Kolkata: In a small dispensary on the ground floor of a nursing home in central Kolkata, an elderly British doctor is the last hope for a steady stream of HIV carriers waiting for free distribution of exorbitantly priced second-line anti-retroviral drugs to prolong their survival.
For the likes of porter Rajiv Yadav, plagued by a disease that is considered a stigma and faced with discrimination and high cost of treatment, which combine to a cocktail as lethal as the fatal inevitable end, the grandfatherly Briton, Jack Preger, is the god who has not failed them.
Preger has not only rushed to a HIV/AIDS combat zone that even the Indian government with its high-on-propaganda-low-on-action report card has so far feared to tread but also offers monetary support to people like Yadav to pay his monthly room rent.
Thirty eight-year-old Yadav and countless others, who are now on the costly second line of drugs to survive, do not receive any assistance from the government. So it is natural that patients who pour in at the Calcutta School of Tropical Medicine (CSTM) here are frequently referred to Preger for free drugs.
The monthly treatment of an HIV carrier on the second line of treatment is anything between Rs.2,500 and Rs.9,000 per month, something unaffordable by Indian middle class standards.
According to UNAIDS statistics of May 2006, India has 5.7 million people living with HIV/AIDS, ahead of South Africa where the figure stands at 5.5 million. Official Indian statistics however put the number at 5.2 million.
"I was a TB patient and then one day during a blood check up I was detected with HIV. Since then it has been a long struggle and life has been akin to carrying the burden of a corpse. I feel weak and am unable to bear heavy weight," says Yadav, who migrated to this eastern metropolis from Bihar's Samastipur district.
"Now the sahib even pays my rent of Rs.500 every month," says Yadav with gratitude.
Says Aparesh Das (name changed), a haemophilia-affected 29-year-old from neighbouring South 24 Parganas district: "I have to undergo blood transfusion and that cost itself is huge. So far I have always purchased my medicines but I cannot afford it any more."
Aparesh, who is married and resides in a place which is about three hours journey from Kolkata, is helpless since he lives on the income of his father and the tuitions his wife gives to local students in their village.
"Nowhere in West Bengal could I find second line of drugs for free or even in subsidy. I work in a small private firm and my employer helped me initially. Now I would die but for the help of Preger," says Raja Mitra (name changed), a 47-year-old father of five daughters.
Preger, 76, with resources generated by his own efforts from friends abroad, has taken up the burden of treating AIDS patients, offering them second-line drugs under the ART (Anti-Retroviral Therapy), free of cost.
ART refers to any of a range of treatments that include antiretroviral medications. These drugs are designed to destroy retroviruses such as HIV, or interfere with their ability to replicate.
"I managed to start this clinic and run it with support from groups in six nations. I am leaving for Spain soon to collect funds," says Preger, who arrived in Kolkata from Bangladesh in 1979 as a Commonwealth citizen. He started his work with the destitute living on the streets, a programme which is still run under the name of Calcutta Rescue and funded by support groups in Europe as well as locally.
"I want to say 'no' to more patients needing second line of treatment but I cannot really refuse them after all when they come," Preger says.
"All the money is spent on awareness campaigns. The sufferers should be taken care of by the government. It is also crazy that Indian companies like Ranbaxy are exporting the drugs abroad while in India it is not yet approved," said Ranjit Biswas, a doctor assisting Jack Preger.
The Calcutta School of Tropical Medicine (CSTM) also acknowledges the services of Preger.
"Jack Preger is really doing a great service. He is giving a lifeline to people and is very considerate with our requests. We have asked him to send us his patients receiving the first line of treatment, and take from us those who need second-line of treatment, which we cannot afford," says S.K. Guha, in-charge, ART Centre, CSTM.
"The government is collecting data from various ART centres about the exact requirement of people who need second line of treatment, which is very complex, costly and difficult," Guha explains.
"The second line has side effects too and so we try to keep the patient on first line mostly," says Guha.
"Efforts are on to reduce the price also and make the drugs cost-effective," he says.
The drugs used in second-line therapy are patented, produced and sold by mostly multinational pharmaceutical corporations.
Ranbaxy Laboratories Ltd recently said that the World Health Organisation (WHO) has included four of its additional anti-retroviral (ARV) products in its pre-qualification list. The products approved by WHO are Efavirenz 600 mg tablets, Efavirenz 200 mg capsules, Stavudine 30 mg capsules and Stavudine 40 mg capsules, the company said in a statement.
"We strongly feel that generic ARVs are essential in the struggle against HIV/AIDS and are committed to providing high quality, cost effective generics," said Malvinder Mohan Singh, Ranbaxy CEO and managing director.