April 10, 2008	Thursday	Rabi-us-Sani 3, 1429

KARACHI, April 9: Thanks to bureaucratic apathy, a significant HIV and Aids care and therapy project has not been commissioned at the Jinnah Postgraduate Medical Centre (JPMC) despite the lapse of a year.

Given the rapidly increasing numbers of HIV/Aids patients in both Sindh and Karachi, the Sindh Aids Control Programme (SACP) identified JPMC for the establishment of a centre of excellence about a year ago. The centre aimed to increase the provision of HIV-care services and provide antiretroviral therapy for patients testing positive to the deadly virus.

During a detailed discussion between JPMC and SACP senior administrators, it was decided that the former would provide the centre space within its premises and facilitate liaisons between the relevant departments.

However, the retirement of the JPMC executive director – during whose tenure the agreement was made–prevented the project the project from taking off as planned. The hospital was originally requested to provide at least two rooms, as well as a waiting area, for the establishment of the Aids/HIV centre but the project is still waiting for clearance from the federal government, which governs the affairs of the 1,200-bed public sector hospital.

One source said that any developments related to the proposed centre were further delayed because of the fact that JPMC officials had suggested to the new executive director that the new centre could be set up only when the SACP, the JPMC and the National Aids Control Programme (NACP) signed a memorandum of understanding.

The source told Dawn that first the JPMC executive directors and SACP officers took time in drafting the MoU; then the federal health ministry, which had been forwarded the MoU for clearance and vetting by the federal government’s law and justice division, delayed matters.

According to a JPMC source, the draft of the MoU was sent to the senior joint secretary of theMinistry of Health in May 2007, followed by a request sent in August, asking for the draft to be examined on a priority basis. However, this drew no results.

Meanwhile, said the source, JPMC and SACP authorities could not speak about the status of the much-needed centre or that of the MoU draft given the absence of any feedback from the ministry or the law and justice division. “The JPMC has nearly forgotten the project,” said the source.

There are currently three centres, one of them in the private sector, working as designated facilities for the integrated treatment and care/prevention programmes against HIV/Aids under the NACP and SACP in the province. Experts and medical professionals believe that this is insufficient and there is an urgent need to establish such a centre in every tertiary care hospital in the province – which is home to about 50 per cent of the known Aids/HIV patients in the country.

Of the estimated 2,000 individuals diagnosed with HIV/Aids, 290 are currently registered at SACP centres while about a hundred are being provided antiretroviral treatment. However, the SACP lacks facilities to address the surgical, eye-related or gynaecological requirements of its registered patients. As a result, there remain the chances of HIV/Aids patients mixing with other patients and the resultant knowing or unknowing spread of the virus, said sources.

Fallen by the wayside

In anticipation of the HIV/Aids centre project being treated as a priority, one of the partners in the JPMC project – the Global Fund to Fight Aids, TB and Malaria (GFATM) – recruited amongst others a full-time doctor, a counsellor and an outreach worker some months ago. These professionals are now working at an SACP centre of excellence in Karachi.

Significantly, the contracts of these staff members are due to expire within a few months; the resultant dearth of qualified practitioners is bound to be felt once the much-delayed MoU is signed between the JPMC, the NACP and the SACP and the centre is established.

Under the draft understanding developed between the various partners of the JPMC project, HIV treatment and voluntary counselling activities were to be financed by the NACP through the GFATM for a year.

Similarly, alongside its other functions, the NACP was also meant to provide antiretroviral medicines including the first line regime for infected adults and children through the SACP to the centre for excellence.

The SACP was meant to provide free consultation services with physicians specialising in infectious diseases, working at the SACP’s centre of excellence at I.I Depot, Karachi, and ensure complete confidentiality to patients in terms of investigation and treatment.

The JPMC, meanwhile, was not only meant to provide two rooms and a waiting area to the centre of excellence but also treat patients at the proposed centre in accordance with hospital policies, facilitate monitoring visits and allow access of facilities after receiving information about a visit.

It was also part of the understanding that if needed, the JPMC would nominate doctors from the medical, gynaecology, surgery and paediatrics wards to be trained on antiretroviral treatment and the counselling of Aids/HIV patients.

Professor Rasheed Jooma, the executive director of the JPMC, conceded the importance for a centre of Aids/HIV in Karachi, which has its share of high-risk groups such as intravenous drug users, overseas workers, male sex workers etc. “After being posted as the executive director of the JPMC, I also took up the matter,” he told Dawn. “But it has developed at a very slow pace and during my next visit to Islamabad, I will definitely make inquiries at the Ministry of Health about the status of the MoU and make efforts towards expediting the setting-up of the centre of excellence at the JPMC.”