The hard-fought battle against AIDS, seen as a very successful global public health campaign of our times, is far from over. The World Health Organisation (WHO) said in a technical report released recently that countries need to be alert to drug resistance possibly undermining the fight against AIDS.
Numbers tell the story of the effectiveness of the campaign so far in India.
The decline in the prevalence of Human Immunodeficiency Virus (HIV) among adults has been consistent in the country - the rate fell from 0.37 per cent in 2000 to 0.34 per cent in 2007 and 0.26 per cent in 2015. This is much lower than the global prevalence rate of 0.8 per cent (in 2015). Health authorities assert that India has achieved one of the Millennium Developgment Goals of halting and reversing the HIV epidemic by 2015.
The number of new cases of HIV infection has been declining in India since 2000-2001. The estimate for 2015 was 86,000 compared to 2.51 lakh in 2000, a reduction of 66 per cent against a global average of 35 per cent. The fall is to the extent of 32 per cent from 2007, which is used as the baseline in the National Aids Control Programme IV(NACP-IV).
HIV-related deaths came down by 54 per cent between 2007 and 2015, against the global average of 41 per cent.
Prevalence is also declining in most States during this period, including ones having a relatively large share of HIV-infected people, notes India HIV Estimations 2015, a technical report prepared by National AIDS Control Organisation and National Institute of Medical Statistics.
Andhra Pradesh and Telangana, Bihar, Gujarat, and Uttar Pradesh account for nearly half of the new infections. These States, along with Maharashtra and Karnataka are home to nearly two thirds of people infected with HIV. Manipur, Mizoram and Nagaland are at the top in terms of prevalence.
But some States have witnessed the opposite trend - an increase in HIV prevalence. Though most of these States have figures that are lower than the national prevalence rate, still some among them like Tripura and Sikkim have recorded a relatively steep climb.
And going by the WHO's global report on Early Warning Indicators of HIV Drug Resistance (HIVDR) released in July 2016, the battle is far from over.
Given the regional differences in the rates of prevalence of AIDS in the country, the challenges vary from State to State. The fall in the number of new HIV cases detected is not as steep as it was earlier and in some States the numbers were either rising or stabilising. Such was also the case with AIDS-related deaths, noted India HIV Estimations 2015. These need to be addressed if the NACP-IV prevention targets are to be reached by 2017.
Drug resistance has been reported several countries, including India. "With limited access in low- and middle income countries to a broad range of ARV drugs from different drug classes, HIVDR will limit treatment options and may necessitate a switch to more expensive regimens associated with greater long-term toxicity. Additionally, significant population-levels of HIVDR may lead to a reversal of hard-won gains in HIV/AIDS-related morbidity and mortality," the report says.
The issue of drug resistance gains importance because of the sheer number of HIV infected people involved. The total number of Indians living with HIV is estimated at 21.17 lakhs in 2015 compared to 22.26 lakhs in 2007. Children below 15 years account for 6.54 per cent and females 40.5 per cent of the HIV infected population.
And about 13.45 lakh patients were on anti retroviral drug therapy (ART), which has played a major role in combating the disease. WHO reported that 1.7 crore people were under ART in different parts of the world as of 2015.
Globally, prescription of ART drugs according to national or international guidelines was followed in 99 per cent of the cases but continued treatment fell to 73.5 per cent on an average over 12 months as against the WHO-recommended target of 85 per cent or above, said the WHO technical report. The numbers relating to the pick up drugs on time and follow-up were also below the prescribed targets and ensuring better compliance called for. The report contained data on early warning indicators such as the loss to follow-up and retention on ART 12 months after treatment initiation, on-time pill pick-up, on-time appointment keeping, pharmacy stock outs and viral load suppression.
In the case of India the performance was excellent on two counts - prescribing practices and on-time pill pick-up. But it was poor when it came to retention and drug stock outs (based on data for 2013-14).
The WHO report called for a better global effort to prevent the emergence and transmission of drug resistant HIV(HIVDR). "In many low- and middle-income countries, HIVDR testing is neither routinely available nor recommended for individual patient management."
