The Catastrophic Illness After Migration

Capstone Health Siruguppa State Taluk Uncategorized

The Land of Paddy is now witnessing several HIV positive cases due to migration.

By Lanka Samanth

Bangalore, April 20, 2019

In the first-week of every month, Naqba (name changed) visits Siruguppa along with her five-year-old son. As a third wife to her husband, Naqba performs all her duties well. Drying like river Tungabhadra, Naqba is losing her weight. After losing around 15kgs now, she weighs around 40kgs. Her daily welding work and labour work in the season becomes difficult for the lean body to do. But there is no other alternative to feed her son unless she works and earns. Every night she thinks about her past and future. Not concerned about her life but the son’s. With all these thoughts, nightmares wake’s her up in the middle of the sleep. The light-headed woman feels distressed about her son, whether he also suffers like her. One can presume her as a thirties woman, after listening to her words “Now, I have only one child. My three daughters passed away a few years back.”

The Delayed Treatment

Naqba is unaware of several things happening in her life. She is unaware of the reason behind her daughters’ deaths. Likewise, she is ignorant of her condition and not used medicines for two years. After two years, in 2017 at Siruguppa AntiRetroviral Treatment (ART) Centre, her blood reports were one among the hundreds of cases registered with Human Immuno Virus (HIV) positive.  From then she is using medicines for HIV. HIV wipes out the immunity in the human body and leads to a severe health condition, if not treated. No doctor can assure for complete cure for HIV, except control with proper medication.

Naqba never gets involved in multiple sexual intercourses. When asked about HIV transmission in her body, she said that “According to doctors, I was infected through my husband.” Naqba’s husband married two women before her. He involved in multiple sexual intercourses at the work site in the cities. She said that “Previously we were dependent on agriculture labour work in our village, but from few years there is no work.” Then people started migrating to cities for work. Naqba’s husband is diagnosed with HIV positive after coming back from Cuddapah and Bangalore. He is a labourer at construction sites in cities.

Like Naqba’s family, thousands depend on labour work in agriculture farmlands, and rice mills. But now there is no work in farmlands, and rice mills in Siruguppa, (‘The Land of Paddy’). It is due to lack of rain and inadequate water supply from the river Tungabhadra.

The Land of Paddy

The entire region of Siruguppa taluka depends on agriculture. Siriguppa taluk spreads around 31.14 square km, with 84 villages, with a population of 52,492 is well known for cultivating varieties of paddy. Around 80 rice mills, a big number in any taluka in the state are present in the Siruguppa. This shows how agriculture is predominant in this region. The Land of Paddy is witnessing inadequate rainfall for a few years. This lead to migration and then an increase in HIV cases in the taluka. One can ask how lack of rain leads to a rise in HIV cases. “The number of cases is increasing consecutively every year and this increase is from past three to four years,” Suresh. K, Counsellor of Siruguppa ART centre and the local resident explain the sequence and consequences.

Around 90 percent of people in the Land of Paddy depends on agriculture. In recent years the farmers rarely see their land wet by rain. To feed their families and lead their livelihoods, people s migrates to cities for work. No city ever cares about farmers. By keeping their dignity aside, most migrants work at construction sites. Here, they end up in sexual relationships with co-workers. Women are sometimes blackmailed by contractors for sexual pleasure. The poor farmers know how to protect farmlands from insects but don’t know to protect themselves from Sexually Transmitted Diseases (STD). All the migrants come back to their villages during festivals, or when there is no work in the city. Along with the sum amount they earned in the city, few carry HIV virus in their body. Now, when they involve in sexual intercourse with their partners, HIV gets transmitted to the partner.

The worrying factor is, HIV transmits to the newborn if the pregnant woman is HIV infected.

“Last year four children were diagnosed with HIV positive,” said Ram, data manager at ART centre. The data says 603 male, 707 female, 50 male children, 53 female children, and 11 transgender HIV positive cases were registered in the ART centre from April 2015.

It is not the same in Naqba’s case where migration affected their life. In another migration story, a high-school qualified Venkatappa (name changed) rushes into ART centre. He is an employee in a petrol bunk and works in the afternoon shift. His chappals are wet by sweat released by his legs, and the shirt is damp with white patches due to sweat Venkatappa owns three acres of land. However, he is not cultivating crops. “There is no rain, what should I do?” The three acres of land has not ploughed since then. Now he doesn’t want to go to Bangalore after a hard time in his life.

It is the last time in 2009-10 that Venkatappa saw river Tungabhadra with adequate water. “My friends and I used to swim in the river at that time (2009-10)”. Later, he migrated to Bangalore and worked with a contractor for the construction of buildings. “There I had sexual affairs with co-workers and was infected with HIV”, said Venkatappa. Tears dropped from his eyes while saying about his wife; “I’m the one that is responsible for HIV transmission to my wife”. His relatives are aware of his condition but not that of his wife. He is one among the 1424 HIV patients who come to Siruguppa ART Centre for medicines. He takes medication for him and his wife as well and never brings his wife to the ART Centre. Because he doesn’t want others to know about his wife’s condition. “You know, How difficult is it to lead a normal life in the village with such condition?” said Venkatappa.  He started taking medicines in 2015.

Despite the increase in ART centres in the country, according to the United Nations Program on HIV and AIDS Gender Action Plan (UNAIDS GAP) report, India ranks three in the world HIV ranking. The rank is the same since 2013.

In Siruguppa ART Centre from November 2018 to February 2019 35 male, 39 female, and 3 transgender cases are registered. No children are detected with HIV in this time period.

Around 2 pm, gradually patients flow is decreasing. People come from different villages to Siruguppa to take their medicines. The last bus to every village is around 4:30 pm or 5 pm. Every morning from 9:30 am the crowd in ART Centre it is similar to the rush in the early morning Sunday markets. “The difficult task is to make patients come to ART and take their medicines every month on time,” said Praveen P, the lab technician, and Suresh. In rural areas, people consider HIV as a social stigma. This might be the reason for Naqba and not sending her son to school. HIV patients are discriminated and avoided by their co-workers at the work sites.

India in Human Development Index

In the case of Venkatappa, he does not want to reveal his wife is suffering from HIV. Likewise, most of the HIV patients hide their HIV suffering from the public. So, they avoid going to ART Centre, as others can see them taking HIV medicines. According to the United Nations Development Program (UNDP) analysis on Bellary district, this is one of the primary reasons for the increase in HIV infection among the patients who avoid treatment. The report states; the countries and regions with low Human Development Index have a high number of HIV cases. And India’s Human Development Index rank is 130.

Many people do not come on time and take their medicines. If HIV patients ignore the treatment or consume the medicines in altered timings, the infection spreads in the body. “It is important to take medicines on time,” said Suresh. The ART Centre duty is to inform Out-Reach Workers (ORW) regarding patient status. “We regularly complain to ORW’s about patients that skip the medication,” said Ram.

Naqba took her medicines and walking towards the Integrated Counselling and Test Centre (ICTC) lab. Praveen is busy in collecting samples for new cases. “After performing tests for two times, your son’s reports are negative,” said Praveen to Naqba. She is overwhelmed by the reports. But still afraid of her son’s health. That is because initially she faced the same situation and later diagnosed with HIV. Her fear can be backed by a proper reason as she diagnosed with HIV after the birth of her child.  The ART officials counselled her saying that if the report comes out positive, they will start a proper medication and the child will be fine. At this, Naqba’s eyes filled with tears.

The ICTC lab technician collecting the blood sample of a person in Siruguppa ART centre.

HIV, a Social Stigma in Rural India

The boy hasn’t gone to school yet. HIV patients are ill-treated in rural areas and kept in isolation. Naqba’s son is five-years-old.  The boys’ friends do not know what HIV is. However, Naqba doesn’t want to take any chances to let others tease her son about his mother’s health condition. Naqba’s son is playing with a plastic bag that she asked him to hold. The bag contains her medicine. She does not scold him for being naughty. She is very patient with the boy. “The only hope for my life is my son,” says Naqba before leaving the ART Centre. She informs Suresh that she will come next month and take medicines. Suresh nods his head with a pleasant smile and says “I feel bad for these people. All I can do is to pray for them.”

According to statistics provided by Ram, four HIV cases have been registered in the first week of February this year. “Some 997 patients are on treatment under our ART centre for the last financial year,” he said.

In his experience, Ram noticed a factor that the uncontrolled sexual desire constitutes for this catastrophic symptom; HIV. Middle-aged widow sometimes due to uncontrolled sexual desire, indulge in multiple sexual intercourses. “I’ve counselled a few HIV patients on such reasons,” said Ram “The reason behind not using the condom is; sexual partner asks why you are using a condom, are you suffering from any disease? But they never think of using the condom is having safe sex”.

CD Marker Cells in HIV Treatment

Previously the treatment is given to HIV patients whose Cluster of Differentiation (CD) marker cells count is less than 200. “Now it is changed, regardless of CD marker count, treatment should be given to the candidate who ever detected with HIV positive,” said Praveen. “CD Markers are used for the identification and investigation of cell surface molecules present on leukocyte. They are also named as Human Leukocyte Antigen (HLA),” said Sravani Gangula, a fellow in Doctor of Pharmacy. The line of treatment given for the patient is determined by the CD Markers count.

The walls of the ART centre counselling room witnesses many stories. Ram spoke to a few patients in person and asked them to collect their medicines. He reported that around 60 people skipped their medication in January. This is a serious issue to be resolved. “We are trying our best to counsel the patients for their treatment,” he said.

Besides Naqba and Venkatappa, HIV is detected in 650 villagers when they returned home from various cities. Some 300 HIV patients are sexual partners of the above- detected patients. “We have registered one transgender case in January. They were infected with HIV in the city,” said Suresh.

Some owners and contractors blackmail and offer money to women for sexual intercourse. Siruguppa ART Centre crew counsell such patients. HIV is highly prone in people that involve in sexual intercourse with sex workers. According to UNAIDS GAP report, of the reported HIV cases in India and other countries, sexual workers proportion is high among the infected. The UNDP analysis report on Bellary states that Siruguppa has the highest 15 percent of sex workers in the district after urban Bellary (26 percent).

Suresh said a noticeable factor; Kenchangudda Thanda registered the highest number of HIV cases. One among every four is detected with HIV positive in Kenchangudda Thanda.

  • Siruguppa farmers cultivate varieties of paddy.

HIV Prevalence in Karnataka

“Unfortunately the non-infected sex workers were also infected with HIV when they migrated to cities,” said Ram and Suresh in a discussion. Based on the case studies, if all these people are infected with HIV in cities, the HIV cases should be in large scale in the cities. But according to Scientific Research, compared with urban and rural Karnataka, HIV infection ratio doesn’t show much difference. Karnataka has 0.47 percent adult HIV prevalence higher than the national average, states NACO HIV Estimation-2017 report. It implies a lack of awareness among the people irrespective of urban and rural areas.

It’s not in case of Naqba and Venkatappa that migration is the reason behind HIV infection, many untold stories are the witness for HIV infection because of migration. According to Dayanand Patil, Tahsildar for Siruguppa, about 35 to 45 percent people from the taluk have been migrated and still few people are planning to. “We don’t record the data. It’s not only the farmers migrate to cities other people migrate for education, job or various other reasons,” he said. However, he agreed to the fact that most of the migrants are farmers.

A Survey in Taluk PU College

A survey conducted in Siruguppa PU College found that students are not aware of sex education. The class 12 biology students learn about the terms condoms, Intra Uterine Device (IUD), and HIV-AIDS. But woefully they use those terms only in the examination. Students asked a few doubts; how can HIV spread from male to female? Why multiple sexual intercourses is the reason for HIV infection and asked about other reasons that cause HIV? This states the level of awareness among biology students. Then what about a daily labour, a housewife, a farmer or a migrant in the taluk?

UNAIDS 2016-21 target is to achieve “Zero new HIV infections among children, and mothers are alive and well,” social protection to HIV patients, empowering young ones to protect themselves from HIV-AIDS.

After the survey conducted in PU College, after Naqba’s agony and worry about her son, after Venkatappa’s regret of being the reason for HIV transmission to his wife, and the lack of awareness and improper medication is the major reason behind this catastrophe. It is more like a social responsibility on every human to eradicate HIV-AIDS from this planet. May the world see a day with Zero new HIV infections!

(Note: Of the mentioned 1424 cases, statistics are available for 1402 cases. Remaining 22 cases have been transferred or dead but not registered yet.)

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