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Journalism of Courage
How soon can India eliminate the mother-to-child transmission of HIV and syphilis infection? The question is being asked as India, despite its tracking and prevention mechanisms, is still to achieve what three tiny Caribbean countries (Belize, Jamaica and St Vincent and the Grenadines) have. They have got the World Health Organisation (WHO) certificate for eliminating the mother-to-child transmission of HIV and syphilis.
“Despite progress, India is yet to achieve such a milestone. Pregnant women do take HIV, Hepatitis B and syphilis tests at ante-natal care facilities in urban or rural areas. What we lack is a quick reporting structure that can link those who test positive for any of these infections to healthcare facilities. That’s the biggest hold-up,” says Dr Ishwar Gilada, president-emeritus, AIDS Society of India.
WHO awards this certification to countries which have brought the mother-to-child HIV transmission rate to under five per cent; provided antenatal care and antiretroviral treatment to more than 90 per cent of pregnant women; reported fewer than 50 new cases of congenital syphilis per 100,000 new-borns, and achieved an HIV case rate of fewer than 500 per 100,000 live births.
As per the National AIDS Control Organisation (NACO),India had 2.5 million people living with HIV in 2022, including 70,000 children. Dr Gilada points out that 66,000 people were infected in 2022, a slight increase since 2021. “There were 32,000 AIDS-related deaths in 2022 (four deaths every hour), though the overall number had reduced by 25 per cent in a year. No fresh data has been released since 2022,” he says.
Why does India lag behind and how do we bring down this rate?
In India, about 64 per cent of pregnant women get medicines to prevent HIV transmission to the unborn child during pregnancy or breastfeeding, according to Dr Gilada. “In the normal course, the transmission rate of the virus from mother to child during breast-feeding is 24.3 per cent. This can be brought down to zero. However if coverage is 64 per cent, then we are allowing 36 per cent of mothers to transmit HIV. So it is roughly nine per cent of HIV transmission from the infected mother to child. This is another missed opportunity, which we truly cannot afford to ignore if we are to end AIDS in the next 72 months (by 2030). Rather we should completely eliminate parent-to-child transmission of HIV as early as possible,” he says.
The targets can be met because while the Hepatitis B Virus (HBV) and syphilis bacteria are highly transmissible, HIV virus is the least transmissible. “Whereas Hepatitis B is preventable with one of the most inexpensive vaccines, syphilis is completely curable. HIV is manageable and its viral load can be brought to the level so as to avoid transmission from mother to child. There are good antiretrovirals (ARVs) and HIV-infected women should be linked to centres and provided the first line treatment regimen — Tenofovir and Lamivudine with Dolutegravir, called TLD,” says Dr Gilada. “This would make them undetectable for HIV in three months, definitely before delivery. That ensures zero transmission of HIV. Additionally, their spouses should be subjected to the same three tests and follow-ups,” he adds.
