New in­fec­tions are down, but the war on AIDS is far from won

Hindustan Times (Gurugram) - - Gurugram - SAN­CHITA SHARMA

Has In­dia won the war against HIV? At best, some skir­mishes have been won, but the Na­tional AIDS Con­trol Pro­gramme needs to pull out all the stops to end AIDS as a pub­lic health threat by 2030 by re­duc­ing new in­fec­tions by 75% by 2020 against the 2010 base­line.

New in­fec­tions have gone down, but not enough. Be­tween 2010 and 2017, an­nual new in­fec­tions fell from 120,000 to 87,580, AIDS-re­lated deaths from 160,000 to 69,110, and peo­ple liv­ing with HIV from 2.3 mil­lion to 2.14 mil­lion de­spite the av­er­age 1.24% an­nual in­crease in the coun­try’s pop­u­la­tion of 1.3 bil­lion.

An­nual new in­fec­tions, which in­di­cate whether an epi­demic is grow­ing or eb­bing, have fallen by 27% dur­ing the pe­riod, com­pared to the global av­er­age de­cline of 16%, but have stub­bornly hov­ered around 80,000 for the past five years.

An­nual in­fec­tions have in­creased in As­sam, Mi­zo­ram, Megha­laya and Ut­tarak­hand while Bi­har, West Ben­gal, Te­lan­gana, Delhi, Jhark­hand and Haryana have seen a de­cline in in­fec­tion lower than the na­tional av­er­age.

Just eight states ac­counted for two-thirds of the 87,580 an­nual new HIV in­fec­tions in In­dia. Te­lan­gana led with 11% of the new in­fec­tions pan In­dia, Bi­har and West Ben­gal ac­counted for 10% each, fol­lowed by West Ben­gal (10%), Ut­tar Pradesh (8%), Andhra Pradesh and Ma­ha­rash­tra (7% each), Kar­nataka (6%) and Gu­jarat (5%).

Given the het­ero­gene­ity of in­fec­tion be­tween states, datadriven dif­fer­en­tial preven­tion and care ser­vices have to be adopted.

For ex­am­ple, among high­risk groups, HIV in­ci­dence is the high­est among in­ject­ing drug users com­pared to fe­male sex work­ers and les­bians, gays, bi­sex­u­als and trans­gen­ders, with the highly pop­u­lated states of Ut­tar Pradesh Bi­har record­ing the high­est in­ci­dence. Apart from test­ing and treat­ing peo­ple liv­ing with HIV, out­reach pro­grammes must in­clude pro­mot­ing safe in­ject­ing prac­tices and safe sex among the high-risk groups and bridge pop­u­la­tions (such as part­ners, mi­grants and truck­ers), who un­wit­tingly spread in­fec­tion to the gen­eral pop­u­la­tion.

In­dia’s “test and treat” pol­icy pro­vides free anti-retro­vi­ral treat­ment (ART) used to treat HIV and AIDS free to every­one who tests pos­i­tive. But with the Na­tional AIDS and STD Con­trol Pro­gramme bud­get this year in­creas­ing frac­tion­ally to Rs 2,100 crore from ₹ 2,000 crore in 2017, the ma­jor­ity of funds are used for test­ing and treat­ment, with lit­tle left for preven­tion and the pro­mo­tion of safe prac­tices and be­hav­iours.

The scale-up of the ART pro­gramme has led to a 71% de­cline in AIDS-re­lated deaths in In­dia, com­pared to 48% world­wide, but the cov­er­age is a low 56% against the global tar­get of putting 82% of peo­ple liv­ing with HIV on treat­ment by 2020. AIDS-re­lated deaths are also ris­ing in Bi­har, Jhark­hand, Haryana, Delhi and Ut­trak­hand.

ART sup­presses HIV vi­ral load to not just lower symp­toms and keep peo­ple liv­ing with HIV dis­ease-free, but also low­ers their chances of in­fect­ing oth­ers. 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 pub­lished in The Lancet HIV.

To per­suade peo­ple to stay on treat­ment, Mis­sion Sam­park (con­tact) has been started to bring back on ART pa­tients lost to fol­low-up. In­te­grat­ing pro­grammes, such test­ing for HIV and syphilis, HIV and tu­ber­cu­lo­sis, and HIV and Hep­ati­tis C -will also help take com­pre­hen­sive ser­vices to a wider pop­u­la­tion.

In In­dia, un­pro­tected sex with an in­fected per­son and in­ject­ing drug use are the lead­ing causes of new in­fec­tion.

End­ing AIDS as a pub­lic health threat by 2030 is only pos­si­ble only if ser­vices are of­fered to all, in­clud­ing high-risk groups, and every­one who tests pos­i­tive gets treated. While de­crim­i­nal­is­ing gay sex will help take ser­vices to les­bians, gays, bi­sex­u­als and trans­gen­der peo­ple, pro­mo­tion of safe in­jec­tion prac­tices still needs a boost to en­sure in­ject­ing drug users and their part­ners are pro­tected from in­fec­tion.


■ Be­tween 2010­2017, an­nual new in­fec­tions fell from 120,000 to 87,580, AIDS­re­lated deaths from 160,000 to 69,110, peo­ple with HIV from 2.3 mil­lion to 2.14 mil­lion.

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