JOIN USWorld AIDS Day (WAD), observed on December 1 every year is a reminder for us to continue to persist and win over the global endemic. This year, the slogan is "My health, my right."
Of the estimated 21 lakh people living with HIV infection (PLHIV) in the country, around 77% know their status. The remaining have either not tested or have been screened at private laboratories but not taken a confirmatory test at the government integrated counselling and testing centre (ICTC).
The common reasons for not getting tested are unawareness of HIV transmission risk, fear of testing positive, unawareness of government testing, care, support and treatment facilities and the fear of discrimination. The last factor is very significant, for many individuals are aware of the government's HIV and AIDS programme but are scared to access these services.
The HIV and AIDS (Prevention and Control) Act, which came into force on April 21, 2017, in India, has defined a "protected person" as (1) HIV positive, or (2) Ordinarily living, residing or cohabiting with a person who is HIV positive, or (3) Ordinarily lived, resided or cohabited with a person who was HIV positive.
It mentions that the protected person cannot be discriminated by anybody for employment, occupation, treatment, use of any service customarily available to the public, right to movement, right to property, isolation, etc. It also points out that HIV testing cannot be a pre-requisite for obtaining employment or accessing healthcare services or education, or for continuation of the same, or for accessing or using other service or facility.
HIV/AIDS has become a manageable disease provided the right medicines in right dosages are taken daily lifelong with more than 95% compliance. India has a robust HIV and AIDS programme with around 22,000 ICTCs (all types) and 528 Anti-Retroviral Therapy (ART) centres; all these services are free. The HIV testing at ICTC provides a confirmatory result, while a test done at a private laboratory has to be confirmed at the ICTC.
The ICTCs strictly follow the mandate of conducting pre-test and post-test HIV counselling with confidentiality. The test result is only disclosed to the person tested or a person authorised to receive the result as per the law, for instance, the treating doctor.
A common myth among people is that AIDS can only happen to female sex workers (FSW), men who have sex with men (MSM) and injection drug users (IDU). But the total estimated size of their population is 14.7 lakhs (http://aidsdatahub.org/) with HIV prevalence of 2.2% in FSW, 4.3% in MSM and 9.9% in IDUs (NACO annual report 2016-17).
This means a majority of the estimated 21 lakh PLHIV are from the general community. So, there is a greater probability of a general community client infecting a sex worker. The inf-ection is then transmitted from a sex worker to many more as s/he has more episodes of sex owing to the nature of work (and many of them unprotected because of client insistence).
The sex worker may not know about his/her own HIV infection, for s/he may not have got it tested or may have gotten it done in the window period (around three months, during which an infected may not test positive with the common HIV test). The clients then infect their other partners - married women are at a greater risk of HIV infection than unmarried women because a condom is hardly used among spouses.
The best way of dealing with any disease including HIV and AIDS (with no cure) is to prevent it or identify and treat it early. A person knows best about the high-risk behaviour s/he is being exposed to, either intentionally or accidentally. Anybody in a sexual and drug-injecting network with even a single HIV positive person has a high chance of infection.
The HIV and AIDS Act has mandated that "every person, who is HIV positive and has been counselled in accordance with the guidelines issued or is aware of the nature of HIV and its transmission, shall take all reasonable precautions to prevent the transmission of HIV to other persons which may include adopting strategies for the reduction of risk or informing in advance his HIV status before any sexual contact with any person or with whom needles are shared with."
The time has arrived for us to come out of the closet and seek the required health assistance.
(The writer is Project Director - HIV/TB/Malaria programs, Public Health Foundation of India (PHFI), New Delhi)