The road to ending AIDS in India

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SANCHITA SHARMA

Through the ‘80s and ‘90s after it was first detected in India in Chennai in 1986, HIV diagnosis meant certain death, sooner than later. Once people were infected with HIV, it steadily whittled away their body’s defence against opportunistic infections such as tuberculosis and pneumonia, making them sicker and weaker till it killed them.

A few got diagnosed, which helped protect their partners, family and caregivers from HIV infection, but fewer still got treated because the medicines were very expensive, highly toxic and not easily available.

It all changed on April 1, 2004, when the then health minister Sushma Swaraj announced that the Indian government will offer free antiretroviral therapy (ART) used to treat HIV at eight centres in the six high-prevalence states – Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, and Tamil Nadu.

Today, India’s “test and treat” policy provides free ART across the country to everyone who tests positive for HIV. As a result, 1.35 million of India’s 2.14 million people living with HIV and AIDS (PLHAs) get free treatment, which has led to AIDS-related deaths reducing from 160,000 to 69,110 between 2010 and 2017, according to data from the NACO India HIV Estimation 2017 report.

ART suppresses the HIV viral load to lower symptoms and keep people living with HIV disease-free for decades. It also lowers their chances of infecting their partners. While there is no study for India, using ART to treat HIV can add 10 years to life and gives a 20-year-old who starts treatment a “near-normal” life expectancy of 67 years in Europe and North America, found an analysis of 18 studies of over 88,500 people that was reported in The Lancet HIV in August 2017. With 2.1 million people living with HIV, India has the second largest HIV epidemic in the world after South Africa and Nigeria, but HIV prevalence in adults aged 15-49 years remains 0.22 per cent, compared to 20.4 per cent in South Africa, which has 7.1 million PLHAs.

In India, HIV prevalence at the national level has steadily declined from an estimated peak of 0.38 per cent in 2001-03 through 0.34 per cent in 2007, 0.28 per cent in 2012 and 0.26 per cent in 2015 to 0.22 per cent in 2017.

The endgame for India is to meet the UNAIDS “90-90-90” targets to diagnose 90 per cent of all HIV-positive persons, provide ART to 90 per cent of those diagnosed, and achieve viral suppression for 90 per cent of those treated by 2020.

Getting people on treatment is easy, and the hard part is ensuring there are no gaps in the availability and access to medicines and ensuring PLHAs stay on it to keep the viral load suppressed.

Stopping treatment midway leads to drug-resistance, which has to be treated with stronger and more expensive drugs that cause toxic side effects.

With most of National AIDS Control Organisation’s 2,500 crore-budget used for testing and treatment, there is little left for prevention and promotion of safe behaviours and practices, such as safe sex needle exchange programmes for
drug users.

New infections have been stubbornly hovering around 80,000 for the past five years, with infections rising in Assam, Mizoram, Meghalaya and Uttarakhand, and declines in infection being lower than the national average in Bihar, West Bengal, Telangana, Delhi, Jharkhand and Haryana.

Just eight states accounted for two-thirds of the 87,580 annual new HIV infections in India. Telangana led with 11 per cent of the new infections pan India, Bihar and West Bengal accounted for 10 per cent each, followed by West Bengal (10 per cent), Uttar Pradesh (eight per cent), Andhra Pradesh and Maharashtra (seven per cent each), Karnataka (six percent) and Gujarat (five per cent). AIDS-related deaths are also rising in Bihar, Jharkhand, Haryana, Delhi and Uttarakhand.

Given heterogeneity of infection between states, data-driven differential prevention and care services must be pushed with active community engagement. For example, among high-risk groups, HIV incidence is the highest among injecting drug users compared to other high-risk groups such as female sex workers, gays, lesbians, bisexuals
and transgenders.

The NACO needs to pull out all the stops to end AIDS as a public health threat by 2030. To do that, it must reduce new infections by 75 per cent by 2020 against the 2010 baseline.

Apart from testing and treating people living with HIV, prevention and protection campaigns for the general population cannot be abandoned as it also helps lower stigma and encourages community participation in seeking prevention services and treatment.

Outreach programmes must also include promoting safe sex and safe injecting practices in the high risk-groups and bridge populations (such as sexual partners, migrants and truckers), who unwittingly spread infection to the general
population.

India cannot end AIDS without condom promotion and community participation.

                (HT Media)