Endgame: How India helped world fight HIV

TAKING THE LEAD Introduction of the first free antiretroviral therapy, at less than a dollar a day, helped bring down new infection by 35% since 2000 and AIDS-related deaths by 42% since its peak in 2004

Lifesaving HIV medicines that help infected people live longer and lower their chances of transmitting the virus to others are the magic bullet in the arsenal of UNAIDS, fighting to end the AIDS epidemic by 2030.

At the end of 2014, there were 36.9 million people living with HIV, with two million new infections reported that year. Almost 16 million of those infected were on free antiretroviral therapy in the middle of June 2015, which has helped lower new infection by 35% since 2000 and AIDS-related deaths by 42% since the peak in 2004, shows UNAIDS data.

This success in cutting back infection prompted an upbeat UNAIDS to announce its 90-90-90 treatment target to fast-track the end of the epidemic.

“Reaching this treatment target by 2020 would see 90% people with HIV knowing their status, 90% people who know their status accessing treatment, and 90% people on treatment having suppressed viral loads. This will also reduce new infections by 75%,” Michel Sidibe, executive director of UNAIDS, told HT in an exclusive interview.

Everyone with HIV should begin antiretroviral therapy (ART) to stop HIV from multiplying immediately after diagnosis, say new World Health Organisation (WHO) guidelines that aim to put all 37 million people worldwide, including two million in India, estimated to be living with HIV on treatment.

There are 15 single and combination medicines available to treat HIV, with Indian pharmaceutical companies playing a huge role in bringing down the price of expensive drugs.

In 2001, Cipla introduced the world’s first 3-in-1 fixed dose ART combination (stavu di ne+ lam ivu di ne+ nevi rapine) at less than $1 a day, compared to the then market price of $12,000 for each patient a year.

“India has played a pivotal role in the response to the AIDS epidemic, especially in Africa. Fifteen years ago, the treatment coverage in sub-Saharan Africa was virtually nill. Now more than 11 million people in the region have access to life-saving medicines and more than 80% of antiretroviral medicines in Africa are sourced from India,” Sidibe said.

In India, an estimated 2.9 million people were living with HIV in 2013, with the prevalence falling from 0.41% in 2001 to 0.27% in 2013, shows data from the National AIDS Control Organisation, which tracks the infection across India.

“Infection patterns are changing, with injecting drug use being the new cause of concern. There are close to 2,00,000 injecting drug users in India, with roughly a third of them living in the Northeastern states. But over the past five years, pockets of injecting use have emerged in Punjab, Delhi, Chandigarh, Kerala and West Bengal and, more recently, in Uttar Pradesh, Bihar, Chhattisgarh, Madhya Pradesh and Odisha, which are making these states new hotbeds of infection,” says a NACO official, who did not want to be named since he is not authorised to speak to media.

But with overall new infection stagnating over the past three years to a little over one lakh, India slashed AIDS funding to `1,397 crore this year, down from `1,785 crore in 2014.

Much of the funds are used to provide free anti-retroviral treatment to everyone who needs it since 2004 — including second-line ART drugs — which has lowered AIDSrelated deaths by 29% between 2007 and 2011. Free ARTs have saved more than 1,50,000 lives in India since 2004, and the current pace of scale-up of services expected to avert around 60,000 deaths annually over the next five years.

EVERYONE WITH HIV SHOULD BEGIN ANTIRETROVIRAL THERAPY TO STOP HIV FROM MULTIPLYING IMMEDIATELY AFTER DIAGNOSIS, SAY NEW WHO GUIDELINES