On December 1, the World Health Organisation joins partners to commemorate World AIDS Day, and this year it is under the theme ‘Equalise’. The UN health agency is calling on global leaders and citizens to address the still wider inequalities that mars the global efforts to end HIV/AIDS.
A recent UNAIDS report -– Dangerous Inequalities, however, suggests that an urgent action to ensure everyone has equal access to HIV prevention, testing and treatment may help get the response back on track. UNAIDS estimates that a combined investment of at least US$ 29 billion will be required for the AIDS response in low and middle-income countries, including countries which formerly considered to be upper-income status, to get on track the global efforts to end AIDS as a global public health threat by 2030.
“We will have to end the inequalities which perpetuate the AIDS pandemic. This time the slogan is a call to action for all of us to work for the proven practical actions needed to address the inequalities,” says Dr Ishwar Gilada, who is the president of AIDS Society of India and governing council member of International AIDS Society.
According to Gilada, all people who are infected must have access to HIV testing and treatment.
A scientific report in Nature says that an estimated 37.6 million people are living with the HIV/AIDS virus worldwide, with an associated mortality of 1.5 million people per year. .These numbers place HIV/AIDS among the ten leading causes of death, mostly among low- and lower-middle-income countries, though UNAIDS data shows that the new HIV infections have been reduced by 54 percent since the peak in 1996 and the AIDS-related deaths have come down by 68 percent since the peak in 2004.
Wider Gap
There has been a wide gap in diagnostic tools, testing and treatment and this has increased during the pandemic because of the focus on Covid treatment. Early detection of the patients is essential for treatment and preventing transmission.
Anti-retroviral treatment (ART) remains the cornerstone for optimal HIV outcomes, including viral suppression (VS), immune recovery and decreased transmission risk, achieving optimal treatment outcomes hinges on treatment adherence. However, many people with HIV face structural, logistical, behavioural, and cognitive barriers to this very adherence.
“We have a robust ART that can result in lowering even undetectable viral load on treatment within just a couple of months. Therefore each new HIV case is a missed opportunity where a range of combination prevention options could have helped prevent the person from getting infected,” adds Gilada.
Such instances have prompted the WHO to stress upon a renewed focus on the populations that have been left behind.
“Only 52 percent of children living with HIV are on life-saving treatment,” notes a recent paper by the WHO.
“If we can show progress in ending the new infections among children and ensuring all are on quality antiretrovirals (ARVs), we have a greater hope and can ensure greater political commitment to end AIDS in all populations by 2030,’’ the WHO paper says.
Challenging landscape
The UNAIDS data shows an estimated 2.4 million people were living with HIV in India in 2021. Out of these, 1.9 million or 77 percent knew their HIV status, 1.6 million were on lifesaving antiretroviral therapy and 1.3 million had suppressed viral load. More alarmingly 63,000 people were newly infected with HIV in 2021 in India. This means 173 new infections everyday or 7 infections every hour in the country.
According to Dr Jatin Ahuja, an Infectious Diseases specialist at Apollo Hospital, maintains that the greatest challenge as far as the prevention and treatment are concerned in India is the stigma associated with the disease. “The people don’t want to come up and get tested. Even if they know, they don’t want to get tested. There needs strong campaigns to make people aware that HIV is just like any other chronic disease and strong family support will play a pivotal role to remove the stigma,” he says.
Also there is an urgent need to approve the HIV self-test kits. This will help people know the status. Another priority should be the elimination of parent to child transmission of HIV.
Currently, the mother to child transmission is about 3 percent of the total HIV cases in India. Coverage of pregnant women who receive medicines to prevent HIV transmission to the unborn child is however only 64 percent. Vertical transmission rate, including during breastfeeding is 24.3 percent. This is another missed opportunity which the world truly cannot afford to ignore if it needs to end AIDS by 2030.
While a changing funding priorities over a period of time is one major issue that leads to such inequalities, Covid-19 pandemic has impacted the HIV/Aids programmes too like other diseases globally. Millions of patients, enrolled on the ART treatment and prevention programmes, missed their medications and came back with a high viral load with new clinical symptoms.
If the current trends continue, more than 1.2 million people will be newly infected with HIV by 2025—three times more than the pre-set estimate of 370,000 new infections by 2025.
--Dr Vanita Srivastava is an independent science and health writer
Read her previous articles
here (Edited by : CH Unnikrishnan)
First Published: Dec 1, 2022 7:03 AM IST
