It was already late in the afternoon when I finally found time for my self and tidied up the mess in my office after the last patient was discharge from the room with a lingering advise that he report back in three days. Johan left the room and enquired “If anything happens could I call even before three days?”, “Yep!” I answered giving him the best smile I could muster for it had been a very long morning. The work at the Clinic would often leave the room filled with an aroma one could always identify with ‘The Hospital smell”; the fragrance a mixture of rectified alcohol spirit, a mixture of dettol, bleach and pungent aroma of tincture iodine formed a new fragrance which if bottled will be call “The Hospital”.

James, the cleaner barged in loudly his signature ‘bang’ hitting the tin dustbin to announce his arrival; to collect the day’s garbage from the clinic and the dressing room. He wore a gown and a bluish colored a mask and gloves. “ I sure am glad that you see reason now; it is good to practice Universal Precaution. About time to come to your senses Eh! James” I call out. James look up from those thick bushy lashes and mumbling some words nodded his head. The door swayed open and with bathed breath rush in the home care team nurse almost knocking the tin from James hands. “ We’re already late Doc…, we will be lucky if we can complete the day’s scheduled by midnight” she exclaimed loudly with her harsh voice. “We have a confirmed appointment to visit three new patients and commit to review four or five ongoing cases” she added apologetically and added “I am told that a few of our patients are getting ready to climb the stairways; all of them ready to move on …. kick the bamboo basket…”.

I gathered my stethoscope hurriedly and a few instruments, stuffing them in a disorderly heap into my bag which was already overstuffed. I followed June the home care team nurse. The van that waited outside the office was spewing smoke, purring away, all set for the day’s home visits. The van stirred from its slumber and soon we were on our way. Home visits are a bundle of mixed feelings of excitement, sorrow, joy, pain anger, often exhausting but always enriching. The opportunity to visit and be welcome to a new family is always an achievement. It so often happened that we were not accepted and are look upon with suspicion in their eyes. So, when we are accepted and we are able to put in some assistance such as counseling and treating the basic ailments that we really felt useful. The change of scene and the chance to get away from the ever-busy office is an added advantage of home visits for it also clear one of the monotonous air. The “Home team” for the day has June, senior nurse, Zam the senior counselor and the Vula the driver. We were also called as the ‘HIV and AIDS Care Commandos’.

We soon drove up a long stretch of greenery and over the hillock we were able to find a place to park the jeep. There were clusters of thatch huts in a neat row and were directed to the first house. Tintin and his family home we accosted poverty in existence with them and we saw the real and ugly face, the colors of absolute bankruptcy, the picture of lingering and ongoing hunger and pain. With each visit, each day we would return with a burden that became heavier and heavier. We carried those burdens that continue to linger on in our thoughts gradually taking shape in more visible ways. We finally came to discover the cause of apprehension and anxiety that often join us whenever we leave the Tintin’s home after each home visit. The realization was that the needy few families that we cared for are the ones that gave us the heartache that became more numbing and more piercing with the end of each day. The gratitude of the families the poorest of the poor that placed Burning hot-charcoals on our heads and cause us to wriggle in restlessness. Especially Tintin and his family touch our hearts and the nervous blushing his caring wife when we visit them. She was so ashamed at each home visit we made for she could not even offer us a cup of tea. Tintin was a chronic alcoholic and had had his share of the needle many years earlier when he was younger. He now looks like a 70-year-old man embraced by the chains of the virus and its gift of Tuberculosis in his early 30 years of age. He really was so thin that when I remove his multiple holed Banyan to auscultate his lungs. The ribs were like fingers of death that wound itself over his chest and the noises in his lungs audible without a stethoscope. He now depends on his wife who earns a few rupees each day selling vegetables. They had a lovely cherubic daughter of four years old. Her beautiful looks, cute smile with dimples whenever she does smile more than compensate her father’s scary looks from the hollow of the eye sockets in withered and wasted and abuse body. What touches me most was the cooking space that had the 3 stones place in a triangle that stood as the stove. The room was immaculately clean and too clean to be comfortable. The stove and cooking place was too clean that there were no ashes on the cooking area. It was then it hit us that they often do not cook which make it thus very clean. Our care, counseling, medications and free medications were welcome but they would not take money. With, a show of pathetic should I say sad act of bravado the wife would say ‘ I am a business women and I will take care of my husband and child’ and would never accept money which we would often offer. It later amounts to insult for them though deep in her heart she would know that that would sure bring in a kilograms of rice. Christmas was three months away, but we decided to build up an atmosphere of the coming Christmas and would give us an opportunity to help out our patients and their families. In the office we collect the amount under the provision of food, line and material support section and hold a meeting. Everyone, including the driver who would even assist in counseling would join the meeting. We went into details of whom to, and what to give? From amongst the 30 home care patients we had we narrowed down to 10 of the most needy families. We, brought a pot, pan with lid and a bucket for one and 10 towels. Then in the corner of my office stood neat plastic bags standing straight filled with 10 kgs or rice in each bag. The next few days were filled with touching episodes and happiness in the face of sadness and sorrow. There were tears of joy in each of the family and the family of Tintin shared the same.

We had visited Tintin when his wife was engaged at the the local vegetable market. Tintin was much better and some color had returned to his face and the noises of crepitations in his lungs could just be faintly heard like the distant sound of crikets in the wild. He coughs less now and even became naughty by stealing a puff of Beri (cigarettes) every now and then. We gave them the towel and the rice and he kept quite too proud to say thank you and looked the other way for he feared to shed a tear as a ‘Man’. We visited them again the next week and the whole family was there and his wife greeted us and said that she had save some money from the relief we gave for a few days from the kgs of rice. It came when they needed most; they fear to even pray for they felt too humble and sacred to ask even God. As we leave house I turned back and look at the oven, and there was Ashes! The blood rushed to my face and I flushed in excitement. My heart leaped to my throat and as I straighten my back from a half bending half-crawling outside the very low door of Tintin’s house. The sun was already way down in the western horizon feeling satisfied with a great day. The joys of laughter and the noises of happiness and the exhilaration of childish excited cries echoed in the nearby clearing. The sounds of children at play. Then the little one came running down the hillock with the golden reflection of the sun on those long brunette hair; she along with her chums the towel we had presented covered her small frail body and she held the towel firmly and securely over her small shoulders.

They all stood on the little porch of their small thatch building waving at us. We waved back with our hearts pounding fast with excitement and we patted ourselves in our minds for the happiness such small gestures gave us.

Our jeep took a turn and sweep away they three happy faces and we went down the hill as the sun took take a dip having done its job of shining down on the good earth. The sun in the western hills seems a little shinner as it prepared to take a dip beyound the next mountain to let the night in.

From THE BOOK

On my way to 5901 West Olympic Blvd to meet with Michael Gottlieb MD the Scientist who described the first AIDS cases in the world in 1981. This is and always is an honor to meet him. A brief article.

Michael S. Gottlieb and the Identification of AIDS

Elizabeth Fee and Theodore M. Brown

THE LEAD AUTHOR OF THIS paper, Michael S. Gottlieb, was, in 1981, a 33 year-old assistant professor specializing in immunology at the University of California Los Angeles (UCLA) Medical Center. When he asked one of his immunology fellows to look for interesting “teaching cases,” he learned of a young gay man with unexplained fevers, dramatic weight loss, and a severely damaged immune system. His mouth was full of thrush, or candidiasis, which was usually seen in patients with a defect in one particular component of the immune system, the T-lymphocytes. Gottlieb later described a process of reasoning that led him to conclude that that this patient was suffering from some syndrome that had not previously been reported.1 He discussed the unusual case with his clinical immunology postdoctoral fellows and internal medicine residents. Additional blood tests confirmed a marked deficiency of T-lymphocyte numbers and functions. Then a postdoctoral fellow who was using a series of new monoclonal antibodies to identify subclasses of T-lymphocytes was asked to examine a sample of the patient’s blood and found that the T-cells bearing the surface marker CD4, the “helper” cells, were virtually absent.

The patient was discharged from hospital without a definite diagnosis but 1 week later was readmitted, this time with fever and pneumonia. The resident physician was concerned about an opportunistic infection in this individual, who was known to have an immune deficiency, and he convinced a pulmonary specialist to perform a bronchoscopy and retrieve a sample of lung tissue for analysis. This procedure is commonly done in immunedeficient patients to identify particular microorganisms, thus allowing for rapid specific diagnosis and treatment. The diagnosis was Pneumocystis carinii, a rare but well-known cause of pneumonia found in some organ transplant patients and children with immune deficiency. The patient was treated and again discharged.

Soon thereafter, Gottlieb heard about 2 patients of Joel Weisman. Weisman and his partner were gay physicians with a largely gay practice.2 Both patients had chronic fevers, swollen lymph nodes, diarrhea, and thrush. Gottlieb tested the T-cells of Weisman’s patients and found they had the same abnormality as his original patient. Over the next several months, both were diagnosed by bronchoscopy with Pneumocystis carinii. Both also had the DNA virus cytomegalovirus (CMV).
The fourth case came to Gottlieb through a former student, Wayne Shandera, who had become the CDC’s Epidemic Control Officer in Los Angeles. Gottlieb told him that there was a new disease in gay men that seemed to have something to do with CMV and pneumocystis pneumonia and asked Shandera to see what he could find out. Shandera had a report sitting on his desk about a man in Santa Monica who had been diagnosed with pneumocystis pneumonia. Shandera went to see the patient and found that the man was deathly ill. The patient died soon after the visit; on autopsy, CMV was found in his lungs. A fifth case came from a Beverly Hills internist. This patient too had Pneumocystis carinii and CMV. Several of these patients went on to develop Kaposi’s sarcoma, a rare skin cancer sometimes found in older men or immunosuppressed kidney transplant recipients.
Gottlieb, an ambitious young man, was excited to think he might have made a significant discovery. He telephoned Arnold Relman, the editor of the New England Journal of Medicine, and declared that he had a story that was “possibly a bigger story than Legionnaire’s disease.”3(p1788) When Gottlieb described his patients suffering from this complicated new malady, Relman advised that, because publication in the New England Journal would take a minimum of three months, Gottlieb should first submit a brief article to the CDC Morbidity and Mortality Weekly Report. This would serve the dual function of alerting public health officials and physicians to the new disease and also stake Gottlieb’s claim to be its “discoverer.” A longer and more detailed account could then be submitted to the New England Journal.

Gottlieb followed this good advice and the result was the rather terse announcement reprinted here. It was generally overlooked; few physicians bothered to read the MMWR. A few weeks later, however, when Alvin Friedman-Kien published a description of twenty-six cases of Karposi’s sarcoma in gay men in New York and California, the media began to pay more attention.4 National Public Radio, the Cable News Network, the Associated Press, the New York Times, and the Washington Post all followed with stories. Gottlieb’s article in the New England Journal of Medicine was published a few months later and attracted enormous attention.5 As Gottlieb said later, the publication of this article changed his life. For several years, it was one of the most heavily quoted papers in the medical literature. The story would unfortunately prove to be a great deal more important than Legionnaire’s Disease.

In the New England Journal article, Gottlieb and his co-authors described a “potentially transmissible immune deficiency”5(p1425) and suggested that a sexually transmissible agent contracted at different times by the patients was the common factor. Asymptomatic infection with CMV had recently been found to be common among the male homosexual population, and acute CMV infection had been associated with immunologic abnormalities, including reduction in CD4 cells. They therefore hypothesized that a new strain of CMV had emerged in the homosexual population and was causing immune deficiency. They also acknowledged the possibility that CMV was a result rather than a cause of the T-cell deficiency and that some other undetected microorganism, drug, or toxin might be making these patients susceptible to opportunistic organisms, including CMV. In an editorial accompanying the publication of the article, DT Durack asserted that CMV infection was more likely to be an opportunistic consequence of immune deficiency than its cause.6

In the early 1980s, Gottlieb treated a growing number of patients with AIDS and continued his clinical research at UCLA, publishing over 50 papers on various aspects of HIV infection and treatment. He obtained one of the earliest National Institutes of Health grants for AIDS research, served on many AIDS-related boards, and became physician to the stars: Rock Hudson, perhaps the most famous of all people with AIDS, was his patient. Gottlieb was also one of the few scientists who were willing to talk openly to reporters in the early years of the epidemic. His colleagues and superiors let it be known that his frequent appearances in the media were unbecoming to an academic.7 Part of the problem, said Gottlieb, was that the UCLA Medical Center aspired to develop cardiac and liver transplant programs, and the physicians feared that if the hospital became too well known for AIDS, transplant patients might stay away.2(p98) They also foresaw that there would ultimately be a lot of AIDS patients without good health care coverage. AIDS loomed as a threat to the well-being of the hospital and Gottlieb, so publicly and professionally identified with the disease, was becoming a nuisance. Despite or perhaps because of his fame, Gottlieb was denied tenure at UCLA and went into private practice in 1987.

In 1985, Gottlieb and Mathilde Krim became the Founding Chairmen of the American Foundation for AIDS Research (amfAR), with Elizabeth Taylor as its Founding National Chairman. AmfAR would make a crucial contribution to AIDS research by supporting innovative projects; it would also help craft AIDS legislation, accelerate research on new treatments, and argue for rapid access to experimental HIV/AIDS drugs.

The Delhi Network of Positive People (DNP+) were crowned champions in the LEH LEH Sports inaugural tournament – ‘Kick for a Cause’ held in New Delhi on September 25th 2011. In all, 8 teams participated in this knockout tournament including a team of internationals living and working in the city. The DNP+ team were organized in defense and made the most of their goal scoring opportunities trumping the AIESEC Alumni team 5-1 in the finals.

The tournament was organized by LEH LEH Sports in collaboration with The Touch of Hope Foundation (THF- www.touchofhopefoundation.org) and AIESEC in Delhi University to use sports as a powerful medium to support AIDS Awareness. Reebok and Coca-Cola were key sponsors of the event.

Siddharth Pandey, the Founder of LEH LEH Sports said “We are delighted with the success of the tournament and the feedback we have been getting. Our primary objective was to get more people off the couch and on to the field and the huge turnout today showed us that increasing access for people to play sports will indeed make this happen. People are keen to play, yet unable to do so on a regular basis as it is not convenient. With our future initiatives, we intend to carry on facilitating increased participation skills, age and gender agnostic team sports”

Loon Gangte, Secretary of DNP+ and Captain of the winning team said, “We are very happy to have played in Kick for a Cause and this victory should dispel notions that we often encounter about HIV+ people. Thanks to all involved in organizing the event.”

==========
THF Media Posts.
Links:

http://www.sportzpower.com/?q=content/dnp-wins-‘kick-cause-soccer-tournament

The shuttle made a false start and then we went on to a new bus which was bigger. The tourists who joined us were late and noisy which annoyed the senior 65 + driver of the huge bus. When we reached Times square it was past 8:30 AM and the streets were not crowded yet. I hailed a cab and it screeched to a halt to see an Indian looking driver. He was happy to take me to JFK and when he help me with my bags asked “Going to Delhi?” I said “No, Not yet to California” and then we drove for the next half an hour to land at the doors of United.

The check in was quick as it seems that weekends New Yorkers or the tourist wanted to enjoy and not flock the airports. It was swift and here I am at the Red Carpet Lounge trying to catch up with some rest and also check my Facebook and other stuff. I board at 11:10 AM for a 5:30 Hours flight to Los Angeles.

I sigh a relief after a hectic week in New York.

Arrived at Chicago O Hare International Airport around 2:30 PM and the line at the immigration was so very long and with very few hard pressed officers at the immigration it took over 1 hours to get to the counter and finally get through the customs. The taxi ride was again over an hour as the football game at the weekend made the roads clogged with traffic and we moved at a snail pace this was however better than last week in Bangkok where it took 2 hours to cover 3.5 kilometers.

The city is cool and bright yesterday but cloudy and cold and wet today. The room at the DANA was nice and I have windows surrounded me (http://www.danahotelandspa.com/rooms-suites/) and I loved the view and the room. Looking forward to meeting Jean Marc and later in the evening Josh driving down from Cleveland Ohio for a reunion after ages.

A nice day.

I took the Meru Cab to T3 and the elderly driver was polite and it took us just 45 minutes drive. The airport was not too crowded and the usually hassle of going through the security check was gleefully avoided.

We went to Kingfishers Lounge which was quite splash of pinkish red and made reading the magazines an exercise and a challenge. The coffee was strong and the waitress had a nice smile.

The walk over the thick carpet was not too easy and the cabin size suitcase dragging was not an interesting episode. We boarded and enjoyed the cool AC for over 45 minute till the plane and the people inside were cool enough to brace themselves for a dramatic takeoff. Once we were airborne the flight seems to choose air pockets as almost all throughout the 2 hours flight to Imphal was one of the most jumpy and bumpy flight.

The air was cool and the lazy afternoon was evident as people laze around. As usual my PRIORITY tagged luggage come last on the belt. Am I the butt of airport loaders practical Joke – I don’t know but this I know I am or probably better off without the tag for having a tag of Priority bag seems to carry no meaning.

The first person I saw was my brother Sam. The next was a taxi driver Ibotombi who remembered me from months ago when I hired his cab. He was all smiles but lament of the bandh and sufferings of the common people of the Land of Gold.

Where do we draw the line and where do we say enough is enough and actually begin living life to the fullest is something other can decide for you but a task you alone can do.

As for example – I have access to Facebook on my Mac, on my Blackberry, on my iPhone and other gadgets and I brought a new TV which also have accessibility to Facebook and can connect via wifi to my TV and use the Facebook for which I need a wifi Netgear connector that will cost me Rs.4000 and then I can use my TV to access and connect with FB. The question is do I need it ? I am writing this blog update on my BB and watching TV on my Mac and my Panasonic TV is now required to access my Facebook.

The lyrics:

Every day, she cried the tears longing to live,
Living in a closet full of guilt, anger and fear;
Tears of loneliness, trembling hopelessly, uncontrolled -
Feeling hopelessness and waiting for the grave.

She lives now, a new life so vibrant,
The ‘meds’ wiped the tears, to set her free;
Transformed her, giving new birth a second chance,
Tomorrow is now hers … as is yours.

Rejection, sadness her only companion,
She lost her beloved, changed her life, so completely;
Clouds of pain, hardship, sufferings vanishes, hope remains,
Facing the future, filled with joy – without fear.

She lives now, a new life so vibrant,
The ‘meds’ wiped the tears, to set her free;
Transformed her giving new birth a second chance,
Tomorrow is now hers … as is yours.

They arose, from the dust — the land of living
The purpose of a life restored with courage and love;
Strong, mind and body, now they’re new faithful companions,
The world takes them now, as its own — once again.

She lives now, a new life so vibrant,
The ‘meds’ wiped the tears, to set her free;
Transformed her giving new birth a second chance,
Tomorrow is now hers … as is yours.

©Dr Chinkholal Thangsing 2007

“Power does not reside in institutions, not even the state or large corporations. It is located in the networks that structure society” – Manuel Castells

Background:
According to the National AIDS Control Organization expert group on size estimation, there are approximately 96,463 to 189,729 male Injecting Drug Users (IDUs) and 10,055 to 33,392 female IDUs in India; north-east India alone accounts for 55, 000 IDUs. Among IDUs, HIV prevalence of≥5 percent has been observed in 10 states . New pockets of IDU are being identified in different parts of the country, which require cognizance and action. India through its National AIDS Control Program stands committed to Millennium Development Goal (MDG) of reversing the spread of HIV/ AIDS by 2015. It is necessary to implement large-scale HIV prevention programme targeting IDUs and their sexual partners with evidence based interventions such as Needle Syringe Programme (NSP) and Opioid Substitution Therapy (OST). Currently many of these services are unavailable for IDUs in the community settings. It is important to ensure that these comprehensive services are available, quality assured, accessible and affordable to majority of IDUs. Adequate coverage with comprehensive interventions requires adequate resources and all efforts must be taken to achieve large-scale coverage to contain the HIV epidemic amongst the IDUs and their sexual partners. It is evident that there is an urgent need to bring comprehensive interventions to scale. To strengthen the existing IDU interventions the Global Fund has funded HIV IDU program titled: “Strengthen the capacity, reach and quality of IDU Harm reduction services” in India. The main objective of this project to is to strengthen the harm reduction programme in the country by improving individual and institutional capacities and strengthening of civil society. The strengthening of civil societies and institutional capacity building will be done by addressing the capacity requirement of harm reduction in the country, setting up of learning centres and by establishing and strengthening national and regional harm reduction networks in the country. As part of strengthening of national level harm reduction network, Indian harm reduction network was established in 2007 under DFID Challenge fund with a mission to secure access to quality health services for drug users within a rights frame work and to support the participation of drug users/primary stakeholders in service delivery and in policy/program development through capacity building, networking, information sharing, research, policy advocacy and collective actions.

The goal of the North Regional Harm Reduction Network Building Workshop is to support efforts in the reduction of HIV transmission and STI prevalence amongst IDU in the Northern region through network development. In April 2011, a three-day workshop “Indian Harm reduction network(IHRN) Strategic workshop” in the New Delhi was organized by Sharan under Global Fund Rd 9 HIV IDU project to strengthen the network. One of the strategic points in that strategic meeting was establishment and strengthening of existing regional harm reduction network. SHARAN the technical partner of GFATM RD9 HIV IDU project focuses on strengthening IHRN through its secretariat and training of key staff and its board members. SHARAN shall facilitate the regional networks meeting and help identify, establish and strengthening of the regional networks. Through a process of various workshops SHARAN will build up the network to a level where Indian Harm Reduction Network and member networks through its members can take up the peer education training of all Harm reduction interventions, which would lead to capacity building of state regional networks and also harm reduction sites in India.

Objectives of the Regional Network meetings:
The two-day regional workshop aims to:

1. Strengthen networking among harm reduction working groups in the region,
2. Share information about IDU harm reduction programs issues and challenges across the region,
3. Formalize the roles and responsibilities of the Regional network and regional working groups.

Goals:

• Analyze a future regional network in South America, its goals, priorities, and actions.
• Identify regional elements for network plan.
• Identify existing relevant networks to engage.
• Identify and recognize critical challenges in the regional and states level harm reduction programs the region.
• Make recommendation that is specific to the project needs.
• Communicate ways to benefit from technology on the web.

To achieve these aims, numerous activities are planned. Participants will concretely build the regional network through experiential exercises and activities. Participants will also engage in regional networking opportunities for those who share common interests. This workshop provides updates on the situation of IDU harm reduction strategies in the region and at national level, especially in regard to HIV among IDUS. Participants will also update each other on regional and share experiences on their IDU harm reduction work. In addition, participants will formalize the roles and responsibilities of the regional network working groups.

At the end of this workshop, participants are expected to have developed a network identity (develop a name for the network), increased contacts with other individuals working on similar issues in other parts of the country , and identified individuals in other regional and national with expertise in areas of shared interest. Participants will have a greater understanding of IDU HIV issues regionally and at national level. Finally, participants have a greater understanding of the organizational structure and processes of the IHRN and regional network. Thus, this workshop strengthens the regional harm reduction network and IHRN by formalizing organizational structures as well as individual relationships between participants in the network.