An HIV/AIDS-infected girl is carried by her mother to attend a peaceful rally to observe the Global AIDS Week of Action in the eastern Indian city of Kolkata in this May 21, 2008 file photo. (Parth Sanyal/Files/Reuters)

NEW DELHI (Reuters) -
Vast distances are a major hurdle to
India's efforts to curb its soaring HIV rate.

India, which has the world's third largest HIV-positive
caseload, gives drugs for free to HIV/AIDS patients. But
doctors say this is not enough to stop the spread of HIV which
is making inroads in rural India, especially among women
infected by itinerant husbands, and also children.

For three days a month, Sambit squeezes into a crowded and
often filthy train for a three hour journey to Delhi to receive
HIV treatment.

“There's no seat and I am very weak,” said the 30-year-old
former tailor, who asked that his full name not be revealed. He
can't afford lodging in Delhi and can barely afford the train
tickets.

“I need to borrow money from my family for all these
trips,” he said.

Many patients in the same position simply give up
treatment, an anathema in HIV therapy as it gives rise to drug
resistance. These patients may then need more powerful second
line treatment, which is not freely available in India.

“Travel can affect drug compliance. Patients who don't get
family support, women who may not like to travel alone will
just give up,” said a doctor at a New Delhi hospital, who spoke
on condition of anonymity because he did not have permission to
speak to reporters.

There are 147 “antiretroviral therapy” or ART centers in
the country, part of a government drive that has been
encouraged by the World Health Organisation in a bid to prevent
HIV from becoming a major health problem.

Delhi has nine such centers and is far better served than
many other states. Up to 6,000 patients receive treatment in
Delhi, nearly half of these live outside the capital.

The government now plans to build “link centers,” small
facilities that are closer to where patients live so people
like Sambit can obtain their medications more easily.

“They just come to pick up the drugs if they have no side
effects and they go home … that saves transport and other
costs,” Rao said, adding that the plan was to have as many as
500 such centers all over India.

INFECTION FIGURES AREN'T GOING DOWN

India has 2.47 million HIV cases, according to the latest
figures, but health workers say the number is rising rapidly
and spreading to new population groups.

“Our numbers are going up,” said Loon Gangte, South Asia
coordinator of the Collaborative Fund for HIV Treatment
Preparedness.

“It's not confined to high risk groups, it's going into the
general population. It's not a problem of sex workers, drug
users or truck drivers. These people have wives and children at
home and the disease is making its way into the general
population.”

Sujatha Rao, director-general of the government's National
AIDS Control Organisation, says doctors are increasingly seeing
women infected by their husbands.

In some clinics, 1 out of 100 women who come for ante-natal
care checkups are HIV positive, she said.

“It is a generalized epidemic,” she said. “We have pockets
where the prevalence is more than 1 percent among ante-natal
care mothers, so we need to intensify our work.”

Out of India's 611 districts, HIV prevalence is more than 1
percent of the population in 156 districts.

“The epidemic is getting deeper into (certain) rural,
general areas of the country … it is migrant-related. They go
to work and then they take back the infection to their homes,”
she said.

Even though HIV drugs are free, only about 155,000 people
have access to retroviral drugs, up from 20,000 just two years
ago.

Health expert say there are many people who do not know
they are infected or who do not know that treatment is
available.

Some health professionals believe India's HIV problem is
closely intertwined with poverty and that the government must
tackle poverty if it seeks to curb the spread of HIV.

“Many of these people are very poor, they worry about food,
shelter. So they may not think their HIV status is a problem
because they don't even know where their next meal is coming
from,” said Errol Arnette of the help group Sahara.

“A lot of AIDS patients die of TB because it's hard for
hospitals to keep them (in hospital). HIV patients are just
thrown in a corner because of heavy stigma.”

(Editing by Megan Goldin)