By Rajiv Theodore

New Delhi, Dec 19, 2019: HIV-AIDS has been controlled to an encouraging degree because of a sustained but focused multi-pronged strategy, claims the head of the program to contain the dreaded disease in the country.

‘’It seems today, we are in the last lap of containing this contagion, but this is the most critical phase as we are in the process of dealing with some very vulnerable sections of the population who could hold the key for its prevention, testing and treatment,’’ Doctor V Sam Prasad, country program director of the AIDS Healthcare Foundation (AHF) India Cares, told Matters India.

Part of worldwide AIDS Healthcare Foundation (AHF), the largest global AIDS organization, operating in 41 countries, AHF India has emerged as a pre-eminent HIV organization with innovative interventions.

Sam added that getting people on treatment is easy, and the hard part is ensuring there are no gaps in the availability and access to medicines. ‘’Stopping treatment midway leads to drug-resistance, which has to be treated with stronger and more expensive drugs that cause toxic side effects,’’ he adds.

Today, the number of HIV patients have gone down on an all India basis from peak 0.38 percent in 2001-2003 to 0.22 percent in 2017, according to figures provided by the National AIDS Control Organisation (NACO), an arm of the government’s health ministry.

Though new infections have declined by 40 percent worldwide since the peak of the AIDS epidemic in 1997, it is critical to reach out to all, including high-risk groups, to end AIDS as a public health threat by 2030, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS) report.

The report also says 24.5 million infected people using antiretroviral therapy (ART) are living healthier and longer lives, indicating that its effectiveness. Annual new infections, which indicate whether an epidemic is growing or ebbing, reduced to 1.7 million in 2018, down from 1.8 million the year before, according to the report.

According to NACO, between 2010 and 2017 new HIV infections were shot down by 27 percent — 2017 being the last year for which official data are available.

The number of people living with HIV fell from 2.30 million to 2.14 million during that period despite an increase in the country’s population. Annual new infections too fell from 120,000 to 87,580, and AIDS-related deaths more than halved from 160,000 to 69,110.

Today, India’s “test and treat” policy provides free ART to all who tests positive for HIV in the country. As a result, 1.35 million of India’s 2.14 million people living with HIV and AIDS (PLHAs) get free treatment, which has led to reduced cases of AIDS-related deaths. It was in 2004 that the Indian government had begun offering free ART in the six high-prevalence states — Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, and Tamil Nadu.

ART suppresses the HIV viral load to lower symptoms and keep people living with HIV disease-free for decades. It also lowers their chances of infecting their partners. Using ART to treat HIV adds at least 10 years to life. It could also give a 20-year-old who starts treatment a life expectancy of 67 years. This was revealed in an analysis of 18 studies of over 88,500 people in Europe and north America and reported in The Lancet HIV in August 2017.

With most of NACO’s 25-billion-rupee-budget used for testing and treatment, there is little left for prevention and promotion of safe behaviors and practices. Sam said at AHF, the organization continues to provide world-class HIV services and practice evidence-based advocacy to translate community needs to policy making/reform.

With the new center of Excellence ART Clinic, AHF India Cares is taking yet-another stride to complement and strengthen the National AIDS response towards “Ending the AIDS by 2030”. Given the heterogeneity of infection between states, data-driven differential prevention and care services must be pushed with active community engagement, he added.

Hence, apart from testing and treating people living with HIV, prevention and protection campaigns hold the key to ring fence AIDS and most important to encourage and seek community participation that will help lower the stigma associated with the disease. Moreover, India cannot end AIDS without condom promotion and community participation, emphasizes Sam.

According to Peter F. Borges, founder and CEO of Human Touch Foundation Communities of people living with HIV, community health workers have played a key role in the HIV response. There is a need to engage them and listen to their stories on making the difference and changing lives. Human Touch Foundation had recently underscored the importance of communities based strategy to further reduce HIV-AIDS at the World AIDS Day (December 1) at Goa.

AHF India launched its first ART clinic in India in the year 2007 and today the clinic currently serves approximately 1,300 clients which would be scaled up to serve more than 2,000 clients soon. More well known as the People’s clinic, the ART center operates for 12 hours a day, six days a week.

’The extended hours will serve the general public and incorporate an evening of ‘’moonlight testing‘’ shift, designed to deliver HIV testing to marginalized communities including LGBTQI, the HIV (PLHIV) infected, drug users and sex workers.

To limit stigma and help make clients more comfortable, the clinic utilizes staff who are part of the LGBTQI community and PLHIV who work to ensure adherence to treatment through specialized peer counseling services. The facility will also be the only ART clinic in India that provides first, second and third-line treatment protocols, as well as up to a six-month supply of antiretroviral medicine to clients who are forced to travel great distances to access treatment, says Sam.

The clinic offers a safe, stigma-free environment and a one-stop shop for a variety of HIV services – Prevention, Testing & Treatment, ART, counseling, extensive laboratory services, consultations with specialists, a pharmacy and free condoms. AHF India recently undertook a project—”condomization” of India by setting up condom dispensers at ‘’strategic locations’’ and even at work places.

Thus, the endgame for India has arrived —-to meet the UNAIDS “90–90–90” targets to diagnose 90 percent of all HIV-positive persons, provide ART to 90 percent of those diagnosed, and achieve viral suppression for 90 percent of those treated by 2020, Sam adds.