Could the world’s health professionals actually end the Human Immunodeficiency Virus (HIV) scourge by 2030? The governments of 190 nations have promised to do so by adopting the United Nations Sustainable Development Goals, formulated in a non-binding document in Rio de Janeiro in 2012. But the task ahead is enormous.
It has been a long, hard fight. Although the virus was first identified in 1983, 34 years later there is no known vaccine or cure. Treatment, prevention and awareness remain the only tools to combat it. Some 35 million people have died of illnesses related to the virus and Auto-Immune Deficiency Syndrome, or AIDS, the disease it causes. By 2016 an estimated 36.7 million people were living with HIV including 1.8 million children.
Since the discovery of the virus, which has confounded the world’s medical profession, an estimated 78 million people have become infected with HIV. In 2016, 1 million people died of AIDS-related illnesses according to UNAIDS data. The vast majority of those living with HIV are located in low- and middle- income countries, with an estimated 25.5 million living in sub-Saharan Africa. Among this group 19.4 million are living in East and Southern Africa which saw 44% of new HIV infections globally in 2016 according to the United Nations.
India, where the disease was first diagnosed in 1986, and which has the third-largest HIV epidemic in the world, with 2.1 million cases, is an example of how difficult the job ahead is.
"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,” said Dr Ishwar Gilada, President of the AIDS Society of India (ASI) and President of the 10th National Conference of ASI (ASICON 2017) held in Hyderabad on Oct. 6. “But is this a reality on the ground? There is no excuse for inaction lest we may fail to meet promises of ending AIDS.
The Indian government’s National Health Policy 2017 promises to “achieve the global target of 90:90:90, for HIV/AIDS by 2020, that is, 90 percent of all people living with HIV will know their HIV status, 90 percent of those diagnosed with HIV will receive sustained antiretroviral therapy and 90 percent receiving antiretroviral therapy will have viral suppression.” These NHP-2017 goals are in line with UNAIDS commitments.
"We need unprecedented action to meet NHP-2017 goals,” Gilada said. “As of 2016, 67 percent of PLHIV (2.1 million) know their status; 1.4 million are diagnosed with HIV and 902,868 PLHIV were on life-saving anti-retroviral therapy. Not only have we not yet reached out to 33 percent of those living with HIV in the country, but also fewer than 50 percent are on ART, despite WHO and NACO guidelines to ‘test and treat all’. Fewer than 65 percent of those living with the virus 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.”
Evidence has shown that if every person living with HIV is on retroviral drugs, 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?
In the states of Andhra Pradesh and Telanga, over the past two years, new HIV infections have begun to climb over the past one to two years, according to Dr Naval Chandra, Co-Chair of the 2017 conference and a professor in medicine at Nizam Institute of Medical Sciences in Hyderabad, adding that in other states the number of new infections may have come down.
Professor Sharon R Lewin, Plenary Speaker, ASICON 2017 and Director, Doherty Institute for Infection and Immunity University of Melbourne, a member of the Governing Council of the International AIDS Society representing the Asia Pacific region, said only about 40 percent of the 5 million people living with HIV in the region are antiretroviral therapy." In Australia, she added, “we have reached the goal of 90:90:90 but we have not changed the numbers of new HIV infections." 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 percent of those on anti-retrovirals are being managed, not treated, at some 530 centers, and the remainder have access to private healthcare, Gilada said. “Retaining PLHIV on ART at public sector centers is extremely crucial for managing HIV in India, as they cater to the majority. Clinical studies tell us about efficacy of drugs in a controlled environment, but long-term effectiveness studies are important to corroborate clinical studies’ findings.”
India had an estimated 86,000 new HIV infections in 2015. Children under 15 years accounted for 12 percent (10,400) of new infections while the remainder, 75,900 new infections, were among adults over 15. The goal to eliminate parent-to-child transmission of HIV by 2020 also mandates an accelerated roll-out of evidence-based measures in India. Countries like Cuba and Thailand among others have already eliminated parent to child transmission of HIV.
Academic partners of AIDS Society of India include the National AIDS Control Organization, Indian Council of Medical Research, the Medical Council of India, UNAIDS, the Association of Physicians of India, Forum of Parliamentarians on HIV & AIDS, People’s Health Organization (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.
Shobha Shukla is the Managing Editor of Citizen News Service. Follow her on twitter @Shobha1Shukla, website: www.citizen-news.org