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Dear Alankar Malviya,

I work as the Officer-in-Charge of the ICTC at the Government Hospital at Srivaikuntam, in Tutucorin District. On the District AIDS Prevention Control Unit (DAPCU), I would like to respond to the sub query namely:

What are the examples of integrated public health services that the DAPCU can follow to integrate NRHM, RCH and TB Control services with HIV prevention and Care?
Presently, when we refer a Person Living with HIV (PLHIV) to the district centre or Head Quarters Hospital, the accompanying worker is from the Social Welfare Department. Therefore, the person from the Social Welfare Department takes the PLHIV to the referral hospital, gets the medicines, and arranges the services, as well as accompanies the PLHIV for testing. At times, after the first referral, consequent treatment and follow up may be missed because the Social welfare workers are from NGOs, and cannot be brought to book if they do not report back to the village or Primary Health Center from which the patient was originally referred. Moreover, if the workers from the Social Welfare Department only decide not to report back to the village health center then the PLHIV will suffer.  At times, the workers from the Social Welfare Department come to the doctor and demand that x-rays be taken for a patient, without telling any other history. We also have come across some incidents of them taking bribes in some cases for providing services.

Additionally, since the whole village is one small community, confidentiality is very important to a PLHIV, than in a bigger place. When a person from the Social Welfare Department accompanies the patient a couple of times, it becomes an open secret as to what could be the reason. In addition, the Social Welfare worker often discloses to his spouse why he has to go to the district headquarters or the city. Thus, the confidentiality is broken and the attendant stigma and discrimination and the fall out of it, including the myriad consequences has done more damages than good.

Alternatively, the Health department may itself provide people in lieu of those from the Social Welfare Department. If we in the Health Department are so flexible to have the consolidated pay scheme then why do not we have people from the health department accompanying the PLHIV, as done in other health matters be it polio, blindness or antenatal cases? There are many qualified Village Health Nurses without employment who are present in the village and district level and they would benefit from such appointments. If a PLHIV transportation incentive is given to the village health nurse, then they can take the PLHIV to the district centre. This will camouflage the PLHIV referral with many others and thus avoid the unnecessary publicity as blatantly occurs when the social welfare department people accompany the patient.

Are the present guidelines prepared taking into account the existing institutional arrangements or does it require modifications?
Every time when we say these suggestions, the District AIDS control officers who call for the monthly meeting for counselors and lab technicians, state that they are only implementing the policies that is got from the centre. They do no t come to the field level. Only then, they can see what is being achieved in the hospital and how things can be rectified. “We just follow instructions, and we cannot make suggestions, or represent the drawbacks”, is the stock reply. Consequently, we are left to conclude that there is no use of having all the District level meetings if the suggestions from the field are not valued or heard.

Dr.  Patricia,
ICTC, Government Hospital,
Srivaikuntam, Tutucorin.
patriciaselvan@gmail.com