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SMARS
Newbie

Reged: 10/05/11
Posts: 6
HIV Care US vs. India and Living in the Mid East
      #258340 - 10/05/11 02:55 PM

Hello...Three days ago I found out that my brother been diagnosed with HIV. My brother is a US Citizen living abroad in the Middle East. We are trying to decide where he should go for treatment, India or the US. At the moment, all he knows that he has the virus and terrified. He doesn't understand anything about it. I had to explain to him the basics and come him down. Obviously, this over whelming for both of us and there are so much to learn and deal with. At the moment, we are trying to determine what is the best next step that he should take. At the same time, I don't won't to make it any worse for him.

Considering I live in the US, I would prefer that he comes here instead, the option is available to him, unlike others. I feel he would get better care (maybe) and society little better than where he lives. I tried to convince him to come here but I failed. At the same time, I don't want to push him and would prefer to just provide him the support he needs. I have so many questions which I know I will have the opportunity to ask later and learn more in the near future. However and for right now, should I be concern that he wants to go to India instead? Nothing against India, it is much better option than others but my concerns are:

1) Will he has access to the same medication that he would have access to in the US?
2) Medication is expensive in the US but there are programs to help obtain it. Is the medication less expensive in India?
3) Access to care in general?

Among other things, I fear for my brother living in the Middle East and the kind of life he is going to have. This is a society that is illiterate, has no mercy or sympathy for people with the virus. Forgive me for saying it but that is the fact including my own family which no one knows at the moment. I am concern about:

The next a few months when he returns to the Middle East
The treatment he would get
If he ever get sick, will they treat him

I've already lost a cousin to the virus and I don't want to lose a brother.

If you have any experience, knowledge or information that you would like to share, I would kindly appreciate it.

Thank you,
SMARS


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cublatin
Newbie

Reged: 10/06/11
Posts: 1
Re: HIV Care US vs. India and Living in the Mid East new
      #258366 - 10/06/11 03:33 PM

Hello
Sorry to hear about your brother.

I'm an HIV+ man, who was living in the middle east myself, I had to leave before I was deported, as u know being HIV over there is illegal, so there are a lot of things to consider while he is still there.
First: where did he test positive? how are his levels? if he is not in need of immediate treatment, he can take his time to leave and arrange everything over there.
If his levels are low and needs treatment, being an american, it would be best for him to go to US. I considered the India option myself, because I have friends there, but being a non-indian, access to treatment is very limited, there would be a lot of red tape and things to arrange before getting it.
If he wants to do further testing before going home, there are many good clinics in lebanon, I've heard good experiences from them. I wouldn't recommend disclosing or doing more tests in the middle east, as I said before, he could be deported, I'm sorry to say all this, but I think he must know also so he can do things accordingly.
If you want to ask me anything else, I'm all ears.

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BrokenWingedBird
Expert

Reged: 11/30/04
Posts: 113
Loc: United Kingdom.
Re: HIV Care US vs. India and Living in the Mid East new
      #258377 - 10/07/11 07:46 AM

Hello, SMARS.

I used to live and work in the Middle East. (I'm from the United Kingdom.) I lived there from the late 1980s, so I know well what difficulties face people who have HIV there, although personally I did not have HIV while living in the Middle East. (I contracted it after leaving.)

Firstly, I second everything that Cublatin has already advised.

Your brother must leave the Middle East. Perhaps this will be hard for him, perhaps he is well set-up there and hoped to live there for many more years, but it is very very far from being the best place for any person who has HIV, including HIV Middle Easterners. As Cublatin has suggested, as soon as officials discover your brother is HIV he may well be deported, although this may vary depending on which state exactly it is in which he is living. Being deported is a most unpleasant business. You are treated like a criminal and escorted from office to office by local police until such time as they have physically loaded you onto a plane.

When I was living in the Middle East, long before the antiretroviral drugs became available, I was introduced to an American citizen who had AIDS, who was working at a hospital, and who was hanging on in the Middle East for as long as he could. He was often too sick to go to work. He had a Western doctor immediately above him and this Western doctor helped protect him, he "covered" for him - although, of course, he was not able to help him with any kind of treatment. But the point is that I used to visit this ill man at his home and I observed the psychological pain he was going through, never mind the physical pains associated with weight loss and loss of appetite that he suffered from. He got no more sympathy or help than that which I and one or two other local acquaintances were able to give him. He was nowhere near an HIV/AIDS support network. This is the point. Your brother now needs to be near such a network. Eventually our ill friend got so ill that he had to resign his job, pack his things while in a sorry state, and fly home to the States. He died shortly afterwards - but that, of course, was in the days when there was no treatment.

So, there is no question about whether your brother should return home. The matter is: how urgently he must do so. This depends upon the date of his infection, how long he has been infected, how soon his CD4 count will drop to dangerous levels. If his CD4 count is currently extremely and unusually HIGH and is viral load is unusually LOW, then he need not panic and he can go about arranging an orderly and "normal" return to his home country, keeping quiet about his condition and not jeopardising documents and references etc. that he may require when he seeks re-employment in the USA. If, however, his viral load and CD4 count are now at levels that would concern an HIV specialist, then he must simply leave the Middle East as quickly as possible and get himself back home and into the hands of a professional HIV clinic in the States.

What if you give your brother's viral load figure and CD4 count to an HIV specialist in the States, or even ask a question of one of the Experts here at The Body, and they advise that he need not start treatment right now? Your brother might then consider that he can hold on, take a test every three months at some clinic outside the Middle East, and postpone departure from the Middle East until his levels indicate he must start treatment. This might sound sensible. However, there are all sorts of reasons why this is NOT wise. For example, he could have a health problem occur in the interim and it could be HIV-related and his Middle East doctors may therefore need to know he is HIV in order to give him an appropriate treatment. But once they find out, they will probably be obligated to document his HIV status and he will be deported while ill. Or he could have an accident, his HIV status might be discovered, perhaps by an enforced blood test, and that is likely to mean immediate, and embarrassing, "deportation". But, most importantly, he could keep his HIV secret for, let's say, three or four years, not manifest any symptoms, and then the next time he takes a test discover that his levels have suddenly fallen dangerously low since the last test. This can happen. It happened to me while I was living here in the UK, and despite living here in the UK it was then a matter of some urgency and panic to get me on a combination of anti-retrovirals IMMEDIATELY before any further damage was done to my immune system. Also, the ARVS I was put on required fortnightly monitoring at the clinic for the first couple of months to ensure that my internal organs were able to cope with them.

So if your brother doesn't need treatment already, he needs to PREPARE for the day when his HIV clinic says it's time for him to go on a combination. He needs to be at home, with a medical support network in place, and, hopefully, with his new home and employment situation at home also sorted out and in place.

If your brother is entertaining the idea of receiving treatment from a clinic outside the Middle East and then passing through Customs at Middle Eastern airports with three months' worth of bottles and bottles of HIV tablets then he is in for some embarrassing trouble, regardless of which country he is from or from which country he acquired the medications! I shall never forget returning to the Middle East after a holiday in India and having every single thing in my suitcase meticulously examined. When the customs official opened my toiletry bag and found a couple of foil-packed sheets of white paracetamol tablets, he popped each tablet out, sniffed them, broke them, and even put them to his tongue. I have never been so insulted in my life. And that was just a dozen paracetamol tablets!

Maybe your brother needs to know that once you are on treatment, you leave a clinic every three months with a BIG bag full of about nine boxes of bottles or foil-sheets containing scores of tablets. Currently I take 4 tablets a day: so that's a bag of 360 tablets once every three months. Clinics usually pop these tablets into a large anonymous-looking brown paper bag to ensure patients' confidentiality: and that's here in the West!

I hope all of the above helps. Good for you for posting your question here. The Body is an invaluable resource for people with HIV from all over the world. It's the best such site on the planet. People in many countries rely on this site. Get your brother to study a little bit of it every day.

BWB.

--------------------
Without a dream, life is a broken-winged bird that cannot fly. Keep hold of your dreams.

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SMARS
Newbie

Reged: 10/05/11
Posts: 6
Re: HIV Care US vs. India and Living in the Mid East new
      #258504 - 10/13/11 11:25 AM

I am so grateful for organization like the AIDS Network in my local community here in the US that pointed me to this site and the forums on this site. In the last ten days, I’ve learned so much from the stories I have read here and what other have shared. Thank you so much.

cublatin and BrokenWingedBird…thank you very much for taking the time to share your experience, support and wealth of information.

Today, my brother is traveling to India to get further testing done and identify his CD4 count and more importantly, his viral load. I wasn’t able to convince him to come to the US instead but I also understand how frustrating it is here with the long wait to appointments and to see a doctor. Regardless, he doesn’t seem to get it or understand the situation. For now, I had no option but to support his decision and try to comfort him until thing settle down and he is at ease.

BrokenWingedBird…You raised several concerns which I have already shared some with my brother. Other concerns I wasn’t aware of and didn’t even think about. For that…thank you.

My brother has dual citizenship which is supported by the country where he lives. He has a good job and income and will most likely want to remain there at least for the next a few month unless the situation changes. If it does, he always has home here in the US and welcome to return anytime. Some of the point you raised very alarming and unfortunate. I am so sorry for what you and your friend had to experience in the region. This is the reason why I would never consider going back. If it wasn’t the job situation here in the US for my brother, he would still be here. I was lucky to come here (US) at young age and was able to benefit from it and adapt.

His CD4 count when he did the test was 359 which concerned me but after talking with some folks and reading about it I realized it isn’t a big deal and it tends to go up and down. I am taking on this since my older brother lacks the understanding of the virus, willing to read, doesn’t have access to information or the support network. I am hoping to at least be the one that build the knowledge so I can provide him the support and guidance if he needs it. Obviously it isn’t easy since and it is a thin line and balance between support and reality. Part of me wants to give him hope, support and at the same time getting him to understand it, recognize it and accepting it. With that comes responsibility on his part towards his own body, the people that loves him and towards others. This doesn’t have to happen today but in phases and when the time is right in the next a few months. The last ten days there were so much uncertainty but I feel much better now and my bother starting to calm down.

I am anxiously waiting for the outcome of the test and the CD4 and viral load counts. This will tell us a lot. The next a few months will be full of challenges but not impossible. I will keep you posted on this tread.

Again, million thanks for your support, sharing your experience and knowledge. I truly appreciate it.

Thanks,
SMARS


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cunta_stalwart
Grand Master

Reged: 06/27/08
Posts: 175
Re: HIV Care US vs. India and Living in the Mid East new
      #258530 - 10/14/11 12:43 PM

the middle east is not India, I don't believe deportation in India is an issue, I'm pretty sure there are clinics and many doctors capable of looking after your brother.

It might be an idea to come home and have your brothers condition investigated in the US then once he is confident on his condition it might be clearer what options he has regarding travel and staying in other countries

--------------------
How Many Roads Must A Man Walk Down Before He Admits Hes lost

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