The fight against AIDS has definitely made considerable progress but formidable challenges confront the path to ending AIDS by 2030, as committed by the countries globally at 70th UN General Assembly in September 2015. The brutal irony is that despite knowing ‘what works in helping us progress towards AIDS’ the uptake of these evidence-based strategies is abysmally low, and some countries like India, have slashed health budgets by 20%.
Embarrassment of riches?
“It is almost an embarrassment of riches because we know how to end AIDS but we are failing to match the scale of response required to do so! Also ironically we save millions globally but loose thousands to HIV nationally” said Dr Ishwar Gilada, President of AIDS Society of India (ASI).
Eliminate mother to child transmission of HIV
“A small country such as Cuba can eliminate mother-to-child HIV transmission by using Indian medicines; but India is far from reaching that achievable goal though we export ART to 168 countries. In India, less than 30% of the pregnant HIV+ve women received PPTCT (Prevention of Parent To Child Transmission of HIV) therapy and that too only single-dose nevirapine, an outdated therapy.
Admittedly, the National AIDS Control Organization (NACO) said India recorded 18,000 children getting HIV from 65,000 HIV+ve mothers in 2009, despite of proven strategies to prevent each of them. The world has achieved near-zero mother to child transmission but NACO aspired for merely 50% reduction. This gross negligence has created thousands of drug resistant HIV+ve mothers as well as children in India. Gladly, NACO has now rectified its strategy and decided to provide best available ART to pregnant women now” added Dr Gilada.
No ART for those who test HIV+ is clinical malpractice
Taking new WHO HIV Guidelines 2015 and latest (strong) scientific evidence into account, antiretroviral therapy (ART) must be provided to every PLHIV – this will not only help keep all PLHIV healthy and enable them to live normal lifespans, but also drastically reduce chances of any further HIV transmission. But 64% of PLHIV in India are yet to get life-saving ART.
“Also it is important to note that 20% patients at free ART roll-out facilities were dead, 12.5% lost to follow-up or stopped ART in 3 years. Only half of HIV infections are recorded at NACO, as the other half infected people do not know their HIV status. This is indeed a formidable gap. Data shows that only 56% of sex workers are reached with HIV prevention program, 38% of them identify correct ways of prevention methods, yet most intervention programs are scrapped.
‘Test and Treat’, Treatment as Prevention (TasP) and Pre-exposure prophylaxis (PreP) for all, Post-Exposure Prophylaxis(PEP) also for the victims of sexual assaults are some of the evidence-backed approaches where we should not delay to maximize public health outcomes” said Dr Ishwar Gilada, who is also one of the first clinicians to come forward for HIV care when first case got diagnosed in India.