The theme of World AIDS Day, to be observed on December 1 is ‘Ending the HIV/AIDS epidemic: resilience and impact.’
The method to achieve this by 2030 is to ensure life-saving anti-retroviral therapy reaches all those who are infected and that all persons living with HIV know their status. Also the aim is to ensure that those on ART are viral suppressed so that infection is negligible. The aim is to make U=U or undetectable = Untransmittable a reality.
Experts treating HIV/AIDS are worried that the COVID-19 pandemic has delayed the World Health Organisation’s target to improve the life of people living with HIV (PLHIV). The target date to ensure that 90% of the PLHIV are reached by 2020 has been delayed, they say.
The aim of the WHO, to which India is a signatory, was to ensure that 90% of PLHIV know their status, 90% of them are on life-saving anti-retroviral therapy (ART) and 90% of those on ART are virally suppressed, before the end of 2020. By 2030, it aimed to make accessible ART to every PLHIV, which in turn reduces the viral load in their blood to undetectable levels. This would result in making negligible their risk of transmitting the HIV.
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Ishwar Gilada, president, AIDS Society of India (ASI), said India had 2.35 million people living with HIV. Of this 1.345 million were receiving ART. There were 69,220 new HIV infections and 58,960 AIDS related deaths reported in India in 2019.
“The 2020 global target is to achieve reduction in new HIV infections and AIDS deaths below 500,000 in a year. But in 2019, we had 1,700,000 newly infected people with HIV and 690,000 AIDS deaths worldwide,” he said, adding that at the end of 2019 globally there were 3.8 crore PLHIV.
“As per the UNAIDS Report 2020, Asia Pacific region saw a 12% decline in new HIV infections and a 29% decline in AIDS-related deaths over the last decade. But the maximum decline of 66% in new infections was in India,” said N. Kumarasamy, ASI secretary general.
Globally of the 37.9 million people living with HIV at the end of 2018, 81% had received testing, 67% received treatment; and 59% had achieved suppression of HIV virus with reduced risk of infecting others globally.
“In India, 79% of PLHIV were aware of their status and of this 71% were on ART, amounting to only 55% of all PLHIV. The number of those virally suppressed had increased but not the target of 90-90-90,” Dr. Gilada said.
“Everyone who tests positive for HIV should be on life-saving ART and viral suppressed. There should be no gap. We must give equal emphasis to prevention, not just treatment. We cannot prioritise treatment over preventing new infections. Such an approach will neither work for ending AIDS nor for ending COVID-19,” said Dr. Kumarasamy.
Although National AIDS Control Organisation stepped up uninterrupted supply of ART during the pandemic, HIV key populations, sex workers and LBGTIQ+ communities faced challenges, as HIV-related services such as for co-infections and co-morbidities were beyond their reach, the ASI said.
The 2017 National Health Policy and the UN Sustainable Development Goals aim to end AIDS by 2030. With only 121 months to meet the target, “We need to achieve zero new transmission of HIV if we are to deliver on the promise of ending AIDS in the nexxt 10 years,” Dr. Kumarasamy, who is also the chief and director of infectious diseases medical centre at Voluntary Health Services (VHS) hospital, said.
India adopted the test and treat strategy of the WHO as a national policy to achieve the target of 90:90:90 by 2020.
“We need to aspire to scale up HIV care to reach 100% of people living with HIV. With several new antiretroviral molecules and ART combinations now available, treatment as prevention must be a norm. India has the third highest HIV burden with 2.35 million,” he added.