Insights into Editorial: Taking stock of the anti-AIDS fight
The Sustainable Development Goals (SDG), adopted by member countries of the United Nations in 2015, set a target of ending the epidemics of AIDS, Tuberculosis and Malaria by 2030 (SDG 3.3).
The key indicator chosen to track progress in achieving the target for HIV-AIDS is “the number of new HIV infections per 1,000 uninfected population, by sex, age and key populations”.
Given the wide diversity of the HIV virus strains, development of a vaccine has been highly challenging but a couple of candidates are in early stage trials. However, mere technical innovations will not win the battle against HIV-AIDS.
Vulnerable sections who are affected by the epidemics:
In the terminology of HIV prevention and control, the phrase “key populations” refers to: men who have sex with men; people who use injected drugs; people in prisons and other closed settings; sex workers and their clients, and transgender persons.
Risk of acquiring HIV infection is 22 times higher in homosexual men and intravenous drug users, 21 times higher in sex workers, 12 times more in transgender persons.
India’s efforts to tackle the HIV-AIDS Epidemics:
The Indian experience has been more positive but still calls for continued vigilance and committed action.
Nine States have rates higher than the national prevalence figure. Mizoram leads with 204 out of 10,000 persons affected. The total number of persons affected in India is estimated to be 21.40 lakh, with females accounting for 8.79 lakh.
Assam, Mizoram, Meghalaya and Uttarakhand showed an increase in numbers of annual new infections.
HIV-related deaths declined by 71% between 2005 and 2017. HIV infection now affects 22 out of 10,000 Indians, compared to 38 out of 10,000 in 2001-03.
India has an estimated 2.14 million persons living with HIV and records 87,000 estimated new infections and 69,000 AIDS-related deaths annually.
The strength of India’s well-established National AIDS Control Programme, with a cogent combination of prevention and case management strategies, must be preserved.
UN 90-90-90 targets report:
India, China and Pakistan are among the 10 countries that accounted for more than 95 per cent of all new HIV infections in the Asia and the Pacific region in 2016, according to a UN report.
The report by the Joint UN Programme on HIV/AIDS, UNAIDS, ‘Ending AIDS: Progress towards the 90-90-90 targets’, gives a comprehensive analysis of the 2014 targets to accelerate progress so that by 2020, 90 per cent of all HIV-infected people know their status, 90 per cent of all HIV-diagnosed people are accessing antiretroviral therapy (ART) and 90 per cent of those taking ART are virally suppressed.
Antiretroviral Therapy (ART):
It consists of the combination of antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease.
ART also prevents onward transmission of HIV. Huge reductions have been seen in rates of death and infections, when use is made of a potent ARV regimen, particularly in early stages of the disease.
Antiretroviral Therapy (ART) is now being given to people living with HIV, irrespective of the CD4 count.
Reasons for the slowdown in progress:
- The success achieved in the early part of this century, through a determined global thrust against the global threat, led to a complacent assumption of a conclusive victory.
- The expanded health agenda in the SDGs stretched the resources of national health systems, even as global funding streams started identifying other priorities.
- Improved survival rates reduced the fear of what was seen earlier as dreaded death and pushed the disease out of the headlines.
- The information dissemination blitz that successfully elevated public awareness on HIV prevention did not continue to pass on the risk-related knowledge and strong messaging on prevention-oriented behaviours to a new generation of young persons.
- Vulnerability of adolescent girls to sexual exploitation by older men and domineering male behaviours inflicting HIV infection on unprotected women have been seen as factors contributing to new infections in Africa.
- Risk factors for cardiovascular disease are high among survivors as they age, with anti-retroviral drugs increasing the risk of atherosclerosis.
- Other infectious diseases, such as tuberculosis can co-exist and cannot be addressed by a siloed programme.
- Mental health disorders are a challenge in persons who are on lifelong therapy for a serious disease that requires constant monitoring and often carries stigma.
There are worryingly high rates of new infection in several parts of the World. Only 19 countries are on track to reach the 2030 target.
Drug treatment of HIV is now well founded with an array of established and new anti-viral drugs.
The success of drug treatment to prevent mother-to-child transmission, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and male circumcision, especially among MSM population, is well-documented.
Success in our efforts to reach the 2030 target calls for resurrecting the combination of political will, professional skill and wide ranging pan-society partnerships that characterised the high tide of the global response in the early part of this century.
The theme of the World AIDS day this year (“Ending the HIV/AIDS Epidemic: Community by Community), which is communities make the difference, is a timely reminder that community wide coalitions are needed even as highly vulnerable sections of the community are targeted for protection in the next phase of the global response.