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Continue focus on AIDS programme

As World AIDS Day is observed today, India, with more than 20 lakh HIV cases, conti-nues to be a worry.
Last Updated 30 November 2015, 18:44 IST
In 2014, 1.5 million people died of tuberculosis (TB) compared to 1.2 million from HIV/AIDS. Clearly, there is still significant work to be done on both TB and HIV/AIDS. However, this also means there has been a major success in reducing mortality due to HIV/AIDS (a 42 per cent reduction since 2004), which was first detected in 1981 in the United States and in 1986 in India.

The government-led Indian National AIDS Control Programme (NACP) has been lauded globally as a major success story: HIV incidence (occurrence of new cases) has reduced 57 per cent in 10 years. With this kind of progress, India is at a stage of building on its achi-evements and must strategically focus on activities to reduce new HIV infections to zero.

The UNAIDS, the HIV/AIDS body of the United Nations, has set a global target of ‘90-90-90’ by 2020 – 90 per cent of people in a country are tested and know their status; 90 per cent of those testing positive are put on anti-retroviral therapy (ART); and 90 per cent of those put on ART have a low viral load. Targets are meant to rise 95-95-95 by 2030.

The UNAIDS estimates that reaching the 90-90-90 target will require a total US $14 billion by 2016, including drug costs, service delivery, community mobilisation, ensuring access to testing and retention in treatment, and pre-ART costs.

India cannot decrease its HIV/AIDS programme budget but needs to significantly increase it; all the more essential in light of significant decrease in international funding. The results of decreasing the budget and slowing the programme may undermine the achievements made so far, leading to a rise in the number of HIV infections and deaths.

With more than 20 lakh HIV cases, India has been maintaining its position as the country with the third largest number of HIV infections in the world, after South Africa and Nigeria. Now is the time for India to demonstrate global leadership with an effective strategy in eliminating new cases in the shortest possible time.

Though India allocates substantial resources to HIV prevention, there remains work to be done in this realm as well as improving education, broadening access to quality treatment and the reducing stigma and discrimination.

The government supports implementation of around 1,850 targeted intervention (TI) projects across the country through the community based organisations and NGOs. They reach out to high risk populations, namely female sex workers (FSW), men who have sex with men (MSM), transgender individuals (TG), injection drug users (IDU), migrant workers and truckers. This strategy has been very successful. 

Condoms and education remain the prime weapons for HIV/AIDS prevention. Research is ongoing for inventing a promising HIV/AIDS vaccine, but preventative prophylaxis (PrEP) for high-risk populations has proven massively successful in other settings.

This approach—a daily low-dose form of ART that prevents infection—is currently recommended by the WHO for MSM and other priority groups, though is not yet promoted. The government provides HIV testing and counselling through more than 16,000 centres spread across all districts of.

Cheaper medicines
India has hugely contributed in converting HIV from a killer to an infection a person can live with. Till the mid-1990s, there was no medicine available. In the early days of the epidemic, PLHIV (people living with HIV) progressed to AIDS often suffered painful deaths due to wasting and secondary infections. With the advent of ART, an Indian pharmaceutical company, Cipla, started producing generic ART drugs that were cheap and more widely available.

The government now provides ART free of cost through around 450 ART and 900 Link ART centres across the country. Now, there is also second line ART available, though limited as it is quite expensive. India’s capacity to produce cheap drugs in-country leads it to act as a major source of ARTs for Africa and Asia.

While there have been substantial efforts to reduce stigma against PLHIV – for instance, legislation that protects PLHIV from termination, denial of employment etc – there is still discrimination associated with high-risk groups such as FSW, MSM, TG and IDU. There are even reports of denial of services at health facilities, especially surgical.

The NACP, in collaboration with the United States Agency for International Development and Public Health Foundation of India, is implementing a pilot District Network Model (DNM)   in Thane, Maharashtra.

This will act as the flagship of the HIV/AIDS Partnership: Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) project for testing different approaches such as increased public-private partnership in HIV programming, community based HIV testing, AIDS Prevention and Treatment System and high-tech real-time HIV/ AIDS service management.

If a breakthrough is achieved, this would contribute to make the national HIV/AIDS programme more efficient. This ‘World AIDS Day’, India, with its growing economy and enthusiastic government approach of finding sustainable solutions must rekindle its commitment and strive to find the budgetary means to march ahead with its HIV/AIDS programme.

(The writer is Chief of Party, PIPPSE Project, Public Health Foundation of India, New Delhi)
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(Published 30 November 2015, 18:44 IST)

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