Solidarity, responsibility needed

This year, World Aids Day is distinctly different because the battle of controlling the Aids epidemic needs to be viewed in the backdrop of the ongoing Covid-19 pandemic. Covid-19 is threatening the progress that the world has made in health and development over the past 20 years, including the gains made against HIV. As Winnie Byanyima, Executive Director, UNAIDS, stated in her World Aids Day message, like all epidemics, it is widening the inequalities that already existed - gender, racial, social and economic.

The ongoing efforts to combat Covid-19 is gaining momentum worldwide with the fast-track approach to roll-out effective vaccines and improved modalities of treatment to reduce the case fatality ratio (CFR). However, it’s still not over for HIV/Aids, because challenges continue to exist. Lockdowns and border closures to stop the spread of Covid-19 impacted both the production and transportation of medicines on the one hand, and impeded access to services, on the other. In responding to Covid-19, the world cannot make the same mistakes it made in the fight against HIV, when millions in developing countries died waiting for treatment.

Women and girls must have their rights fully respected, and criminalisation and marginalisation of gay men, trans-genders and sex workers must stop.

At least 68 countries still have laws that criminalise same-sex sexual relations. How can we reach out with prevention messages and treatment interventions effectively without social endorsement and acceptance of key populations like LGBTQ and sex workers? Young women and girls (15-24 years) accounted for all new HIV infections in 2019 indicating they are emerging as the new vulnerable and high-risk group in the AIDS epidemic.

Eliminating stigma and discrimination, and placing people as the prime focus to safeguard their fundamental rights are important and hold the key to end the collective pandemics of HIV and Covid-19. An all-inclusive people-friendly approach in the areas of awareness, advocacy and prevention strategies are important lessons to be learnt from HIV/AIDS response thus far.

In 2019 at the national level, there were an estimated 23.49 lakh people living with HIV (PLHIV), with an adult (15-49 years) HIV prevalence of 0.22%.

Maharashtra had the highest estimated number of PLHIV (3.96 lakhs), followed by Andhra Pradesh (3.14 lakhs), Karnataka (2.69 lakhs), Uttar Pradesh (1.61 lakhs), Telangana (1.58 lakhs), Tamil Nadu (1.55 lakhs), Bihar (1.34 lakhs) and Gujarat (1.04 lakhs). Together, these eight states constituted 72% of the total PLHIV estimates in the country.

Nationally, the annual new HIV infections have decreased by 37% since 2010. The decline in annual new HIV infections has been noted in all States/UTs except for Tripura, Arunachal Pradesh, Chhattisgarh and Chandigarh. The highest decline has been noted in Karnataka (75%), followed by Himachal Pradesh (74%) and Andhra Pradesh (65%).

NACO has to address many challenges during Covid times to maintain and improve the chain of the care continuum. Among the priorities are creating options to collect anti-retroviral therapy (ART) from the nearest ART centers; multi-month dispensing (MMD) of ART; upgraded ART with a more robust Dolutegravir-based regimen in accordance with WHO guidelines; providing online training programmes for doctors, counsellors, outreach workers (ORW) and managerial staff; keeping track of treatment adherence by sending reminders for follow-up; additional focus on counselling PLWA about the importance of mask, hand hygiene and physical distancing; counselling on the importance of adherence to ART; and getting swab/RT PCR test done for Covid-19 without any anxiety and fear.

Global solidarity and shared responsibility towards effectively reaching out awareness, prevention and treatment strategies to all segments of society without any discrimination appears to be the only way forward to combat both the epidemics of HIV/Aids and Covid-19.

(The author is Chairman, Asha Kirana Charitable Trust, Mysuru, and has been treating HIV patients for 20 years)