World AIDS Day | India must gear up to end HIV/AIDS by 2030

Context: The theme of World AIDS Day, to be observed on December 1, is ‘Ending the HIV/AIDS epidemic: resilience and impact.’

Analysis

  • 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.
  • It is now proved that low viral load and effective treatment that suppresses the virus makes the disease non-transmittable.

90-90-90 targets

  • India adopted the test and treat strategy of the WHO as a national policy to achieve the target of 90:90:90 by 2020.
  • 90–90–90 is an ambitious treatment target of the WHO, to which India is a signatory, to help end the AIDS epidemic.
  • By 2020, 90% of all people living with HIV will know their HIV status.
  • By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
  • By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
  • 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.
  • The 2017 National Health Policy and the UN Sustainable Development Goals aim to end AIDS by 2030.
  • 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.
  • 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.
  • India has the third highest HIV burden with 2.35 million.
  • Mizoram has the highest HIV/AIDS prevalence rate in India. Two other north-eastern States — Manipur and Nagaland — follow Mizoram in that order.
  • The Love Brigade campaign of Mizoram is a collaboration between the society and the bike and taxi associations for distributing free condoms to their clients in a “non-stigma approach” while riding with them.
  • The provision of generic Anti-Retroviral drugs (ARV) from India to the world has had a critical impact in controlling the HIV epidemic.
  • India’s unique HIV prevention model is centered around the concept of ‘Social Contracting’ through which the Targeted Interventions (TI) programme is implemented.
  • Under the Test and Treat Policy of India, approximately 50,000 people living with HIV (PLHIV) who were lost to follow-up were linked back to Anti-Retroviral Treatment services through ‘Mission SAMPARK.’
  • The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017 has provided a legal and enabling framework for safeguarding the human rights of the infected and affected populations.
  • 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.
  • 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.

Global Prevention Coalition (GPC) for HIV Prevention.

  • Member States of GPC had agreed to reduce new adult HIV infections by 75% at the end of 2020 from 2010 levels.
  1. UNFPA, formally named the United Nations Population Fund, is the United Nations sexual and reproductive health agency.
  2. United Nations Programme on HIV and AIDS (UNAIDS) is leading the global effort to end AIDS as a public health threat by 2030 as part of the Sustainable Development Goals.

Antiretroviral therapy (ART)

  • Antiretroviral therapy (ART) consists of the combination of antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease.
  • ART also prevents onward transmission of HIV.
  • While there is no cure, effective Anti-Retroviral Treatment (ART) drugs are available which can prolong the life of an HIV positive person, thus enhance the quality of life as well.
  • Patient has to take life long treatment once initiated on ART. It is freely available at ART centres across India.

Cause of concern

  • 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.
  • 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.

National AIDS Control Organization (NACO)

  • In 1986, following the detection of the first AIDS case in the country, the National AIDS Committee was constituted in the Ministry of Health and Family Welfare.
  • In 1992 India’s first National AIDS Control Programme (1992-1999) was launched, and National AIDS Control Organization (NACO) was constituted to implement the programme.
  • An additional important institutional mechanism, National Council on AIDS comprising of 31 Union Ministries, 7 Chief Ministers and leading Civil Society representatives under the chairmanship of the Prime Minister of India was created to garner political commitment.

All about HIV AIDS

What is HIV?

  1. HIV stands for Human Immuno-deficiency Virus.
  2. HIV after entering the human body gradually destroys the immune system, i.e. the ability to fight infections/ diseases.

What is AIDS?

  • AIDS stands for Acquired Immune Deficiency Syndrome.
  • It is the later stage of HIV infection.
  • It is a condition in which a group of symptoms appear as the immune system becomes very weak.
  • It can take around 8-10 years from the time of HIV infection to the stage of AIDS.
  • HIV infected people can lead symptom–free and productive lives for years.

Do all people with HIV have AIDS?

  • No. Being diagnosed with HIV does not mean a person will also be diagnosed with AIDS.
  • Healthcare professionals diagnose AIDS only when people with HIV infection begin to get severe opportunistic infections (OIs), or their CD4 cell counts fall below a certain level.

How do people get infected with HIV?

  • HIV can be transmitted through:
  1. Unprotected sex with an HIV infected person;
  2. Transfusion of HIV infected blood or blood products;
  3. Sharing of needles contaminated with HIV infected blood; and
  4. from HIV infected mother to her baby – during pregnancy in her womb through her blood, at the time of birth when the baby is passing through the mother’s genital tract or after delivery through breast milk.

Can I get HIV from getting a tattoo or through body piercing?

  • It is recommended that instruments that are intended to penetrate the skin be used once, then disposed of or thoroughly cleaned and sterilized.
  • Personal service workers who do tattooing or body piercing should be educated about how HIV is transmitted and take precautions to prevent transmission of HIV and other blood-borne infections such as hepatitis B virus.

Can I get AIDS from sharing a cup or shaking hands with someone who has HIV or AIDS?

  • While HIV is found in saliva, sharing cups or utensils has never been shown to transmit HIV.

Can HIV be transmitted through an insect bite?

  • No, Insects cannot transmit HIV. Research has shown that HIV does not replicate or survive well in insects.
  • HIV does not reproduce or live in the mosquito’s saliva. HIV is a fragile virus that does not live outside the human body.

Is there a connection between HIV and other sexually transmitted infection?

  • Yes. Sexually Transmitted Infection (STI) can increase a person’s risk of becoming infected with HIV five to eight times more. The STI causes ulcers or discharge from genitalia, STI increases the chance of acquiring and transmitting the chance of HIV infection.

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