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Civil society organizations working in the field of HIV prevention and treatment have called for ending missed opportunities to end AIDS by 2030.
“We have adequate and efficient tools to end AIDS - be it the science-backed tools and approaches to prevent HIV transmission, or diagnosing and treating people living with HIV (PLHIV) so that they can live healthy and fulfilling lives. With these tools, we are progressing but not progressing fast enough as we should, to end AIDS by 2030. An array of missed opportunities is plaguing the AIDS response worldwide. Factors like lack of accountability, sub-optimal programme effectiveness, and complacency are slowing us down from reaching the goal of an AIDS-free world. Covid-19 pandemic did play spoilsports, but we cannot use it as an excuse towards non-achievement of goals,” said Dr Ishwar Gilada, president of AIDS Society of India (ASI), and Governing Council member of International AIDS Society (IAS).
“We have robust anti-retroviral therapy (ART), that can result in undetectable viral load for those PLHIV on treatment within just a couple of months and by now it is amply clear that Undetectable is Untransmittable or U=U. Thus, each new HIV case is a missed opportunity where a range of combination prevention options could have helped prevent the person from getting infected. Likewise, every AIDS-related death is a grim reminder that it could have been averted because we have proven science-backed tools to make AIDS death a history,” said Dr Gilada who is also secretary general of Peoples Health Organisation.
Taking note of the World AIDS Day-2022 theme, “Equalize”, he called for doing away with the inequalities which perpetuate the AIDS pandemic. The “Equalize” slogan of UNAIDS is a call to action for all of us to work for the proven practical actions needed to address inequalities to help end AIDS. All PLHIV must have access to HIV testing and treatment. Laws and policies should help end (and not abet) stigma and discrimination faced by people living with HIV and by key and marginalised populations and laws like India’s HIV/AIDS Act 2017 should not remain a toothless weapon, he added.
UN SDGs as well as National Health Policy of India promised that by 2020, 90% of people living with HIV will know their status, 90% of these will have access to ART and 90% of those on ART will have viral suppression.
“Most countries were not able to deliver on 2020 HIV targets of 90-90-90 but made commendable progress. Conveniently shifting goal posts will not help end AIDS. We can end AIDS by 2030 but the curve will not bend by itself. We need to remember that we could have achieved these goals had we succeeded in eliminating missed opportunities in the AIDS response. We should have ensured that the full HIV combination prevention spectrum and complete range of diagnostics, treatment, care and support services were reaching everyone, especially those among the key populations. We should have worked with a heightened sense of purpose and urgency to help prevent HIV infection transmission and avert AIDS deaths. Ending AIDS is one of the targets of UN SDGs. Unless we progress on all SDG goals and targets, we will not be able to progress towards ending AIDS as we should,” said Dr Gilada.
According to UNAIDS, an estimated 2.4 million people were living with HIV in India in 2021 (including 70,000 children). Out of these 1.9 million or 77% knew their HIV status; 1.6 million (or 65% of 2.4 million) were on lifesaving antiretroviral therapy; and 1.3 million (or 55% of 2.4 million) had suppressed viral load. More alarmingly, 63,000 people were newly infected with HIV in 2021 in India - 173 new infections every day or 7 infections every hour. And sadly, there were 42,000 AIDS-related deaths in 2021 (5 deaths every hour).
India, despite progress towards eliminating parent to child transmission of HIV, is yet to achieve the goal. Coverage of pregnant women who receive medicines to prevent HIV transmission to the unborn child (during pregnancy or breastfeeding) is 64%. Vertical transmission rate including during breastfeeding 24.3%. This is another missed opportunity which we truly cannot afford to ignore if we are to end AIDS in the next 96 months (by 2030), rather we should completely eliminate parent to child transmission of HIV as early as possible, said ASI president.
While overall HIV prevalence in adults in India is 0.24%, HIV prevalence in sex workers is 1.9%; in gay men and other men who have sex with men (MSM) it is 3.3%; in transgender people it is 3.85%, and in people who inject drugs it is 9%. Whereas HIV prevalence in prisoners is 1.9% but coverage of antiretroviral therapy is only 28.7% in prisoners. If current trends continue, more than 1.2 million people will be newly infected with HIV in 2025 - three times more than the pre-set target of 370,000 new infections by 2025.
India’s capacity to produce generic HIV medicines and supply them worldwide did result in major successes for the global AIDS fight as over 90% of antiretrovirals consumed globally were from India. “The next best opportunity to eliminate the difference between “what we know works” and “what we do” is now. We know how to prevent HIV, diagnose HIV, treat, care and support PLHIV. But the gap between -where we are and where we need to be or what we can do and the ground reality is a chasm we cannot afford to have anymore. Bridge the gap to end AIDS,” opined Dr Gilada.
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