Editorial Notes

[Editorial Notes] Taking stock of the anti-AIDS fight

The slowdown, which places targets out of reach, calls for a renewal of political commitment, finances and engagement.
By IASToppers
December 09, 2019

Contents

  • Introduction
  • 90-90-90Target of UNAIDS
  • Ups and Downs in countering HIV/AIDS
  • HIV scenario in India
  • Drug Treatments of HIV
  • Key Facts
  • IT’s Input

Taking stock of the anti-AIDS fight

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Introduction

  • The Sustainable Development Goals (SDG), adopted by member countries of the United Nations in 2015, set a target of ending the epidemics of AIDS, Tuberculosis and Malaria by 2030 (SDG 3.3).
  • The key indicator chosen to track progress in achieving the target for HIV-AIDS is “the number of new HIV infections per 1,000 uninfected populations, by sex, age and key populations”.
  • The phrase “key populations” refers to: men who have sex with men; people who use injected drugs; people in prisons and other closed settings; sex workers and their clients, and transgender persons.

90-90-90Target of UNAIDS

UNAIDS, the lead UN agency that coordinates the battle against HIV, adopted the 90-90-90 target.

It states that by 2020,

  • 90% of all people living with HIV will know their HIV status.
  • 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
  • 90% of all people receiving antiretroviral therapy will have viral suppression.

90-90-90 Target of UNAIDS 2019

Ups and Downs in countering HIV/AIDS

During 2000-2018

  • During 2000 and 2018, there was a reduction in new HIV infections by 37%. Moreover, HIV-related deaths fell by 45%, with 13.6 million lives saved due to Anti-Retroviral Therapy (ART).
  • The drugs developed, during this period, to combat a disease were widely available due to generic versions made available by Indian generic manufacturers.
  • According to a report by UNAIDS, of the 38 million persons now living with HIV, 24 million are receiving ART, as compared to only 7 million nine years ago.

Taking stock of the anti-AIDS fight3

After late 2018

  • At the end of 2018, while 79% of all persons identified as being infected by HIV were aware that they have HIV, 62% were on treatment and only 53% had achieved viral suppression, falling short of the 90-90-90 target set for 2020.
  • Due to gaps in service provision, 770,000 HIV-affected persons died in 2018 and 1.7 million persons were newly affected.
  • Only 19 countries are on track to reach the 2030 SDG target. Central Asia and eastern Europe has more than 95% of the new infections among the ‘key populations’.

Reason for slowdown in Progress

  • Due to expanded health agenda in the SDGs, resources of national health systems were increased decreasing doucs on HIV. Even global funding streams started identifying other health priorities.
  • Improved survival rates reduced the fear of HIV/AIDS.
  • Improved survival rates in persons with HIV bring forth other health problems, diverting attention from HIV to those problems. For instance, Risk factors for cardiovascular disease are high among HIV survivors and Mental health disorders are a challenge in persons who are on lifelong ART therapy.
  • Failure to pass the risk-related knowledge and prevention-oriented behaviors of HIV to a new generation of young persons.
  • Vulnerability of adolescent girls to sexual exploitation by older men and domineering male behaviors inflicting HIV infection on unprotected women in Africa.

HIV scenario in India

  • HIV-related deaths declined by 71% between 2005 and 2017.
  • HIV infection now affects 22 out of 10,000 Indians, compared to 38 out of 10,000 in 2001-03. The total number of persons affected in India is 21.40 lakh, with females accounting for 8.79 lakh (41% of total).
  • India has 87,000 new AIDS infections and 69,000 AIDS-related deaths annually.

HIV scenario in India 2019

  • 9 States (shown in red in above fig.) have rates higher than India’s Adult HIV prevalence (0.22). Mizoram leads with 204 out of 10,000 persons affected.
  • Assam, Mizoram, Meghalaya and Uttarakhand showed an increase in numbers of annual new infections.

Drug Treatments of HIV

  • Drug treatment of HIV is now well founded with an array of established and new anti-viral drugs.
  • The success of drug treatment to prevent mother-to-child transmission, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and male circumcision, especially among MSM (men who have sex with men) population, is well-documented.
  • Given the wide diversity of the HIV virus strains, development of a vaccine has been highly challenging. Hence, mere technical innovations will not win the battle against HIV-AIDS.

Key Facts

  • Risk of acquiring HIV infection is 22 times higher in homosexual men and intravenous drug users, 21 times higher in in sex workers and 12 times more in transgender persons.

IT’s Input

AIDS statistics in India

HIV scenario in India 2019 2

HIV scenario in India 2019 3

During 2018-19,

  • 79% of people living with HIV knew their HIV status,
  • 82% diagnosed with HIV infection are receiving free antiretroviral therapy
  • 79% are virally suppressed.

Taking stock of the anti-AIDS fight4

Conclusion

Success in our efforts to reach the SDG 2030 target calls for resurrecting the combination of political will, professional skill and wide ranging pan-society partnerships that characterised the high tide of the global response in the early part of this century.

The theme of the World AIDS day 2019 (“Ending the HIV/AIDS Epidemic: Community by Community), is a timely reminder that community wide coalitions are needed even as highly vulnerable sections of the community are targeted for protection in the next phase of the global response.

The strength of India’s well established National AIDS Control Programme, with a cogent combination of prevention and case management strategies, must be preserved.

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