Persistent efforts, innovations show path forward in tackling HIV/AIDS challenge in West Bengal

Healthcare providers in West Bengal are grappling with new patterns of high risk behaviour that are making tracking and testing patients difficult, despite the case load remaining at stable levels

In the district of Paschim Medinipur, West Bengal, ground-level intervention health worker Nilanjan Sil recounts an increasingly common scenario. “A gay man gets married to a woman because of social pressure, but also has a male sexual partner outside of the marriage because he can’t be open about his sexuality in a small town,” he explains. “This creates a loop where, if the man tests positive for HIV, his wife, future offspring, and his other partner are at risk of infection.” 

Cases such as these are merely one of the many issues in the intricate web of challenges in West Bengal’s fight against HIV/AIDS. Though the overall caseload is not alarming, the changing nature of cases triggered by new behaviour patterns has made it increasingly difficult for healthcare workers in the State to track new infections.  

What is changing in West Bengal?

While India is doing well in its battle against HIV/AIDs, healthcare workers on the ground point to issues that could throw up obstacles.

Over 2.5 million people are currently living with HIV in India, but adult HIV prevalence is at 0.2 per cent and estimated annual new HIV infections are at around 66,400, said Union Minister of State for Health Anupriya Patel recently, citing the ‘India HIV Estimations 2023’ report. More than 1.7 million people receive free antiretroviral therapy (ART) through public healthcare systems at present.

As a signatory to the United Nations’ Sustainable Development Goals (SDG), India has committed to ending HIV/AIDS as a public health threat by 2030, and Bengal’s caseload is tied to this end goal. Immediate interventions, tracking, and containing of infections have become crucial steps in this journey. 

Sunetra Chowdhury, an Integrated Counselling and Testing Centre (ICTC) counsellor at the Government Medical College, Kolkata who has been working with persons living with HIV/AIDS says the centre screens close to 200 people every day, among whom 1% test positive for the infection. Ms. Chowdhury however points out that the real challenge is not the positivity rates, but “high risk behaviour among patients which makes partner tracking and controlling infection spread very difficult.”

These behavioural challenges are backed by recent data, highlighting sharp increases in new infections among high-risk groups. According to data shared with The Hindu by the State’s health department, the number of new HIV cases in MSM (men who have sex with men) has more than doubled from 482 in 2021-2022 to 1,058 in 2023-24. The numbers have also steeply risen -- over a fourfold increase -- for Injecting Drug Users (IDU) from 47 to 206 during this period. The number of new infections among sero-discordant couples (a couple where only one partner is positive) has gone up from 733 to 1,416 as per the data. . 

High risk behaviour

“Unprotected sex, sexual relationships with multiple partners who may not have been tested for sexually transmitted diseases and frequent changing of partners in this scenario, are causes of concern,” Ms. Chowdhury says.

In addition to this, social taboos and stigmas continue to linger: most people who test positive do not feel comfortable sharing, even with their healthcare providers, details about the number of their partners, partner types, or other high risk sexual behaviour, making it harder to track down potential patients and contain the spread of the infection. Through repeated counselling sessions, Ms. Chowdhury says, counsellors try to convince every patient to bring in their partner/s for screening and to build awareness.  

Another issue is injecting drug use. Despite increased awareness about the risks of sharing needles, healthcare workers across government medical facilities say this issue continues to persist. A group of friends tend to use the same syringe to inject drugs, which spreads the infection rapidly, they say. 

Counsellors like Arundhati Dutta at Kolkata’s MR Bangur Hospital are at the forefront of the problem. Sitting at her desk at the end of the day, she looks worried as she keeps calling patients who have newly tested positive, requesting them to come back to her centre to start their medicines. She talks of one male patient who tested positive, but whose wife was not. This patient, she says, also has tuberculosis and Hepatitis B, making him vulnerable. The issue however, she explains, becomes tricky to navigate as it becomes a marital issue between the couple, which also makes it harder to track down the source of the infection. There are many such cases at the centre, she says.

Interventions and the way forward

Field worker Amit Chakraborty, who does ground-level interventions to raise awareness and increase screening, says, “We try to identify communities where the number of cases is high, find people who may have high-risk behaviours, and start intervention.” 

One way of doing this is by involving the community: Nilanjan Sil who is part of the LGBTQIA+ community, works as a manager at the Sampoorna Suraksha Kendra (SSK) programme at the Medinipur Medical College and Hospital. Since he is part of the community his interventions meet with more success in getting patients to open up about their sexual relationships.

Despite this, resistance persists. Many people continue to be averse to the idea of counselling or medication, brushing off interventions. But Mr. Sil insists that face-to-face counselling works better in this regard.

Providing free bus, and train passes to help patients get to government hospitals, where they can be screened and be given free medicines, is one way the government is deploying to bring patients in.

Innovations are also part of the efforts: Mr. Sil for instance, has joined several dating apps to help connect with patients and understand behaviour patterns. “We meet on the app, anonymously, where I can counsel them and understand their needs to help serve them better.”

As Bengal grapples with a multi-faceted HIV/AIDS prevention and treatment issue, more innovative strategies, interventions, and repeated counselling will have to be stepped up, to usher in hope in the path towards achieving India’s goal by 2030. 

Published - November 30, 2024 03:00 pm IST