World AIDS Day: The disappearing conversation around HIV

Last Tuesday marked the 29th death anniversary of popular British singer Freddie Mercury, who was diagnosed with HIV in 1987 and died of bronchial pneumonia from AIDS at the age of 45. He had kept his ailment private until 24 hours before he passed away on November 24, 1991. Two years later, 49-year-old tennis champion Arthur Ashe died of complications from AIDS on February 6, 1993.

As AIDS went on a high spin claiming many more celebrity (and ordinary people’s) lives, we kept their memories alive to remind ourselves of how the Human Immuno-deficiency Virus (HIV) enters the body, causes AIDS, impacts lives, and what we could do to protect ourselves

On the trodden path

World AIDS Day: The disappearing conversation around HIV

In the last decade though, AIDS stopped making headlines as the health crisis it once was. The main reason for the drop in conversation is that the numbers have drastically reduced from an annual three million new cases during peak years (1992 to 2005) to 80,000-plus every year now, says JVR Prasada Rao, former Union Health Secretary, who was at the helm of India’s AIDS control programme between 1997 and 2017, and also authored Celebrating Small Victories: My Journey Through Two Decades of AIDS Response.

“HIV infection is no longer a major inhibitor of the quality of life. Like asthma and diabetes, it is now understood as a lifestyle management disease,” he says. Hereminds us that AIDS has not been eliminated nor has it found a cure through vaccine yet. But an integrated control strategy and new effective treatments with drugs have helped those who are HIV positive live an unencumbered life for as long as they perhaps would have without the virus.

Anandi Yuvaraj, Coimbatore-based AIDS activist concurs that aggressive prevention campaigns and improved access to scientifically-driven tests and treatment drastically reduced the HIV/AIDS infection rate in the last decade. Though trapped in stigma, AIDS saw community participation and activism and that helped plug the mother-to-child route of transmission of HIV infection. “The ante-natal treatment protocol has evolved. Every pregnant woman mandatorily undergoes the Rapid Test and irrespective of the level of CD4 count (that checks the immunity strength in those with HIV-infection) is put on treatment,” she says. Earlier only those with higher CD4 count got priority to get the drugs while others had to wait to buy them. Now the drugs in various effective combinations are provided free to all in the Government run Anti-Retroviral Therapy (ART) clinics. “Also, the upgrading of blood banks, testing and quality of voluntary blood donors [following the ban on sale of blood] has ended the transmission of HIV infection through blood transfusions,” adds Anandi.

Conversation continuers

World AIDS Day: The disappearing conversation around HIV

“It is imperative that we keep talking about AIDS so that everybody knows how one can and cannot be infected. Otherwise, the distance we have covered in the fight against HIV will be lost,” says Rao. “Though the new infection rate is down by 65 to 75%, we have to achieve the UN’s Sustainable Development Goals set at 95% by 2030. This means we should bring down new cases to 5,000 a year if we are looking at eliminating AIDS as a public threat.”

Where we need special help is the most vulnerable communities affected. “Upto 98% of new HIV infections today occur in the sex workers, MSM (men who have sex with men), and IDUs (Injecting Drug Users),” says Yashwinder Singh, director, (Policies) of Humsafar Trust, the quarter-century-old Mumbai-based advocacy group that counsels members of the LGBT community.

But the Government’s focus has now shifted from prevention to only treatment with the withdrawal of global and bilateral funds. Also with the decline in prevalence rate, the Information Education Campaigns suffered a setback and the conversations around AIDS diminished.

Says Mona Mishra, strategic planning consultant (HIV/AIDS project), UNDP: India is a low spender on healthcare. While the country’s health budget has remained between 1.2 % and 1.6 % of GDP in the last decade vis-a-vis the growth in population, the Government reduced the expenditure for ongoing AIDS projects by up to 60 %. As a result, the preventive interventions took a hit, she adds.

Unlike Gen X who was fed on awareness campaigns on use of condoms (remember actor Shabana Azmi appearing in ads going around AIDS wards shaking hands and hugging people to convey that the infection is not acquired through touch but through unprotected sex), generations after have not had these conversations. This means a whole new generation (born after 2004) runs the risk of been raised on Internet knowledge, downloading dating apps and hook-ups. “We need to discuss safe sex with adolescents and provide them with the right knowledge inputs because you cannot change natural desires and sexual behaviour,” says Singh.

He wonders why condom ads are always about a man and a woman but never show two men. “Our school curriculum opposes sex education without realising how education and awareness play a crucial preventive role,” he says. Since HIV infection is now mainly caused by engagement in high risk behaviours, Singh says tapping the online medium, flagging messages, rapport building, and scaling up testing is the new challenge. “Evidence for the social determinants of HIV transmission is available but effort to target the social inequalities is limited,” he says.

Stigma busting

World AIDS Day: The disappearing conversation around HIV

Dr Monica Goel, consultant physician at Mumbai’s Hinduja Hospital talks of a woman she has been treating for HIV over the last eight years. The woman leaves her medical files with the doctor. “She does not keep any prescription or medical report related to her ailment at home for the fear of being caught and shamed. She has asked me not to mention her disease when she comes with a family member for her follow-up treatment,” says Dr Goel.

It is the advance treatment that allows the woman to live normally in the comfort of her family and home. “She is aware of her status and no longer feels she is suffering from a life-threatening disease or is a threat to anybody else,” says Dr Goel. It is now proved that low viral load and effective treatment that suppresses the virus makes the disease non-transmittable.

“More testing, early detection, effective treatment and protection will remain the mainstay to end HIV-infection. We only need to replace shame and stigma with frank conversations,” she adds.

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Printable version | Jan 24, 2021 9:28:53 AM |

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