Ensuring care for those with infection a challenge

From being a death sentence, HIV/AIDS has now evolved as a chronic yet manageable disease, with early and effective treatment utilising anti-retroviral drugs.

Thus, even as the State continues to focus on the goal of preventing new HIV infections in the general population, the major challenge in the coming years would be ensuring continued care and support services for those who are surviving with the infection.

“Kerala’s HIV prevalence rate has further come down, from last year’s 0.19 per cent to 0.12 per cent this year. The total estimated number of those living with HIV in the State is 25,090. We have achieved almost zero transmission of the infection from mother to child; the infection among those groups considered to be high-risk is also coming down because of our intensive programmes. But high-risk behaviour of those in the general population has been resulting in new infections,” a senior official working in the area of HIV/AIDS said.

“Our focus will soon shift exclusively to the issues faced by those living with HIV because the anti-retroviral therapy (ART) has made it possible for them to live normal lives.

“When the State began offering free ART in 2004, the strategy had been to start treatment when the CD4 count reached 200. (CD4 is the cell count indicating the stage of HIV infection when drugs should be started). In the last two years, we raised the CD 4 cut-off to 350 and soon it will be made 500. This means that we are offering treatment very early to HIV +ve persons,” said M. Prasannakumar, former head of the technical support unit for the Kerala State AIDS Control Society.

Early ART is now a major strategy to prevent new infections in the community because the transmission potential of the virus when a person is on ART is very low, he said.

According to KSACS, HIV prevalence rates among targeted high-risk groups have been coming down steadily, especially among the injecting drug users (IDU) and female sex workers.

“The IDU group has been a concern, but we have now started oral opiod substitution therapy in over 10 government hospitals and the infection rate amongst the group is coming down. Influx of migrant workers — we have some 25 lakh in the State — could be a concern but we can also seek relief in the fact that they are all from the low-prevalence States of West Bengal, Assam, and Orissa,” Dr. Prasannakumar said.

But the euphoria over the State’s successes should not result in complacence in the health system because new infections have not totally disappeared in the State, warns Ajithkumar, Professor of Dermatology, Thrissur Medical College.