Bombay High Court orders second line treatment to people living with HIV/AIDS


The Network of Maharashtra People with HIV had filed a petition in public interest in March 2009 in the Bombay High Court against the Ministry of Health & Family Welfare of the Union of India, the National AIDS Control Organisation (NACO), Maharashtra State AIDS Control Society, Sir JJ Hospital and the Ministry of Health of the State of Maharashtra on the issue of provision of free second line treatment to HIV positive persons who were not responding to first line antiretroviral therapy (ART). The petitioners demanded that the respondents be directed to ensure that all those in need of second line ART on the basis of clinical evaluation be provided with such treatment free of cost irrespective of geographical location, registration with an ART centre, time-span on first-line ART or any other condition. The petitioners stated that despite the initial phase of the pilot programme for provision of second line ART being completed, there were stringent restrictions as to who can obtain the treatment at centres and that those restrictions were not based on medical need but on arbitrary cut-offs including length of time on first line treatment, residential address of the patient etc. The Network of Maharashtra People with HIV had conducted a fact-finding study amongst people registered at ART centres in Pune for whom first line treatment was no longer working. Details of eight such extremely critical persons, some of whom had a CD count as low as 14, were provided in the petition with their consent. The petition also pointed out the shocking revelation that people who are eligible for second line treatment were being made to sign waivers to the effect that whilst they understand that first line ART was not working on their bodies, they could not afford second line ART and would hence like to continue with the first line treatment. These patients did not understand what they had signed and the implications of such a waiver upon their treatment. The Government of India had begun providing first line treatment to people living with HIV/AIDs since 2004. However, resistance to first line ART had developed gradually as a result of which many persons were not responding to the treatment. After a campaign by several advocacy groups across India, the Government started a pilot programme in 2008 in two hospitals (Sir JJ Hospital in Mumbai and Tambaram Sanatorium near Chennai) for dispensation of second line ART. Under the programme anyone not living in the state was not eligible to receive the treatment regardless of medical need. It was further announced that from December 2008, the Government would bring eight more centres across India under the second line treatment pilot project. However, at the time of filing of the petition, some of these centres neither have drugs nor the facilities for testing and provision of the treatment. In an affidavit filed by NACO in the Supreme Court in October 2008 in a related matter, it was stated that the technical resource group at NACO had, on the basis of the prevailing scenario, recommended that second line ART be provided in a phased manner starting with a pilot project at two centres and that during the pilot project, patients who had been on ART at those centres for at least six months be considered for treatment. By an order dated August 13, 2009, the High Court recorded that the competent authority of the respondents had decided to provide free of cost appropriate treatment including second line and any other treatment as may be advised to the petitioners and any other patient with HIV. This order will provide relief to several persons across the country who are not responding to first line treatment but who are unable to obtain second line ART as they are not eligible under the arbitrary norms laid down by NACO.