HIV infections

Nobody will guarantee that blood transfusion is 100% safe: NACO official

The politics of mega blood donation camps is interfering with quality control of blood collected, according to the National Aids Control Organisation.

A Right To Information query by activist Chetan Kothari revealed that 2,234 people in India contracted HIV infections from contaminated blood transfusions between October 2014 and March 2016. The data shared by the National Aids Control Organisation became the center of a wide discussion. Reports stated that the former minister and current Member of Parliament Jyotiraditya Scindia raised the question in the Lok Sabha asking the government whether it was aware of the problem. A report in Lancet, an international medical journal, also raised questions about the poor blood safety in India.

Any person undergoing a blood transfusion is at the risk of contracting transmissible infections such as HIV, Hepatitis B, Hepatitis C and syphilis, even though HIV infection is spread mainly through sexual behavior and use of needle and syringes. The role of the government is to ensure that donated blood is screened for these infections before it is transfused into a person requiring blood.

Scroll.in spoke to Dr RS Gupta, deputy director general and in-charge of blood safety at National Aids Control Organisation to understand the challenges for making blood transfusions safe in India.

How did these people contract HIV following a blood transfusion, given that it is mandatory for every blood bank in India to test donated blood before it is transfused to a patient?
When a person tests positive for HIV infection, we counsel them and take a detailed history to understand how they got infected with the virus. This is done to know the mode of transmission active in the community. Owing to the stigma attached to the disease, most people would say that they got the infection through blood transfusion.

It is impossible for us to go back and trace the blood that they were given and track the donor of that blood. Less than one percent of HIV cases can be attributed to blood transfusions. There was a time when close to ten percent of HIV infections were a result of blood transfusions.

What mechanism is in place to prevent spread of such transfusion transmissible infections?
Donated blood is screened for all transfusion transmissible infections before it is given to a patient in need of blood. We currently use the ELISA (enzyme-linked immunosorbent assay) test to screen the donated blood. The problem is that there is no test available which can say with certainty that the blood is free of any infection. If the blood donor was recently infected with HIV, Hepatitis B and Hepatitis C, the test will not be able to pick the infection from the blood. In medical terms we call it the window period which is when the blood, though infected, does not have the traces of the infection which can be picked by a test. Nobody will guarantee that blood is 100% safe.

In many developed countries nucleic acid amplification test (NAT) is used to test donated blood as it is more effective in screening the infection. Why is India not using it?
Yes, NAT is more effective a test compared to our current tests but it is very expensive. NAT is seven times costlier than the conventional test and it too can miss the infection. It can detect HIV infection in the blood in a seven-day window period, whereas ELISA will detect it between 21- and 28-day window period. Still there is a chance that infected blood will be given to a patient. Blood transfusion is a lifesaving procedure and just because there is a risk, we can’t let people die who are in want of blood transfusion. How is that right?

(At present 95% of the donated blood in the country is tested through ELISA)

We can’t use an old test (ELISA) just because it is cost-effective and allow people to get such life threatening infections. How can NACO ensure to people that the donated blood is free of any disease?
We need the community’s support for that. Blood donors need to give an honest and detailed history to the bank where they are donating blood. Before they donate blood, the counselors ask them questions about their sexual history and if they have suffered from any sexually transmitted infections in the past. A person who had jaundice should not donate blood. If the donor screening is done meticulously, the blood we get will be free of these infections. We are asking banks to display the donor screening form so that people who are not eligible don’t donate blood. We need blood but we also need quality blood.

If there is a mechanism to screen donors already in place, why is it not working?
Blame it on the political agenda (blood donation) camps. They always complain that we didn’t take blood of everyone who turned up for the camp. We brought 100 people and you are taking blood of just 80. It is not about numbers, we want blood donation camps every day in a sustained manner. I am not happy the way camps are being conducted in the country at the moment. We need blood across 365 days/12 months. Camps should be spread across the year to maintain a regular supply of healthy blood. We collect 12 million to 13 million litres of blood annually. I can’t deny the possibility that some blood can be infected.

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Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

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This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.