HIV Tales from my diary-Tale 8

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There are very few Moments of pride in everyone’s life. Most relevant out of such moments can be when a father is recognized by his progeny’s ( son or daughter’s) name. For a learned student ( read doctor) , getting a referral from his mentor / teacher is a matter of pride. People like me also feel proud when one of the seniors ,who is your role models too, poses faith in your abilities. It was one such moment in my life when a role model like senior ( once classmate in school and a dear friend since then) Dr. Kukreja, a renowned physician referred a patient to me. The referral was from a distance of 100 odd kilometers but this was only a small prize ,compared to referral by him , ( after all I was one of the only ten twelve physicians all over the country , who started treating HIV patients). Seeing his referral slip, my joy knew no bounds. But the effervescence of joy settled soon in vapors of hesitant worries, when ,I realized that a eunuch was in front of me with a positive HIV report (on preliminary testing). Some unknown fear scared me while trying to counsel and enquire about her history ( personal family and sexual )which is important for we the doctors. The path of my search for mode of transmission of HIV in her was laden with speed breakers. After all this was my maiden experience of this sort. 
It is estimated that there are 50,000 to six million eunuchs in our country and they mostly live in Mumbai, Chennai, Kolkata and Delhi. 

Historically , the 

 legend in the Mahabharata ,is that ,Aravan was the son of Arjuna and Nagakanya. Aravan offered himself to be sacrificed to Goddess Kali just to ensure the victory of the Pandavas in the Kurukshetra war. 

The only condition that he made was to spend the last night of his life in matrimony. Since no woman was willing to marry one , who was doomed to be killed, Krishna assumed the form of a beautiful woman called Mohini and married him. The hijras of Tamil Nadu consider Aravan their progenitor and call themselves aravanis. 

The hijra community is divided into seven houses, each headed by a `nayak’ who appoints gurus or spiritual leaders to train their wards or `chelas’ in badhai and protect them. Hijras in South India do not have the same cultural role as their counterparts in North India and most of them take up sex work as a means of earning a living. 

Kothi is a term used to describe male homosexuals who take on the female role; Many kothis marry owing to family pressure but continue to have same sex relationships. 

Eunuchs have ambiguous backgrounds. Some of them are intersexual; others are born male and fail to develop. Gay men and transsexuals also are included in their ranks, according to experts who have worked with the community. Contrary to popular belief, most are not castrated, says Ashok Row Kavi, president of the Humsafar Trust in Mumbai, a male sexual health. 

Eunuchs ( also known as Hijras or khusras or third gender )used to scare me otherwise also , ever since my childhood for some unknown reason. Until the day of my brother’s marriage when they came asking for Shagan. Their demand was beyond the limits of my parents supply of currency annually. An argument erupted and it soon acquired threatening proportions and one of them threatened to do a naked dance ( routine method employed by them to fleece and scare ordinary people) in case their demand was not met with. By now , I had , however graduated as doctor and was posted in civil hospital, Jalandhar. I thought of scaring them with my Daktari and challenged them to do a cabaret as I was not scared to see naked bodies .Female folk of my house didn’t like that and ultimately the feud ended with some bargaining on both sides. 

The drama ended with scope of replay after an interval later in life and leaving a strange taste in mouth. Answer to the question “How many years later it will happen “, was hidden in the uterus of mother future. 

The delivery will occur in the name of Neelam twenty five years later was not known to me. In that moment of my pride was hidden a moment of fear too. In a bid to postpone the fear, I looked for an escape route and asked for some more tests including confirmatory tests of HIV. Not only that I requested her to meet me in Pathankot itself ,where I was to visit seven days later , to address a gathering of doctors about my experiences face to face with HIV. I told her the date of my visit with a thought in the back of my mind that I will use my seniors shoulders to allay my anxiety and fear and examine and take history there only in his presence. Ek se bhaley do, I thought. The time to to see an eunuch naked -had arrived after two and a half decades and there was no chance of any negotiation or threat was possible this time. The week passed by in a jiffy. I reached my friend’s clinic cum residence and found Neelam waiting for me. I shared my fears with Dr. Kukreja and asked him to accompany me to examination chamber for examination etc. He was as reluctant as me. We however gathered loads of courage and went on to just see her reports and her private parts. She had tested positive for HIV confirmedly and had anal warts. Her viral load was high and Cd4 low. Mental barriers got broken and I prescribed her the medicines, which I told will be available from Amritsar only and will be costly. She told me to visit next day for collecting them. Another day to face her was my next challenge but by now I was better prepared mentally. 

Her next visit to my clinic was a revealing and learning day. Neelam was one of the four siblings of her parents. The whole family knew her reality as she was living away from them but was in regular touch.Money was the common link between separated daughter and the family. She used to literally pour in money for the family , the same family which was reluctant to see her in broad day light because of nightmares they thought may surround them. Her two sisters were married in distant towns and wanted physical and mental distances to be maintained. Parents were aged and ailing. The only brother loved her very much as per her opening introductory statement of her family , to me. But as the wrappings of relations were being unwrapped, the reality which emerged was no different than the true story of modern day relation’s. Pyaz ke chilke utartey gaye, pole khulti gayi, under kuch tha hi nahin ( as onion leaves got peeled off, nothing was inside) . Her brother’s love was all due to money. Neelam was a ” kothi ” and favorite of her Guru. Guru used to have anal sex with her and inturn she will have plenty of money at her disposal. Her sex work will add to her income. Her own requirements, cosmetics of various types were not at all heavy on her heavy pocket but the affectionate brother of hers never forgot to lighten her purse and that too on a regular basis. He could build a house and hefty bank balance despite being unemployed because of his sister’s earnings. After all, his sister was a khusra ( means impotent) and not potent like him. To me, brother was actual impotent in terms of erections of income on his own, whereas Neelam was the potent earner for her brother and his fulsome family of a wife and kids and will always ensure orgasm. 

As the news of Neelam was broken to her brother, he offered all monitory help to her and promised to be her pillar of strength morally and money wise . I put Neelam on Indianavir ( considered potent PI with lesser pills to be taken per day,at that time. This is a drug which is obsolete now, although ) along with Zidovudine and Lamivudine combination. The total cost per month was around 4000 rupees in those days. But money was no issue with her to begin with. She started gaining weight, was happy and started doing well. As a routine , I used to keep telephone numbers of my patients in those days, so that I can remind them about medicines , just to ensure Cent percent compliance. 

Neelam , however refused to give me her number as she apprehended bad name to the whole community of hijras which may lead onto stoppage of their earning by way of sex work. Although she did not give me her telephone no. yet she was regular in her treatment and I hardly needed to remind her , except once , may be after six months of initiation of her treatment. In a bid to contact her , I chose an indirect route and called Kukreja, but he had no clue to her whereabouts. I had no alternative but to wait and pray for her. 

My wait ended after six months when she was back in a worsened state of health. She had stopped treatment as her brother refused to support her and even refused to give her own money back. Even she had fallen from grace in the eyes of her Guru, who was no more a gold mine for her. The sex work stopped. Neelam’s purse became air light. 

Now she wanted me to put her on cheaper medicines. I bowed to her wishes as I thought something will be better than nothing. I started with a combination (Zidovudine,Lamivudine and Nevirapine ) whose cost was less than half of her earlier ART cost (1500 rs. Per month). I wanted to help her live potently. 

Next few months saw not much improvement in her condition. Even my lucky (roll )number 213 ,which saw me enter medical profession and which was also the file number of Neelam in my records,was failing to change her luck. Her visits weaned off in a way no mother weans off her breast fed child, abruptly. She evaporated in thin air. I believe , she must be remembered in past tense by her family by now, if at all they remembered their kamaoo putt( earning son). For me , however , she can never be a past tense as even after her death (?) she left me wiser , freer from fear of eunuchs. The result is that now I face the community more confidently without hesitation. 

May she be a liberated soul

Rakesh Bharti 

( Neelam is a changed name to protect her secrecy and dignity). 

Post script : I was never hassled by Hijras after the marriage of my two sons , may be the community knew that I knew 

HIV Tales from my Diary-Tale 9

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Tale of Coincidences. Paulo Coelho is an Alchemist who has given a simple formula of turning any metal (sadness ) to gold ( happiness). He says,happiness can be attained by knowing the universal language. This language is akin to computer language and is only binary. The two main components of binary universal language are love ( 0) and Fear(1). The moment one learns them well, the whole universe starts conspiring for ones happiness. Beauty is that this language has no grammar, it can only be expressed and felt. You can always express and feel love and fear. 

This tale of Bimal and Satinder is a tale woven with these two emotions in plenty. Both were dieing from the fear of death a decade ago and are now alive and living with love surrounding them all around. 

It was almost the same time when their respective worlds were crumbling. 

Bimal’s wife was sick like death itself and was reduced to bones only. Her fever , reduced weight and some swellings in neck and axillae ,misguided, as usual , the most enlightened. She was taken in the lane of a Mycobacterium Tuberculosis. The path was suggested by none other than a specialist on the presumptions alone. It is not so uncommon,to not bother about evidence for over confident people with a Masters label as suffix. The only vision many masters develop is tubular. Same happened in her case ,the over confident specialist ,started treating her with DOTS ( Daily Observed Treatment of TB , the treatment modality adopted by WHO at that time – which of course also has fallen from grace ,naturally ,now because of its faulty design ) , missing the cause of immunosuppression and refusing to look beyond his own vision. He was like an ox with shields around his eyes and going round and round for extraction of oil (कोल्हू के बैल की तरह ). Somehow , Sukhwinder, was brought to me one day. 

She was married to Bimal since 1997. She was only 27 ,when she was found to have HIV in 2006. I sent her to VCTC a govt. Agency to confirm me fears and her diagnosis. The confirmation came too for the couple , although. Further investigations found a store house of cryptococci ( a deadly fungus) in her totally immunocompromised body. She was offered best of the treatment by me ( VCTC specialists lacked the knowledge and material then ) but it was too little too late in her war against survival. She succumbed sooner than expected and left behind a helpless Nirmal and her seven year old son . Bimal went into te pence mode instantly , he felt guilty for her death. His repentance, of one night stand without protection ,was however meaningless. It was he who actually died that night wen lust took over love. He remembered the night which looked bright at that time, the night whose one moment of pleasure darkened his many nights ahead. His suffering from Herpes Zoster a viral infection after sometime of that pleasurable moment was a pain for him and his physician both. The alert Physician , in his case was pained to inform his HIV status to him in 2003, itself. Destiny forced him to shut his eyes to stark reality of death and he overlooked the danger. He passed on and lost his partner in life to the death , deservedly . Her death made desperate and he started looking for ways to sign off from this world. His world , however, was now limited to aging parents and a lively son. All of them ,drew boundaries around him and he became determined not to invite death for them. He started his own antiretroviral medicines in the form of Zidouvudine plus Lamivudine and Nevirapine from govt run ARV center. He insisted to have medicines from

market as he has not only lost his wife but also faith in govt. agencies. I was as determined as him. I forced him to go to ART center considering his economic status. His health and economic status both started becoming pink. So much pink that started investing in his physician that is me. He used to bring costly pens , knowing my love for them , as Diwali gift for me. He was unaware that pen was my strength too and the same strength may one day write his own story too. Anyways , he was back on the track and his life acquired an engine, full of steam of energy. His love for life and son and parents was enormous. It was love all over except a small corner , once occupied by Sukhwinder. The vacancy in his world started bothering him at times. It was in one of such times that he came across SAATHI DOT COM and Satinder Kaur’s number. He gave a missed call to her. 

Satinder Kaur, an aanganwari worker was found to be HIV + in 2003. Her husband , an intra venous drug user failed to cope up with the stress of the presence of a deadly virus in him and preferred death over life. He refused to live with the drugs and ran to the rail lines. The engine driver of the train running on the lines although applied brakes yet could not save him from death. He left behind Satinder with the virus and a seven year old male child. Shattered Satinder however preferred to live on. She was put on antiretroviral drugs ( Zidovudine, Lamivudine and Nevirapine) in 2006. Coincidentally she was also taking treatment from same center as Bimal but never met him. It was the missed call she got from him ,which led on to their meeting. It was year 2010. 

Their hearts, souls and bodies kept meeting for next six years. The lives of two of them was like two banks of same river or rail tracks going side by side yet not together. Their children were also growing ,playing on two banks of the river. Initially Children never thought about the similarities of two banks but as they grew older, they started imagining impossible and at times even guilty because of their own ” banks” going bankrupt on grounds of morality. Bimal and Satinder , started failing to look straight into their own progeny’s eyes , despite doing nothing wrong. Their only fault was that they had come a long way in life with the virus. Gone were the days of death was looming large over them. Now they were alive and the struggle was to live with the virus and live like any other homo sapiens. Both with a will to shed darkness and attain “light” spoke to the children. The univers started conspiring to fill the gaps in their lives. The bridge between fear of death and love for life was almost complete. The language without any grammar was writing a new essay. Bimal and Satinder tied the knot no one likes to open. Both got 

married in January 16.

The tale of Bimal and Satinder which was once woven with one single emotion of fear has now full of other emotion ” love” . The Alchemist, the Almighty , some say Universe has unearthed Gold in their rusted life. Both were dieing from the fear of death a decade ago and are now alive and living with love surrounding them all around.

My story ends with the same tag line as the all grandma tales used to end. My Nani ( grandma) used to say “as their life changed for good , may everyone’s life changes for good. ”

Amen Nani. 

Long live Bimal , long live Satinder. May you both live happy always and live to see your progeny , feel happy about you. 

May your story never end. May your story inspire many to live. 

Rakesh Bharti 

HIV Tales from my Diary-Tale 10

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The Malay word “Sayang” has no equivalent word in English to describe a common emotion in Malaysia. it is affection, love, sorrow and pity all at the same time. The nearest English word to express the same is ” bitter sweet”. That day was also a bittersweet day for Mansukh. It was after a nine month usual wait of human gestation that Mansukh was blessed with a son and that too on the day of birthday of his father. An Impromptus party was a double dhamaka on its way and in full swing ,when a sudden twist occurred. The fire crackers will become damp squibs was not imagined by anyone. As it happens many a times , the dish turns out to be agrodoice , the bitter taste of sweet dish overpowers. The breaks on the party in full swing came in the form of sudden gush of blood spilled on the floor. ManSukh’s father vomited blood and fainted. 

Blood reminded him of his discovery of some medicines found accidentally in his father’s cupboard some months ago. He could clearly recollect ,the Goggle search about the medicines,which made him dumbfounded. His blood got drained instantly. Still he had no guts to confront his own father. Mansukh did not want to wash some dirty linen of his father ,even within the four walls of his house at that time. But , this turn of events forced him to confront her mother. The truth lay bare ,in front of his eyes , drowned in a pool of blood. Now , was no time , however , to run away from reality. It was rather time to rush to the hospital. ManSukh’s first encounter with reality was like a bitter cucumber, whose head was not cut and rubbed with salt. Even after three and a half decades of the epidemic , the attitudes of health care professional has not changed. The first hospital , where he took his father , refused to admit him after knowing his HIV status. The second hospital , where , he concealed the fact at first go , did admit , but the attitude there also took no time to change colors ,like a chameleon ,after revelations of HIV status on fresh testing. Mansukh had no alternative but to have a brave face in all odds. By now his mother has told him the history. She told him about me and the treatment I offered in 2003. He faced the doctor and told her about his father’s HIV physician and requested her to seek my help. His own classmate , who was the treating physician too ,in that corporate hospital ,was so much under the weight of her degrees and ego that she refused to have my (a senior and known for HIV expertise) advise and help. She kept on wearing the veil of pseudo knowledge and refused point blank to ask me , the Sukhmeet’s ( ManSukh’s father ) HIV physician since proverbial ages. She said,” no second opinion, if you want you take your father to him”. Believing in his classmate and doctors abilities , he and his family continued to suffer in poly pharmacy and the whims of corporate doctors. Two weeks down the lane and no improvement in his father’s condition gave a push to the rebellion in him. He got his father discharged and sought my expertise. 

The moment I saw Sukhmeet, I was taken back ,to a decade and half ,in time. 

Sukhmeet was referred to me by a smart general physician after rightly suspected and detecting HIV in him , who had suffered from an attack of Herpes Zoster.

 I was shocked to learn that Sukhmeet ,had no high risk behavioral activity ,which could have allowed the entry of the virus in him. I could only put my needle of suspicion in his acquiring HIV to the needles used for taking his blood for donation – donation of life to others. His habit of donating blood and save others lives probably led him to the world of AIDS. All due to some ,mean, greedy healthcare worker ,during the process of blood donation. Money can really kill conscious, I thought. 

The high pedestal of society on which Sukhmeet was sitting proved to be a hurdle in his treatment. I started ,the gentleman ,with the best possible combination of drugs of that time ( Stavudine – drug as extinct as Dinosaurs today Lamivudine and Efavirenz ).

Since purchasing drugs from the market was like facing the piercing eyes of a policeman by a thief, in those days, Sukhmeet , like many of my other patients ,also asked me to get medicines for him ,from the market. This all for anonymity. I did the needful ,goes without saying. He was also found to have TB in his lungs. More medicines were prescribed to him. 

More Medicnes and less faith is a rule. How could Sukhmeet be an exception. He left everything and switched over to Haldi ( turmeric) and Gau Mutra ( cows urine) on the advise of a practitioner who proclaimed himself to be an AIDS specialist and was on the run to make money at the cost of people’s life. The natural ways of unnatural doctor , so as to say, were not to work and they did not work( treat ) too. 

Sukhmeet ,returned to my fold ,not after a lapse of very longtime ,but with a lot more deteriorated health. 

Although restarting the drugs in treating HIV is not easy and always useful, yet I took the risk. Years rolled down. Journey of life for Sukhmeet once again came back to highways of health. Bittersweet dish returned , however. Stauvudine ,the dinosaur, started showing its colours. Sukhmeet’s cheek looked withdrawn ,his neck acquired buffalo hump proportions and he started looking gravely ill despite being doing fine otherwise on virological and immunological parameters. His social status will not allow him to be moving around with the condition, doctors called ” lipodystrophy”. Once again ,he was about to shun allopathic treatment but was caught by me ,in time. 

Switch from Stauvudine to Zidovudine ( another drug) helped stay his facial appearance from further deterioration. That was 2004. Habits ,they say ,die hard and so do the beliefs . A person may die of them but they don’t die. Sukhmeet once again faultered ,despite knowing that only route to survival with HIV was 100% compliance of drugs. He became casual in taking his medicines. 2007 , he was back to me once again. He was back to me after a lapse of couple of years, with hardly any life left in him. He was back once again with the assurances of promises to be kept. New drugs , new life appeared for him and once again he was back to life. But , he did not forget to tread his own path. Cent percent compliance of doctors advise was not his cup of tea despite the fact that he dealt in tea and wanted people to take tea 24x7as a habit. The expected occurred again. 

Today ,after a decade later he is back with me , after spoiling his own , as well as his son’s moment of joy and making an agrodoice of a sweet dish. 
Celebrations and jubilation in full swing to celebrate his first grand son party were soiled by his blood on the floor. 

 When I asked his son , why did he not take care of his father when he found HIV medicne in his cupboard, he shared his cowardice to confront his own father. I also thought , how can a son wash his own father’s dirty linen , stripping them down to birth suit with holy water from the Ganges before final adieu. He had , naturally , no guts to confront his father. More than his father , however , he was more astonished to observe healthcare workers attitudes. It looked as prehistoric three and a half decades ago. one hospital refused to admit on prior intimation , other becomes reluctant to keep after detecting on their own.Young doc doesn’t want to consult senior. Mansukh was shattered. He was lost in his own jungle of dense sad forests when he brought Sukhmeet , his father ,and my old patient, to me. He was accompanied by his mother , who was not a stranger to me. Once again , the story was repeated. I got annoyed , showed my anger to Sukhmeet and his wife. The annoyance ,we , the doctors can’t resist , when we are frustrated with our failures in treating a patient successfully. Although in most cases the cause of failure is non compliance by the patient , yet the doctors take it as their own. The failure of therapy ,in case of HIV ,is more complicated despite so much advancements. From ,no drug to one to three to twenty plus drugs known today, from one to two to six groups of drugs available today to treat HIV, treatment becomes more difficult rather than easy in patients like Sukhmeet. A patient failing you in complying your orders with a regularity of pulses of a healthy human being. Their regular irregularities signal severe disease and a moribund heart. Like one of my earlier patients “Prateek “, Sukhmeet , was also out there to teach me more and more of HIV medicine. Once again , I found myself in the school of learning and on the path to learn to use new medicines from new and old groups of drugs available. I was challenged to bring the sinking ship of Sukhmeet, out of deep waters ,once again. I ran helter skelter ,from one book to other,from one senior to other , from one company manufacturing HIV drugs to other. I ran just to find a perfect toe chain for his damaged vehicle. Choosing a combination of Dolutegravir 50 mg twice a day and a single pill of Tenofovir and Emtrictabine daily , at the cost of around 6000 rupees per month for life time was a painful decision for me, but a physician is bound to take pains for the pleasure of others. It is a different matter that some consider pain of a physician as their pleasure. The fact remains, wearer only knows the site of pinch. Sincere doctors keep doing things for restoring public faith. I am no exception. I keep learning. If my first patient taught me lot of HIV Medicnes , my latest patient Sukhmeet is also out there to teach me use of newer molecules. He , I am sure will live on ,to enjoy the joys of his grandson’s , son birthday party. He is only 52 , after all. 

I wish him long life and wish to keep learning ,but of course not at the cost of patients like Prateek and Sukhmeet , who continue to loose their battles of life , just out of ignorance and less belief in their doctors. 
Marviroc, Enfuviritide, Etravirine and rilpivirine, raltegravir, elvitegravir, Dolutegravir, Darunavir, Vivecon and bevirimat are the new alphabets of the language of HIV Medicines , whose grammar is yet to be learnt by me. I need to make sentences and write essays. 

I am sure to learn it all without getting new Prateek and Sukhmeet. 

Rakesh Bharti

HIV Tales from my Diary-Tale11

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My Audioseption was at its best concentration when he gave me a call. 73 year old, Manjit’s call ,somehow sent tremors to all other four sensations of mine, as well. I could visualize tears in his saddened eyes, smell his agony, feel the bitterness in his mouth and could sense the pain he was passing through. Manjit was widowed seven years ago and has well settled children abroad. He was living alone in a royal way. Ever since his partner left him alone he started visiting Gymkhana club every day, playing cards, having regular two pegs of scotch in evenings. His mornings on week ends will be well spent joking around with Jockeys and friends in the local Golf club. His life style was envy to many of his age. The only speed breakers in his life were coming through his knees. His son , who , is settled abroad , booked an appointment with the best of KTR surgeon. The operation was fixed in a big corporate hospital. All was set to reset his life , when came a setback. Manjit was found to have suspicion of HIV in his body. Battery of tests increased the panic and confirmed the diagnosis. Knee was not replaced , rather , he was referred to a physician, who proclaimed to know HIV by default because of his degree in internal medicine. But this 80’s pass out forgot that he never tried to sharpen his skills by looking at books again. The sequel was prescription of Duovir- N {Zidovudine ( hardly used now a days)plus Lamivudine plus Nevirapine combination one bid from day 1} in wrong way. This is no more a preferred combination these days in the developed as well as other world. Still whenever used due to economic reasons, it is prescribed it is prescribed as Duovir ( AZT+3TC) one tablet twice a day with Nevirapine 200 mg one tablet a day for first two weeks and then it is advised to switch over to Duovir-N ( combination of AZT+3TC+NVP) twice a day. Manjit’s son consulted his doctor friends in USA. They were not happy and recommended to see another HIV physician. The ball was in my court now. Manjit fixed an appointment with me at the earliest and I obliged sensing his pain and agony. 

His interview with me baffled me. I could not decipher the mode of transmission of HIV in his case. He had two earlier surgeries in good hospitals , no blood transfusion, no nothing to suggest any high risk activity which can lead to HIV transmission. I was confused and finally ordered Western Blot test ( despite viral load being 27K and Cd4, 348 and positive tests by three different kits) to clear the dark clouds surrounding the mystery of his diagnosis. I told him, ” let’s first confirm your diagnosis , uncle”. This ball of mine, was a real googly 

and stumped him leg before. He burst into tears once again. 

His confession put me to a ” think mode “. I was thinking about sex and seniors : the 70 year itch. I was reminded of an article by Loren Stein, I read sometime back. 

Horny old broads, dirty old men. These commonly used terms speak volumes about how society views older people who are interested in sex.

Experts say such derogatory labels reflect a deep level of discomfort in our youth-oriented culture with the idea that seniors are sexually active. Sex is identified with reproduction, youthful attractiveness, and power — and most young and even middle-aged people do not want to confront the inevitability of growing old.

“Use it or lose it,” says geriatrics expert Walter M. Bortz, 70, author of three books on healthy aging as well as several studies on seniors’ sexuality. Dr. Bortz, a professor at Stanford Medical School, is past president of the American Geriatrics Society and former co-chair of the American Medical Association’s Task Force on Aging.

“If you stay interested, stay healthy, stay off medications, and have a good mate, then you can have good sex all the way to the end of life,” he says. 
Sex is different but not diminished

Wellborn’s openness about sex — and the frequency with which she has enjoyed it — may be somewhat unusual, but her perspective is not. One advantage of growing older is that personal relationships can take on increased importance as children and careers take a backseat. Seniors can devote more time and energy to improving their love lives. And while some seniors may be forced to give up strenuous sports, sex is a physical pleasure many older people readily enjoy.

Men may suffer from impotence or have more difficulty achieving and sustaining erections as their blood circulation slows and testosterone levels decrease. Impotence is also more prevalent in men who have a history of heart disease, hypertension, or diabetes. Now there are drugs to help such seniors. Some experts, in fact, worry that these drugs may cause an upsurge in AIDS in people over 50, because they are not likely to take precautions; they urge older people who are dating to practice safe sex. 

Coming back to Manjit and his old age , I had an eye opener. The moment I told him that we may have to confirm his diagnosis. He started looking for an curtain where he could hide but could only find his lowered eyes , no more in contact with me. He stopped looking into my eyes. ” Two years ago , I had sex “, he told. 

” Who was she ?” Was my natural query. 

” Beta , I told you , I stopped having any erections many years ago. I actually, had sex with a man”. 

I made a fool of myself further by asking that was an active partner or passive. A man who is impotent can only be passive , he sort of mocked at me. 

The rubic cube puzzle of his acquiring was now solved. I put him on best of first line ( as desired by his son ) although costly ,combination of Dolutegravir ( Instgra) 50 mg along with a tablet of Tenvir- EM ( Tenofovir plus emtricitabine ) daily. He is showing absolute fantastic virological, immunological and clinical stability for last six months. 

He is a happy man now. His appearances in my clinic , however, leave me grappling with the question of sex and seniors : 70 year itch. 

Rakesh Bharti 

HIV Tales from my diary-Tale 12

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Twinkle Khañna in her book ” The legend of Lakshmi Prasad” narrates a fictionalized story based on Arunachalam Muruguntham and his marvelous invention of low cost sanitary pad making machine. Hero of her tale is Bablu, a simpleton , who tries to fill the life of her newly wed Gowri with small moments of joy, in his own idiosyncratic way. At regular interval he presents her with small gifts. One day when he found his wife using a cloth for her menstrual periods , he decides to gift her sanitary napkins. The exorbitant price , however , forced him to innovate a cheaper alternative. Taking two leaves from a nearby tree , he placed cotton between them, pressing firmly with hands till it flattened. He then wrapped the flattened cotton in the muslin cloth and stitched up all the corners. Within twenty hours of touching a sanitary napkin, Bablu had managed to make his own. The narration by Twinkle Khanna took a pause for me at this and took me back to remembrances of various innovation , we Punjabi’s excel in. The pause led to a journey down the years and ended with the memories of a similar simpleton. Surjit Kaur hailed from a village situated right at the India Pakistan border. Her village was in the news for all wrong reasons in those days. Majority of that village youth were reported to be falling pray to intravenous drugs. They were in a hurry to push Manipur , the state reporting maximum IVDU in the country at that time,to a second place. It was ,however , not her village idiotocracy which made me remember her , but what made her immortal in my eyes was an innovation. Middle aged ,Surjit Kaur came to me with multiple hemorrhagic blisters on left side of her upper chest. They were all covered with sanitary napkins. I always thought the napkins were meant for something else, but this simpleton from a village used it for stopping bleeding from her blisters. She explained to me that if they can absorb bleeding down there then why not here. Simple logic great innovation. But her innovation covered another agony. Herpes zoster in such a severe form and that too in a lady from a village known for IVDU, raised the level of my suspicious to the level of HIV. My suspicion, despite my wishes against , came true. Further interrogation revealed that she was widow of a school teacher , who visited me sometime ago. Pritam Singh ,her husband visited me with chronic ulcers and their scars all over his thighs. They were tombstones of the injections he used to take. He came to me not only for treatment of those scars but also to get rid of his habit of intravenous drugs use. I sought the help of my psychiatrist friend , at the same time advised him ARV after detecting HIV as a co inhabitant to the habit of intravenous drugs in his mind and body. 
 I had just returned after attending an international HIV conference in Cairns, Australia, where I heard about needle exchange program. Recollecting the lessons learnt there , I thought of implementing same on a small scale in Pritam’s village. With the help of the respected teacher that is him ( Pritam Singh) and that village’s sarpanch, we the members of AAG, Amritsar, organised a health education camp right in his school. AAG (Amritsar AIDS Awareness Group),was the first NGO of north India made by few like minded doctors, journalists and lawyers with the intentions to extinguish the spreading fire of AIDS. The captive audience listened to the group members with patience. There were some turbulent moments for youth and inquisitive ones for elders. The elders were keen to know ways to alleviate youngsters from falling pray to serious ailments caused by IVDU. My experience convinced them for a needle exchange program. We returned with a promise to exchange their used needles with new sterilized ones with the hope that if not IVDU, we could at least succeed in stopping HIV, Hepatitis C &B in its tracks. The program continued for sometime. To be precise till Pritam Singh 

Signed off and our funding from British highway authorities ( yes we begged a funding for one year , but could not continue for various reasons , purely ours). Surjit Kaur , the innovator , revived my interest in the village. More visits , however proved futile as even this pillar ( Surjit Kaur) of our strength there ,fell pray to HIV. 

Wish her innovation could have rubbed on us for more time and we could have done more innovations for the unfortunate villagers. All however was not lost and I ,now hear ,that the village has learnt its lessons a very hard way. The incidence of IVDU’s , as per state statistics , have gone down drastically in that village. 

Rakesh Bharti 

HIV Tales from my diary- (Tales 13-17..of Healthcare workers suffering ) Tale 13

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Next few tales are related to the healers suffering themselves.
The panic button, the healers press once exposed non sexually to the virus is louder than any hooter announcements of war. As school kids ,during 1965 ,India Pakistan war ,the hooter used to be an adventure. In school, we used to hide below the desks. At home ,standing below doors or running to trenches used to be like hide and seek games. Black outs were experiences of unique variety. The sound of the hooter of HIV exposure real or imaginary is however more like an explosion of fear bomb in the minds of exposed that way. N number of times , over the years , I have been disarmed of my sleep ,de robbed in public because of this bomb scare. I still can’t forget one such scare while waiting for my cup of coffee in the newly opened Coffee Cafe Day ( CCD) in my town. I was just imagining the luxury of CCD in Europe brought home. The coffee cup, however was not be , and was broken by the tring tring of my cell phone. The hospital owner , a friend , wanted me to rush to his OT before they could operate upon a head injury patient , who was a doctor too. ” But why me ?” was my natural query to an unnatural call. I was told to stop wasting time in asking questions and be there.
The OT staff ,including the top anesthesiologist of the city was reluctant to operate upon this doctor brought from a nearby town because of his doubtful HIV status. The moment I saw Rajesh’s wife , a doctor herself , even my moment of bafflement arrived. This was only a couple of moths ago that the couple came to me for a dermatology consultation. Suspecting a rare tumor of endothelial cells of blood vessels ( Kaposi Sarcoma) a hallmark ,red flag sign of HIV patients , I had to hesitantly ask her to clear the mystery of his HIV status of Rajesh. Hesitantly , because he was a senior and a lovable friend. It was some years ago that the whole medical fraternity of the neighboring town was whispering in each other’s ears about the HIV status of Rajesh, a doctor of para clinical sciences, himself. The whole gossip game started after he lost his consciousness one day , and the cause of meningitis turned out to be cryptococci- a direct indicator of compromised immunity with 99 percent certainty of full blown AIDS. Toxoplasmosis , Oesphageal Candidiasis, Pneumocystic carinii Pneumonia and Cryptococcal Meningitis/ CMV retinitis , known by acronym of TOPIC were like signature tunes of music of death approaching HIV – AIDS patients. The doctors stature deterred everyone to ask the reality, but gossips never ended. Gossip rather became gigantic in proportions. I still remember ,one day ,few of this doctors trainees came to me and wanted to know ,” Sir can we attend his lectures”.
” Why are you asking that ?”
“Because we have heard he has AIDS”. The question answer session lasted for some thirty minutes as I had to explain that rumors should not be believed and moreover the virus under scanner doesn’t spread by casual contacts. So much was the ignorance about the disease that even medicos were scared to even face a patient as teacher. People stopped shaking hands with the doc and switched to indian style of greeting by folded hands to greet him.
Naturally , when he came to me with a suspicion of skin malignancy and my doubts between Psoriasis and K.S. , I had to confront him with straight questions despite my own hesitation. The couple denied with full force. I was baffled more. I wondered , why people enjoy others agony and gossip becomes their pastime at others expense. If there was no HIV then why ridicule the man and make him like an untouchable. My primary diagnosis changed and the couple went away. On that eventful day when Rajesh had a fall and suffered the injury on head, my focus returned.
He got the injury because he became almost blind with CMV retinitis ( third red flag raised by the virus in him). I was face to face with his reality , which he and his wife has so vehemently denied sometime ago. The couple did that so as to hide the scars of mind , to run away from the stigma. They did not have faith in my medical ethics and suspected like others , I may also not add salt to their injury. They thought , I may add wind to the fire like gossip of character assassination of the duo. They did not want the medical world to know about something ,for which ,the world will not understand their innocence. They never realized that they had not done a crime and all fingers are not alike, I was different. To contract a disease is a misfortune but not a crime. Living in the fear of stigma , couple wore a veil of secrecy and in the process denied the best medical talent around to handle. Suffering from various deadly ailment could not save his life but decidedly , he left a lesson for those still alive. The loud and clear message revive an old Punjabi saying ” if there is fire , shout from the roof top of your house”. If you hide your health issues even from your healthcare friends ,then even God can’t save you. His memories of recognizing me just from my voice will linger forever in me. The last ditch efforts after this proved futile and even the surgery conducted after my counseling to the staff, could not save the doctor friend. The occupational hazard took away a life, just because of fear of stigma , just because of denying far vision to self , just because —–.
Rakesh Bharti

HIV Tales from my diary-Tale 14.

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( Tale 2 of healers suffering themselves )
The whole medical fraternity was excited to witness a first mega event , a seminar on the current most topic of interest to the world at that time. The seminar on HIV and AIDS had invited faculty from far and wide. The whole show was sponsored by Indian pharma companies manufacturing generic anti retro viral drugs. I being , one of the first few in the region offering treatment to such patients was a natural invitee. I was not invited as audience but as a faculty and the topic allotted to me was most easy as well as difficult. I was to speak on counseling of victims and their families. The desire to shine among the galaxy of stars of the field , led me to prepare an extra ordinary show of talent. I convinced, one of my patients ( Surjit Kaur) to declare her status in public , just on the strength of my counseling skills. I wanted to prove to the people that there is nothing to feel ashamed of , to feel stigmatized . I wanted to tell people that one can live despite the virus and live with dignity. Surjit Kaur was working as a staff nurse in a hospital , I used to visit and admit HIV patients. That day she was on a night duty and was down with fever for sometime. She had been listening to my lectures on the disease and attending my patients too. Like many of paramedics , she also took the Internet path to diagnose her ailment and got her HIV test done without asking anyone . Next morning ,she was off duty , but the breaking news of her being tested positive spread like wild fire in the hospital. The whole hospital knew her HIV status before she could know. Two days later , the glass panes of hospital were broken and the security guards had a real tough time in facing the fury of Surjit and her husband. Her husband refused to get himself tested and was certain that hospital has given the virus to her by way of not providing adequate universal precautions to her and other staff while handling HIV victims. Once the storm went over , the hospital authorities with all cunningness at their command , forced Surjit to resign. A reluctant repulsive world which had its fulcrum as her husband forced her to find newer ways to survive. She landed in my chamber. I was furious at the inhumane behavior of the husband and hospital both. With tact and cajoling I could tackle her husband , who confessed and was confirmed also as the source of her ailment. But hospital , her employers , were not to be tamed , just because the cowardice raised its head in her body and soul. Despite assurances of legal help and standing by her , she refused to fight for her rights. I was left with no other option but to bow to her wishes and put her on treatment. I could manage the drugs from some donations I used to get from
Dermatology patients for such patients. Anti retroviral drugs started working and she also started looking for more work. Fortune , they say favors the brave. Same happened with this lady ,who might not have fought for her working rights but did fight like a brave woman for her life. She was offered a job again. This time she was offered a job in a sister branch of same hospital which had shown her the door earlier. The fear of rejection after testing before joining , brought her to me ,midway through her routine monthly visits. I was sure about the procedures. Based on the basis of that surety , I reassured her that no one will test her for HIV. It was not the norm then. She got the job again and joined as staff nurse in OT. The surgeon of the main hospital was now posted in the sister branch. Bad luck was still chasing her. The surgeon took no time in remembering her old Saga. It was a different matter that despite the old saga she was a new person now. My assurances and support helped her acquire the much needed courage to face adversities. She made the surgeon speak to me and I did the rest of the job. She was retained this time and only change she was made to face was getting charge of duties not entailing handling of blood. The couple was happy with my help from time to time. They had become real tough guys. Tough to the extent ,that ,they agreed to openly declare their status in that first ever seminar of its kind and make me a super star in the eyes of many. Medical fraternity did not only applaud my presentation but also appreciated the courage of the couple and my counseling capabilities. I walked the talk and became the talk of the town because of the gutsy couple. Surjit and her husband are still around and are aging gracefully with HIV , which has bowed its head to their courage.
My salutes to Surjit duo.
Rakesh Bharti

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