India better placed today to combat AIDS: Expert

Mumbai: There is no cure for Human Immunodeficiency Virus (HIV), however, with access to effective prevention, diagnosis, treatment and care, HIV has become a manageable chronic condition, enabling People Living with HIV (PLHIV) to lead long and healthy lives, according to Mumbai-headquartered People’s Health Organisation (India).

India has contributed in making anti-retroviral therapy (ART) affordable and accessible to 92 per cent of PLHIV globally, said Dr Ishwar Gilada, Secretary General, PHO. Dr Gilada is President Emeritus, AIDS Society of India, Governing Council Member, International AIDS Society.

“ART can result in undetectable viral load within a couple of months ‘Undetectable is Untransmittable’ or U=U and one step beyond Untransmittable means Zero. U=U=0! So, each new HIV case is a ‘missed opportunity’ where a range of combination prevention options could have helped prevent the person from getting infected,” said Dr Gilada.

“Every AIDS-related death is a grim reminder that it could have been averted because we have proven tools to make ‘#AIDSdeath’ a history. We should ensure that full HIV combination prevention spectrum and complete care and support services are reaching everyone, including the key populations with sense of purpose and urgency,” he said on the eve of 36th World AIDS Day (WAD) (1 December, 2024) which is themed “Take the rights path: My health, My right!”

“We have adequate and efficient tools to end AIDS - be it the science-backed tools and approaches to prevent HIV transmission, or diagnosing and treating PLHIV so that they can live healthy fulfilling lives. But an array of ‘missed opportunities’ is plaguing the AIDS response globally. Factors like lack of accountability, sub-optimal programme effectiveness, and complacency are slowing us down from reaching the goal of an AIDS-free world. Covid-19 pandemic did play spoilsports, but we cannot continue that excuse forever. We need to tone-up fast,” said Dr Gilada.

Speaking about the current scenario in India, he said: “India had 2.54 million PLHIV in 2023 (including 70,000 children), slightly up from 2.5 in 2022 and 2.4 million in 2021. Alarmingly 68,450 people were newly infected in 2023, 187 new infections daily, slight increase since 2021. Sadly, there were 35,870 AIDS-related deaths in 2023, four every hour, though it has increased by 11 per cent in a year. In the journey towards #endAIDS goals, one of the earlier milestones has to be elimination of mother to child transmission (MTCT) of HIV, but despite progress, is far from this goal. That doesn’t even need change in behaviour unlike sexual mode of transmission. India. Coverage of pregnant women who receive medicines to prevent MTCT was 64 per cent. MTCT or Vertical transmission rate including during breastfeeding is 11.75 per cent, as against 24.3 per cent in natural course; is another ‘missed opportunity’. Rather we should completely eliminate vertical transmission of HIV by 2030.”

India's HIV prevalence peaked in 2000, showing a continuous decline for the past two decades with 0.55 per cent in 2000, to 0.32 per cent in 2010, 0.21 per cent in 2021 and 0.2 per cent in 2023. However, there have been a resurgence in HIV with an increasing number of new infections, especially in young people along with rising trends in Sexually Transmitted Infections (STIs) - Human Papillomavirus-HPV, Hepatitis B and Syphilis leading.

Fortunately Syphilis is curable, its cure is affordable, but faces shortage of injectable long-acting penicillin and doctors hesitant to administer it. Though HBV and HPV are incurable, but are fully vaccine preventable, with HBV vaccines available at a pittance of cost, but in short-supply.

Data-backed science has long raised alarm on low coverage of HIV services for the most vulnerable - the key populations.

“While overall HIV prevalence in adults in India is 0.2 per cent, in sex workers it is 1.9 per cent; in men who have sex with men (MSM)- 3.3 per cent; in transgender people- 3.85 per cent, and in injecting drug users (IDU)- 9 per cent. HIV prevalence in prisoners is 1.9 per cent but ART coverage is only 28.7 per cent in prisoners,” he added.