Promise to end AIDS by 2030: Are we on track?
, CNS (Citizen News Service)
(CNS): Governments of over 190 nations, including India, have promised to end AIDS by 2030 by adopting the UN
Sustainable Development Goals (SDGs). But the current data, trends and experiences of HIV experts pose serious concerns
on if we are on track to end AIDS by 2030.
"Since India diagnosed its first case in 1986, we have enough piled up scientific evidence to know what are the proven
approaches for preventing HIV transmission and caring for people living with HIV (PLHIV), so that they can live normal
lives. But is this a reality on the ground? There is no excuse for inaction lest we may fail to meet promises of ending
AIDS" said Dr Ishwar Gilada, President of the AIDS Society of India (ASI) and President of 10th National Conference of ASI (ASICON 2017) which will
open in Hyderabad on 6th October 2017 on the theme of: Action, Science and Innovation for ending AIDS.
Promise of 90:90:90: Real or mirage?
The National Health Policy 2017 of Indian government promises to “achieve the global target of 90:90:90, for HIV/AIDS by
2020, that is, 90% of all people living with HIV will know their HIV status, 90% of all people diagnosed with HIV
infection will receive sustained antiretroviral therapy (ART) and 90% of all people receiving antiretroviral therapy
will have viral suppression” (Source: 220.127.116.11. of National Health Policy 2017 of Government of India
). These NHP-2017 goals are in line with UNAIDS commitments too. Despite progress there is a long way ahead of us, if we
are to meet these goals.
"We need unprecedented action to meet NHP-2017 goals. As of 2016, 67% of PLHIV (2.1 million/ 21 lakhs) know their
status; 1.4 million (14 lakhs) are diagnosed with HIV and 902,868 PLHIV were on life-saving ART (source: WHO SEARO
). Not only have we not yet reached out to 33% of PLHIV in the country, but also less than 50% of PLHIV are on ART,
despite WHO and NACO guidelines to ‘test and treat all’. Less than 65% of PLHIV who know their status, are receiving
ART. We cannot become complacent in our efforts, because failing to reach out to each of the estimated PLHIV and putting
them on ART threatens to reverse the progress made in fighting AIDS” said Dr Gilada, who was among the first few doctors
in India who came forward for HIV management when the first case got diagnosed in the country.
Scientific evidence has shown that if every PLHIV is on ART, with viral load suppression, the risk of HIV transmission
is negligible, and the person can lead a normal healthy life. But in India, with very limited capacity to do viral load
testing, it is not known how many of the documented 9,02,868 people on ART are virally suppressed. Viral load monitoring
of every PLHIV on ART is necessary, emphasizes ASICON 2017 experts, else how would India meet the goal of achieving
viral load suppression for 90% of those PLHIV who are receiving ART by 2020?
Dr Naval Chandra, Co-Chair, ASICON 2017 and Professor in Medicine, Nizam Institute of Medical Sciences, Hyderabad said: "In other states
of India number of new HIV infections might have come down, but in Andhra Pradesh and Telangana combined, in last 1-2
years we are seeing a sudden increase in new HIV infection."
Dr Franco Buonaguro, National Cancer Institute, Italy, said that viral hepatitis co-infection in PLHIV is now recognized as a major public
health problem resulting in increased morbidity and mortality among PLHIV including those on ART. Nonetheless all PLHIV
should be tested for HCV.
Professor Sharon R Lewin, Plenary Speaker, ASICON 2017 and Director, Doherty Institute for Infection and Immunity University of Melbourne,
Australia, who is also a member of the Governing Council of the International AIDS Society representing the Asia Pacific
region, said: "In Asia Pacific, about 5 million people are living with HIV and about 40% of them are receiving treatment
[antiretroviral therapy]." She added that "in Australia we have reached the goal of 90:90:90 but we have not changed the
numbers of new HIV infection." She put the spotlight on challenges in HIV prevention and new ways we need to explore to
effectively prevent transmission of HIV.
"In India today, almost 80-90% of PLHIV on ART are being managed, not treated, at some 530 ART centres of NACO, and the
remaining PLHIV access private healthcare. Retaining PLHIV on ART at public sector ART centres is extremely crucial for
managing HIV in India, as they cater to the majority of PLHIV. Clinical studies tell us about efficacy of drugs in a
controlled environment, but long-term effectiveness studies are important to corroborate clinical studies’ findings”
added Dr Ishwar Gilada.
India had an estimated 86,000 new HIV infections in 2015. Children less than 15 years accounted for 12% (10,400) of
total new infections while the remaining (75900) new infections were among adults (over 15 years). The goal to eliminate
parent to child transmission of HIV by 2020 also mandates accelerated roll-out of evidence-based measures in India.
Countries like Cuba, Thailand among others have already eliminated parent to child transmission of HIV.
Academic partners of ASI include Government of India's National AIDS Control Organisation (NACO), Indian Council of
Medical Research (ICMR), Medical Council of India, UNAIDS, Association of Physicians of India, Forum of Parliamentarians
on HIV & AIDS, People’s Health Organisation (PHO), CAPRISA South Africa, among others. Over 500 HIV medical experts of various
clinical and scientific disciplines from across the country, and other nations including USA and Australia, are taking
part in ASICON 2017.
, CNS (Citizen News Service)
(Shobha Shukla is the Managing Editor of CNS (Citizen News Service) and has written extensively on health and gender
justice issues since decades. Follow her on twitter @Shobha1Shukla, website: www.citizen-news.org