World AIDS Day 2020: Despite ambitious global targets, India's progress in AIDS control falls short in a few crucial aspects

Since the inception of the National AIDS Control Program in 1992, India has done a commendable job of raising awareness and of bringing down the number of HIV infections. Still, India has a long way to go in terms of achieving her set targets. Today, on World AIDS Day (1 December), is a good time to reflect on the progress India has made in AIDS prevention and control, and the way forward.

Burden of HIV/AIDS in India

India’s first AIDS case was detected in 1986 and since then the burden has grown to an estimated 23.49 lakh persons living with HIV (PLHIV) in 2019. According to the India HIV Estimates 2019 report, the prevalence of HIV among adults was estimated to be 0.22 percent. It may seem like a small proportion. However, given India’s population, it translates to 2.1 million people. The number of AIDS-related deaths was estimated to be 58,960. As per the statistics, it seems that after reaching a peak in the early 2000s, both the prevalence and mortality are showing a downward trend. This paints a promising picture.

Trend of adult HIV prevalence in India (1981 to 2019, in %. Source: HIV Estimates 2019 Report

India’s HIV/AIDS control targets

India is a signatory to the United Nations Sustainable Development Goals and has committed itself to achieving the target of ending the epidemic of AIDS by 2030. The UNAIDS has identified 2020-specific fast-track targets, which include

–75 percent decline in new HIV infections from the 2010 baseline value,

–attainment of 90-90-90 treatment goals (90 percent of PLHIV are aware of their HIV status, of which 90 percent are on HIV treatment, of which 90 percent have suppressed their HIV load),

–elimination of new HIV infections among children, and

–elimination of HIV/AIDS-related stigma and discrimination

India has achieved a 37 percent reduction in new HIV infections between 2010 and 2019, which is still very far from the envisioned 75 percent. As per an UNAIDS 2020 report, around 30 percent of Indians between 15-49 years of age reported discriminatory attitudes towards PLHIV. With regard to the 90-90-90 target, 79 percent of PLHIVs are aware of their HIV status, of which 71 percent are on HIV treatment. While the progress is noteworthy, it does not look like India will be able to meet the targets within the set deadlines.

Impact of COVID-19 on AIDS prevention and control

The COVID-19 pandemic has affected the delivery of other health services. It has had a severe impact on the prevention, diagnosis, and treatment of AIDS. The UNAIDS report expresses the scepticism that all the progress that has been achieved till now, might be undone due to COVID-19. During the initial stages of the pandemic, when the whole of the country was under lockdown, access to Anti-Retroviral therapy centres became a lot more difficult. To add to that, people who had not yet disclosed their HIV status found it difficult to maintain the secrecy. There have been reports about enough doses of particular medicines not being available for the infants of HIV-positive mothers. People are having to travel long distances for life-saving ARV therapy, and NGO workers are putting themselves at risk of COVID-19 to access ARV drugs for PLHIVs.

Focusing only on COVID-19 while side-tracking other public health issues will lead to an increase in morbidity and mortality due to other diseases. The district-level health authorities should coordinate with the NGOs and actively involved communities so that the supply of ARV drugs and other facilities can be accessed uninterrupted.

Activists prepare to release campaign materials into the air ahed of World AIDS Day on the banks of the Ganges River in Kolkata, India, Wednesday, Nov. 30, 2016. World AIDS Day is celebrated on Dec. 1 every year to raise awareness about HIV/AIDS and to demonstrate international solidarity in the face of the pandemic. (AP Photo/Bikas Das)

The way forward

While designing any response to HIV/AIDS, it is necessary to not forget that it has serious social implications. The groups most affected by HIV/AIDS in India are female sex workers, men having sex with men, injecting drug users, and transgender people. All of these groups face discrimination even without HIV status. Hence, sensitization of the general population and authorities dealing with them is of utmost importance. There has been criticism concerning how the National AIDS Control Organisation spends its budget. The majority of the allocated budget is towards counselling, testing, and ART. This leaves only a little money for Information, Education, and Communication (IEC) programs, which are fundamental to changing the popular narrative and public perspective about PLHIV, and removing the stigma associated with it. Preventive strategies (such as IEC) are as much needed as the curative strategies for the control of HIV/AIDS. AIDS is a public health problem and the importance of preventive care cannot be stressed enough.

It has been two years since the Government of India had passed the HIV & AIDS (Prevention and Control) Act 2017. However, its implementation remains questionable. The Act provides for notification of a ‘Model HIV and AIDS Policy’ by the Centre for establishing standards for safe workplaces, grievance redressal mechanisms, and informed consent for tests. The Wire has reported that even after two years, the policy is still in the drafting stage. The Act also provides for the appointment of ombudsman for addressing the complaints related to violations. However, the state governments have not acted on it yet. The NACO should make this information available in the public domain so that there is accountability and transparency.

Strong implementation of the Act will ensure that the PLHIVs can lead a normal life without any discrimination.

Sunila Dixit is a Research Analyst at the Takshashila Institution and her research focuses on various areas of public health. She tweets at @SunilaDixit 

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