A month after India’s Ministry of Health and Family Welfare assured free treatment to all people who have tested HIV positive, at least six states have reported that they have run out of life-saving medicines.

The states are Bihar, Andhra Pradesh, Meghalaya, Nagaland, Maharashtra and Delhi.

Besides medicines, the diagnostic machines and kits that measure the immune levels of HIV positive patients are also out of stock or non-functional in Gujarat, Assam, Bihar, Uttarakhand, Mizoram, Andhra Pradesh and Nagaland.

On May 24, the National Coalition of People Living with HIV in India wrote to the National Aids Control Organisation, asking it to restore the supply of medicines and the services immediately.

The letter said that some patients have been forced to sell their valuables in order to buy drugs from the open market.

Antiretroviral medicines have to be taken everyday at a fixed time. Patients are advised to set an alarm clock to ensure that they take their medicines on time. Failing to adhere to this regimen can lead to drug resistance among patients.

Already, doctors say that some rural patients have stopped making the long journey to the Antiretroviral Centres at district hospitals, knowing that they are unlikely to receive their medicines. Some have even given up on the treatment.

Last month, before the Lok Sabha the HIV/AIDS (Prevention and Control) Bill 2017 was passed, Union Health Minister JP Nadda gave a verbal assurance that all HIV positive people would be provided treatment free of cost.

Earlier, the department was providing medicines to only those patients with a CD4 count of 500. The number is a reference to the level of CD4 cells in a patient’s body and is an indicator of immunity levels. The Ministry’s new “Test and Treat” Policy states that all patients irrespective of their CD4 counts will be provided treatment.

But the version of the Bill that was passed only provides for treatment to HIV positive people “as far as possible”.

Among other reasons HIV activists have criticised the Bill, they note that it offers no legal options in cases of stock-outs of medicines, like the present one.

Stock-outs temporary, says NACO

Though the National Aids Control Organisation said that these stock-outs of medicines and diagnostic kits are temporary, activists said that CD4 kits have been running short or completely out of stock for more than six months. These kits help doctors determine whether the medicine protocol is working for the patient.

Dr Naresh Goel, the Deputy Director General of the National Aids Control Organisation, said that the CD4 kits had been bought only recently, and prices were still being negotiated for the point of care CD4 machines.

On the medicine stock-out, the national body blamed the state authorities. “There are stock-outs of a few medicines in a few centres in these states,” said Dr Manish Bamrotiya, programme officer, Antiretroviral Therapy, NACO. “We have told the State Aids Control Societies to evenly distribute the medicines.”

HIV activists said that the National Aids Control Organisation and state officials are lax in planning ahead for medicines and diagnostics. “The state officials too need to inform NACO about what is their stock requirement on time,” said Firoz Khan, the national coordinator of National Coalition of People Living with HIV. “Only when the stock is over do these people planning.”