ON THE occasion of World AIDS Day (December 1), Dr Sheela Godbole, Director, Indian Council of Medical Research-National AIDS Research Institute (ICMR-NARI), told Anuradha Mascarenhas in an interview that for testing and treating all or at least 95 per cent of those potentially infected, we must in the next few years develop and field-test strategies that not only enable equity in access to care but also evaluate how well these strategies are working.
This World AIDS Day, UNAIDS has sent out an appeal to address the inequalities which are holding back progress in eliminating AIDS. What according to you are the key areas that need to be addressed?
HIV has always affected certain population groups or communities disproportionately. These communities are also often underserved or challenged in terms of access to healthcare in general and HIV prevention, diagnosis and care continuum in particular. The Indian government provides free HIV and Sexually Transmitted Infection (STI) prevention services, free and quality HIV testing and free and immediate treatment and monitoring once a person is diagnosed with HIV. But not all who need seem to access these services. As we focus on ‘Elimination of Mother to Child transmission HIV and Syphilis’ or Vertical transmission which is the new moniker for this; ‘testing and treating’ all / or at least 95 per cent of those potentially infected, we must develop and field-test strategies that not only enable equity in access to care but also evaluate how well these strategies are working. The focus of the NACP V too is also to keep communities central to the AIDS response. There are various reasons for inequitable access which includes people residing in remote or hilly areas, lack of awareness about testing centres or free ART, occupations which limit the ability to go to a testing or treatment centre during working hours. These are some of the challenges we identified in our impact evaluation study of the ART programme completed some years ago.
Despite the existence of medications that can control HIV and even reduce viral transmission, HIV continues to be a health threat to millions worldwide. What is the situation in India?
Actually, the list of top five leading causes of death globally does not include HIV/AIDS anymore. This is largely due to the phenomenal increase in access to antiretroviral treatment worldwide and in India and the continuing availability of newer treatment choices as well as improved diagnostics. The impact evaluation of NACO-GoI’s Free ART programme (2012-2017) by ICMR NARI revealed that the chance of death was halved among people on ART at the end of five years of treatment at ART centres. The risk of death was three times more in the absence of ART. In India, by the last estimates of 2021, about 23.19 lakh (18.33 lakh- 29.78 lakh) are expected to be living with HIV including 81,000 children. It is estimated that annual AIDS-related deaths have declined by 82 per cent since 2010 and Maharashtra is one of the states where they have declined by more than 85 per cent. (NACO-NACP V strategy document 2022).