When 13 people in the hamlet of Premganj were diagnosed as HIV positive in one day last November, health workers in in Uttar Pradesh, India’s most populous state, knew something strange was happening.
As more cases cropped up in the district of Unnao, Scroll journalist Kanchan Srivastava reported that the workers have likely traced at least eight of the cases back to a single “doctor” who had treated the patients for minor ailments with compromised injections carrying the HIV/AIDS virus. The cases will be officially recorded by India’s Department of AIDS Control.
“In most of the cases there doesn’t seem to be any other way the infection spread than contamination,” says Amit Sengupta, a director at Jan Swasthya Abhiyan, a non-profit health network. Most of the cases were in children and the elderly, not high-risk populations.
Quacks—a common term, in India, for unqualified doctors—are a widespread issue in India, where the gaps between public health services can foster unregulated private clinics. Some regional surveys estimate that 70 percent of the health providers in rural India have no formal medical training, according to the British Medical Journal. Sometimes they have studied homeopathic or ayurvedic medicine, but under law are not supposed to prescribe allopathic (or mainstream) medications.
But since they’re often the only option, communities trust the "doctors" to dole out prescriptions and diagnoses. While researching malaria in India a few years ago, many rural Indians I spoke to told me they trusted these so-called quacks even more than government doctors because they gave out injections—which they deemed more effective—instead of just pills.
In the case of Unnao, reported across local media, a district hospital official had already ordered an investigation into the quack in question, months before the HIV cases were found. But Sengupta says this often yields few results: “In theory, yes, the administration is supposed to try to stop the practice, but actually that seldom happens,” he tells me. In other instances in India, fake doctors have performed life-threatening sterilization procedures on women without licenses, and last year one was accused of killing a 19-month-old child.
This makes it even more difficult for the country of 1 billion to curb HIV/AIDS rates. While the country has been able to lower its rates in the past two decades, a third of a percent of the population—around 2.1 million people—remains HIV positive. Interventions and public health programming are less effective when people rely on unreliable private clinics.
Meanwhile, the Indian government has started training quacks in an official capacity, hoping to provide them with safe medical standards and mitigate the danger they inflict on an unsuspecting population. But Sengupta said these initiatives are sporadic and slow moving, and can’t take the place of better access to both public and private care.
“The issue is not about the spread of HIV, the issue is that there is a clear lack of facilities either public or private practitioners that are qualified,” he said. “It’s an unacceptable situation.”
Correction 1/5/18: This article has been updated to clarify that "quack" is a common term used for an unqualified doctor in India.
Update 2/7/18: On Wednesday, Indian police arrested Rajendra Yadav, an unlicensed doctor who's accused of infecting at least 46 people with HIV by re-using a syringe. "He was arrested on a tip-off and is being questioned about his role in the case," Unnao police chief Pushpanjali Devi told the AFP. Authorities will do forensic testing on medical instruments in his possession. Still, Unnao's chief medical officer S.P. Choudhary doesn't believe one fake doctor is responsible for all of the new HIV cases, citing unprotected sex among a migrant trucker population as another possibility.
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