What is HIV – AIDS?

Human Immunodeficiency Virus (HIV) is a virus that attacks cells in the immune system, which is our body’s natural defence against illness. The virus destroys a type of white blood cell in the immune system called a T-helper cell, and makes copies of itself inside these cells. T-helper cells are also referred to as CD4 cells.

Acquired Immune Deficiency Syndrome (AIDS) is a set of symptoms (or syndrome as opposed to a virus) caused by HIV. A person is said to have AIDS when their immune system is too weak to fight off infection, and they develop certain defining symptoms and illnesses. This is the last stage of HIV, when the infection is very advanced, and if left untreated will lead to death.

Source: AVERT

Standard antiretroviral therapy (ART) – ART consists of the combination of antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. ART also prevents onward transmission of HIV.

Source: WHO

Relevant Data:

• India has the third largest HIV epidemic in the world, with 2.1 million people living with HIV.
• In 2017, HIV prevalence among adults (aged 15-49) was an estimated 0.2%.
• The HIV epidemic in India is driven by sexual transmission, which accounted for 86% of new infections in 2017/2018. 
• The three states with the highest HIV prevalence, Manipur, Mizoram and Nagaland are in the east of the country.

Key affected population in India:

• Sex workers – In 2017, an estimated 1.6% of female sex workers in India were living with HIV. Stigma and discrimination against sex workers restrict the access of sex workers to healthcare.
• People who inject drugs – HIV prevalence among this group is high, with injecting drug use the major route of HIV transmission in India’s north-eastern states. In 2017, 6.3% of people who inject drugs were thought to be living with HIV.
• Transgenders – HIV prevalence among transgender people in India was estimated to be 3.1% in 2017, the second highest prevalence among all key populations in the country. In April 2014, the Supreme Court recognised transgender people as a distinct gender. Since then, health and welfare programmes to meet this group’s specific needs have been set up.
• Migrant workers – There are an estimated 7.2 million migrant workers in India, of whom 0.2% are living with HIV. NACO categorises groups of migrants as ‘bridge populations’, as they form links between urban and rural areas, and between groups that are at high- and low-risk of HIV transmission.

Government Efforts:

The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. National AIDS Control Board (NACB) was constituted and an autonomous National AIDS Control Organization (NACO) was set up to implement the project. The most recent programme, NACP-IV (2012-2017, extended to 2018), aims to reduce annual new HIV infections by 50% through the provision of comprehensive HIV treatment, education, care and support for the general population and build on targeted interventions for key affected groups and those at high risk of HIV transmission. A key component of the NACP-IV is the prevention of new HIV infections by reaching 80% of key affected populations with targeted interventions.

Source: NACP

The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act of 2017 safeguards the human rights of people living with HIV and AIDS. The statute aims to provide equal rights to persons with HIV and bring them into the mainstream. The Act makes it a legal obligation to protect the privacy of persons with HIV and AIDS and addresses dircrimination meted out to persons with HIV and AIDS.

Source: The Hindu

How have the control programmes performed

• Compared to neighbouring countries, India has made a good progress in reducing new HIV infections by half since 2001.
• Overall, India’s HIV epidemic is slowing down. Between 2010 and 2017 new infections declined by 27% and AIDS-related deaths more than halved, falling by 56%. (UNAIDS Data)

Key challenges –

• Mother-to-child transmission – One of the leading causes of HIV transmission is from the mother to a baby. The challenge is even more serious in case of India as a number of females are not aware of their HIV positive status.
• Lack of Pre–exposure prophylaxis – Pre–exposure prophylaxis a daily course of anti-retroviral (ARVs) taken by HIV-negative people to protect themselves from infection, is not widely available in India.
• Social problems – There are various social  reasons which act as a deterrent to HIV eradication that include the fear of disclosure and social stigma, low social support, inadequate communication and education, and depression related to living with HIV. However, in 2018, implementation on the HIV AIDS (prevention and control) Act 2014 began. The law criminalises discrimination against people with HIV and AIDS, including within employment, healthcare, education, public facilities and public office, as well as protecting property and insurance rights.
• Vulnerable status of women – Women, particularly in rural areas, have little control or decision-making powers over important aspects of their lives. Women living with HIV are reluctant to access health care for fear of discrimination and marginalisation, leading to a disproportionate death rate in HIV women.
• High HIV prevalence in children – India is also home to arguably the largest number of orphans of the HIV epidemic. These children endure stigma and face an impenetrable barrier in many Indian societies. This situation encourages children and their guardians to hide HIV and discourages access to essential treatment services (if available).
• Data issues – There is alack of integrated quality data systems, a structure for case-based reporting, district HIV and key population size estimates.
• Tuberculosis and HIV – tuberculosis is the biggest killer of HIV patients across the world. In 2016, 12% of people newly enrolled in HIV care in India had active TB.

Way ahead

• HIV Testing and Counselling – Though the number of HIV testing and counselling centres in India has seen a significant increase, there is a need for more HIV testing and counselling centres.  Other options like more mobile testing units, self-testing kits etc. must be encouraged.
• Encouraging community based testing – Community-based testing is particularly important, as the stigma of HIV and the criminalisation of populations at high risk of HIV discourages many people from attending clinics and health facilities.
• Peer to peer HIV interventions – National AIDS Control Organisation (NACO) programme successful peer-to-peer HIV interventions (when individuals from key affected populations provide services to their peers or link them to services within healthcare settings) for sex workers. Such programmes must be extended to other affected groups.
• HIV Education and approach to sex education – Increasing awareness among the general population and key affected populations about HIV prevention must be a central focus.

Article sourced from: AVERT