Mudhol swallows the bitter pills of HIV and poverty

Capstone Health Mudhol

Mudhol taluk has witnessed an increase in the number of HIV patients in the past five years. While on paper, only 10 per cent are registered with the taluk hospital, doctors estimate that about 30 per cent of the population suffers from this deadly disease that not only affects them physically but also mentally and financially.

Savyata Mishra|Bengaluru

Every month, *Sanjana spends a furtive day travelling from Shirole to the HIV treatment centre in Mudhol taluk hospital to receive her monthly treatment for HIV. She is a slight woman of not more than 5 feet 3 inches, who lost her husband two years ago to the same disease that now ails her.

She says that he had a history of indulging in sexual intercourse with multiple partners when he worked as a construction worker in the cities. Now, the 45-year-old Sanjana struggles to make ends meet for her five children. She works as a labourer on the sugarcane fields for six to eight hours a day. 

*Revati M used to be a female sex worker (FSW) until she was diagnosed with the Human Immuno-deficiency Virus (HIV) three years ago. Her life took a turn for the worse because she had to stop doing the work that brought food to her and her children’s plate. She was neither literate nor trained enough to do any other work. She is one of the numerous FSWs who inhabit the dingy shanties of Mallamanagar, Junjurkoppa, Hirekere, etc… of Mudhol taluk. These areas are designated red-light areas subject to frequent police crackdowns. Along with being a means of income, the profession serves as a link between them and the world outside their shanties which constantly shuns them. 

The Chief Medical Officer of the taluk hospital, Dr Ashok Suryavanshi, says that an estimated 30 per cent of the taluk population is afflicted with the deadly HIV disease. However, on paper, only 8-10 per cent are receiving the Anti-retroviral treatment (ART) at the taluka hospital of Mudhol. These are mostly female sex workers, migrant labourers, lorry drivers and sugarcane farmers. Over the last 5 years, there has been a 25 per cent increase in the number of HIV cases in the taluk, according to the doctor.

“People are hesitant to visit hospitals for their treatment. This is the stigma associated with HIV that proves fatal. In many cases, fearing exposure, they seek treatment at private hospitals making their sustenance difficult,” Dr Suryavanshi informs. 

The doctor explains that people prefer private hospitals because they feel more guarded from attention than they do in government hospitals where hundreds flock everyday to receive treatment. But the treatment at these hospitals cost a bomb, getting many into serious debts. Their situation is further worsened trying to afford unending trips to hospitals, buying medicines and keeping up a nutritious diet. 

A 2017 report by National Aids Control Organisation (NACO) shows that Karnataka has the third-highest population of people living with HIV (PLHIV). In Bagalkot district, Mudhol and Jamkhandi taluk rank highest in HIV cases, various sources in Mudhol confirmed. Over the past five years, there has been a 25 per cent increase in the number of registered cases at the taluka hospital, according to the doctors there. This, despite various governmental and non-governmental interventions, is a cause for worry.

Data provided by the taluk hospital showed that of the total population in the taluk, there are about 4400 cases registered with the Anti-retroviral Treatment (ART) centre in the hospital with an addition of 25-30 new cases every month. Between 2015 and 2019 alone, 2,520 cases were registered with the hospital and about 96 per cent of them started treatment. The data also revealed that about 54 per cent of the total cases registered between 2015 and 2019 are females, both adult and child.

Bagalkot district has around 5000 sex workers registered with Chaitanya, a community-based organisation that works for the dignity and rights of women like Revati in the entire district. Rekha Gadi, the secretary of the NGO in Mallamanagar informed that about 1500 of them are HIV positive. 

The rise in HIV cases along with other factors like illiteracy and poverty is also attributed to the prevalence of the Devadasi system. Revati comes from a family of women who were devadasis, which means the slave of God. 

However, this system has been twisted to serve the purpose of the poverty-stricken families or to legitimise sex-trafficking. It has pushed several young girls into prostitution to secure a source of income for poor households. “I was declared a devadasi as soon as I attained puberty. I was married off to a man to ensure that my children in the future had a surname, but was expected to attend to customers and earn a living out of it,” says Revati. She says that most of the customers who come to her are sugar-cane farmers or migrants. 

The secretary of Chaitanya, Ms Rekha, says, “During the months of September to March, there is a huge demand for agricultural workers and lorry drivers for sugarcane factories. People migrate from different villages of the taluk during this season and indulge in such pleasure.”

Dr Rashmi, who is in the charge of the ART centre of the Mudhol taluk hospital says, “The migrant labourers and drivers are usually HIV positive and do not take the treatment regularly due to the nature of their work. They are most likely to put their own families and the FSWs they get involved with, in danger of contracting HIV.”

The scope of HIV is not limited to Bagalkot district or Karnataka alone. In India in 2017, Maharashtra had the highest estimated number of PLHIV. This was followed by Andhra Pradesh, Karnataka, Telangana, West Bengal, Tamil Nadu, Uttar Pradesh and Bihar, together accounting for almost three-fourths of the total estimated PLHIV, a report by NACO suggests. A study conducted by Karnataka Health Promotion Trust in partnership with different foreign colleges showed that in three taluks of Bagalkot, namely Jamkhandi, Bagalkot and Mudhol, respondents in Mudhol were more engaged in high-risk sexual behaviours than the other two talukas.

High-risk sexual behaviours were more common among devadasi women. Among men, those whose marriages had dissolved, those who lived in households with a low standard of living and those who travelled due to work were identified as high-risk groups. 

Revati was infected by one such migrant worker three years ago. Although she has given up her profession, she stays emotionally disturbed and under fear of death. “I am trying my best to do what I can for my two children so that after I die, they will not succumb to the same fate,” she says. Fortunately, neither of her children has contracted the deadly illness. She is now married to a lorry driver whom she met through the profession and is also employed as a community coordinator for HIV in the ART centre of the taluk hospital. 

Sanjana, on the other hand, is not quite fortunate. With tears in her eyes, she says, “I was able to work for 12 hours a day in the fields. Now, even six hours of work tires me. I get paid less for not being able to work for long hours. Relatives cut off ties with me after I was diagnosed with HIV. Who will look after my children after I die?” 

The counsellors at the ART centre of the Mudhol hospital say that one of the major challenges they face during counselling sessions with the HIV patients is making their partners, parents and families understand. “The reaction of family and society is what attaches shame to this disease, dissuading the patient to seek proper and regular treatment,” a counsellor, Saraswati says. The fear of being ousted from home or being shunned by partners and society forces them to either hide their disease or seek clandestine treatment at private hospitals, which is not quite easy. 

FSWs, particularly, face a lot of harassment from their partners sometimes leading to bloody fights. The disease not only costs them financially but also physically and mentally. Revati explains that since there is always a need and desperation for money, they are forced to agree to unprotected sex which pays them more. This leads to the spread of HIV, infecting more and more people. 

“Earlier, awareness about HIV was poor and the stigma, high. This meant HIV positive people not seeking treatment. Evidently, the mother to child transmission of the HIV virus was extremely high. This resulted in generations of children being born infected with the virus,” Dr Shashank Bhide, Senior Medical Officer of the ART centre, explains. 

Another major challenge is ensuring that the person diagnosed with HIV has a nutritious diet. “The drugs are powerful and therefore make a healthy diet all the more important.  Sadly, people are poor and often struggle to keep their heads above the water. On top of that, they have a family to feed,” Dr Rashmi says. 

A report suggests that at 30 percent, Bagalkot district tops the list of HIV prevalence among TB patients in Karnataka. HIV makes a person prone to other illnesses like herpes, pneumonia, tuberculosis (TB) and wastage in children. 

Sanjana’s youngest daughter has tested positive for HIV. While explaining her struggle, she reveals that her daughter frequently falls ill. She has now developed herpes on her back, making her irritated and more difficult for her mother to stay away from home. 

Dr Rashmi says, “When patients come for their monthly check-up, they are also tested for these diseases and provided with appropriate medicines. That is why it is crucial to be regular.” 

To help the vast number of HIV patients cope with their daily lives in the midst of this crisis, Dr Rashmi says, there are counsellors at the ART centre. “They are selected from amongst female sex workers to provide an incentive to the community of FSWs to leave the profession and look for an alternate source of income. They also help other families deal with the disease and try to purge the stigma around it,” she adds. 

“FSWs occupy the lowest strata in the society. The literacy rate is low. They have no real dreams for their children and child marriage is rampant. By providing them with counsellors who can relate with them and give emotional support, we try to prevent them from taking drastic decisions or slipping into depression,” she further says. 

The programme manager of Chaitanya, Mr Srikanth Kadam says, “We encourage the children of the FSWs to take up jobs of peon and attendants in offices. The women are encouraged to take up jobs of housemaids or agricultural labourers.” This organisation conducts regular outreach programmes to educate people about the importance of safe sex. They conduct the hand-to-hand distribution of “Nirodh” condoms, which are supplied to them by the Karnataka State Aids Prevention Society (KSAPS). KSAPS is the funding agency for other such community-based organisations like Jeevan Jyothi that provide targeted intervention in various districts to control the spread of HIV. 

“To stop the mother to child transmission, we have a dedicated a special maternity care ward where we keep the HIV positive mother under observation 48 hours prior to the delivery. We give her a certain kind of drug to stop the transmission. Hence, if a mother who comes to us for delivery hides her medical history, it increases the probability of the child being born positive,” informs Dr Suryavanshi. 

Dr Bhide, however, offers a glimmer of hope. He says, “Due to increasing awareness, the number of new cases has gone down. The mortality rate has also gone down. A person whose life expectancy was 8-10 years five years ago has now gone up to 12-17 years, given the person takes a proper diet, maintains hygiene and stays away from sexual intercourse with multiple partners.” 

The doctors and patients feel that much remains to be done to break the vicious circle of poverty and prostitution and the HIV menace. The literacy level should be increased and appropriate reservations should be there to ensure the availability of an alternate source of income. 

Sourav Bhattacharya, the nutrition specialist with UNICEF said, “the linkages between HIV/AIDS and undernutrition are both strong and long-lasting. Through a vicious cycle of poor immunity, disease and undernutrition, the impact is altogether devastating in terms of poor human and economic development, low food production and food insecurity, and poor individual nutritional status.” He explained that HIV’s overall negative socioeconomic impact is further intensified and accelerated in environments where food and nutrition insecurity and undernutrition is rampant. He suggested that strong monitoring to ensure successful and timely programme implementation is what authorities could do on the nutrition front to address the HIV cases. In this, there should be proper indicators for assessing progress, strengthening of network and sharing of lessons learnt particularly among affected communities.

Dr Bhide feels it is a funny situation. People in Mudhol are both hush-hush and complacent about HIV. Since the disease is so common, people have become indifferent to its seriousness. They become negligent about the treatment and go on with their lives as usual. “We as a society need to do more about accepting and supporting the people with HIV and at the same time not disregarding the urgency of this silent epidemic,” he added. 

* indicates that names of HIV patients have been changed


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