In the middle of pain, panic and woeful lack of information, Dr Anupama is undertaking the unenviable job of treating ‘Positive people’. The medical officer in-charge of ART (Anti-Retroviral Therapy) centre in Belgaum has to provide a fair dose of counselling, advice on nutritious food and make sure her patients are ready to take Anti-Retroviral drugs.

As any medical professional would acknowledge, treating HIV/AIDS patients is perhaps the trickiest one. To begin with, there are no definitive cures to the ailment.

Lifting them up from the negative and pessimistic psychological state, in which most of them aren't regular in taking the treatment, and helping them deal with the social stigma attached to their condition calls for doctors to be mentally strong and remain insulated from the sufferings of their patients. Many of them find it hard and give up treating HIV/AIDS patients altogether.

In this situation, Dr Anupama, a young doctor, considers her work at the ART centre to be a vital service to those who not only need treatment, but also care and support.

Anti-Retroviral drugs were out-of-reach of rural Indians as they were costing around Rs 10,000 earlier this decade. Though the cost came down to around Rs 2,000 with the advent of generic drugs, it still remained expensive. This prompted the government to provide them for free. For this purpose, ART centres across the State were established in April 2004.

Initially, three centres - Bangalore, Mysore and Hubli - were set up and 12 more started functioning last year, taking the total number to 15. The Belgaum centre opened in August 2006.

Nestled in the border between Maharashtra and Karnataka with a high migrant population, the district is one of the high-prevalent areas in the State, where more than one in hundred is infected with HIV/AIDS. Dr Anupama says establishing the centre is vital, as people here can't afford to go as far as Hubli or Mysore for treatment.

The doctor says 506 among the 2,031 registered patients who are in the third or fourth level of WHO guidelines, are currently receiving anti-retroviral drugs, while about 125 were transferred from Hubli, since the inception of the Belgaum centre.

“It's our job to make sure that all our patients get the drugs,” the doctor insists. “That is why we see the stock (of drugs we have) and then register patients for ART. Another important thing is that the drugs, once given, have to be taken for life without break, as any interruption would make the patient resistant to drugs.”

Patients are subjected to CD4 test so that the start of ART can be delayed. With good lifestyle and nutrition, one can lead a normal healthy life for many years without ART. The drug is recommended only for those who have a CD4 count of below 200, an indication of drastic reduction in their immunity levels.

“It's very hard sometimes to make patients see the point as far as the treatment procedure is concerned,” Dr Anupama says. “We take pains to explain during our counselling the need for nutritious food and good exercise, with which positive people can stay healthy. But most of them aren't convinced and insist on taking ART.”

She says even some private practitioners spread wrong information about ART, as most of them are not aware of diagnostic procedures, especially the need to take CD4 count. Once tested positive for HIV, they send them for ART, not realising that one need not start ART for many years.

She regrets that some are insensitive to the needs of patients in rural areas. “As most positive people need high-protein diet, doctors ask them to eat paneer and cheese. These are rural folks who find it hard to get a decent meal. How can we expect them to eat paneer and cheese?” she asks.

Persuading patients to take psychological counselling is another major challenge for Dr Anupama. This is vital since many positive people have high stress levels and depression. “They think psychiatric treatment is only for the mentally ill. But, I tell them that even I go for psychiatric help to reduce my stress levels,” she says.

More than stress, doctors like Anupama feel helpless when they try to calm down anxious patients. “I see girls as young as 16, infected with HIV and married barely six months ago, whose husbands are bedridden. Many of them are pregnant and are nervous about the possibility of their babies getting infected. Their situation makes me feel terrible.”

She says ART may not be a life-saving drug but, thanks to the medication, many who are on ART have been living with HIV for more than 15 years.