and Control unit, which is situated in the Collectorate here, are cited as reasons for low motivation levels.

“There are only nine employees and all are on contract. We are like bonded labour here, no medical leave and no guarantee of job security. Here, anybody can be shunted out at any time,” laments supervisor K. Nagarajan.

The flip side is many patients living with HIV are leading a normal life thanks to regular medication and motivational counselling.

Kottaichamy (45) of Kottampatti block tested positive 15 years ago and, through the support of an NGO, is managing the immunity level of his body to control infection.

“My wife, myself and my son, who is studying in Class VIII, are all HIV positive. My wife tested positive when she was pregnant,” he admits candidly.

Another affected patient is now living with hope after she was counselled following two suicide attempts. Bhama (name changed), a 32-two-year patient, is now an HIV counsellor in Karungalagudi/Kottampatti area.

“For the past 10 years, I have been living with HIV. I got it through my husband and we are now divorced. I will help all members of the HIV community to lead a normal life,” she says. Bhama has a 11-year-old daughter.