Is India doing enough to treat AIDS?
A decade ago, condom promotion as part of HIV prevention campaigns was so ubiquitous that the moral police started counter-campaigns alleging it destroyed the nation’s culture and heritage. It didn’t. What it did was lower HIV infections from an estimated 5.1 million in 2003 to 2.1 million in 2017.
With annual new infections hovering around 80,000 over the past five years, complacency set in with a visible shift to other priority health programmes. The budget outlay for the National AIDS and STD Control Programme stagnated and HIV awareness hoardings were replaced with campaigns promoting immunisation, contraception and tuberculosis prevention and treatment.
India’s overall health budget increased by ₹5,437 crore – an 11 per cent increase over 2017–to ₹52,800 in 2018, the outlay for AIDS went up by ₹ 100 crore, from ₹ 2,000 crore in 2017 to
₹ 2,100 crore in 2018.
It’s not enough. India’s large population base of 1.32 billion makes it home to the world’s third largest HIV population of 2.1 million, after South Africa (7.1 million) and Nigeria (3.2 million), even though as percentage of the population, infection levels are low. Adult HIV prevalence in India is 0.28 per cent, compared to South Africa’s 18.9 per cent, shows UNAIDS data for 2017.
The majority of the budget allocation for HIV and AIDS is spent on counselling, testing and antiretroviral therapy (ART), which is given free to treat everyone who tests positive for HIV. There’s little money left for information, education and communication programmes that are central to prevention and lowering stigma.
The high number of people who tested positive for HIV in Unnao in Uttar Pradesh over the past few months has put the spotlight on the threat of undetected cases in some districts of states like Uttar Pradesh, which have a low overall prevalence compared to the national average of 0.28 per cent.
While HIV prevalence is falling in traditional high-prevalence states such as Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu and Telangana, new pockets of infection have emerged in Uttar Pradesh, Gujarat, Bihar, Delhi, Chhattisgarh Rajasthan, Odisha and Jharkhand, shows the National AIDS Control Organisation’s (NACO) biennial HIV Sentinel Surveillance 2016-17.
Of the 14 sites with more than two per cent prevalence, five were in Bihar, Chhattisgarh, Odisha, Rajasthan and Uttar Pradesh, while one-third of the 56 sites with more than one per cent prevalence were in Bihar, Chhattisgarh, Delhi, Gujarat, Jharkhand, Odisha, Rajasthan and Uttar Pradesh.
Treating and suppressing HIV viral load not just lowers symptoms and keeps people living with HIV disease-free, but also makes their chances of infecting others negligible. While there is no study for India, using ART to treat HIV can add 10 years to life and gives a 20-year-old who starts treatment a “near normal’ life expectancy of 67 years in Europe and North America, found an analysis of 18 studies of more than 88,500 people, reported The Lancet HIV in August 2017.
A study to compare life expectancies of people with HIV at age 20 showed those with the infection were 13 years behind healthy persons, found a US study in 2016. The effect of HIV on life expectancy is almost comparable with people who have uncontrolled diabetes.
This information, however, has clearly not trickled down to Unnao, Premgunj village, from where 50 of the 58 confirmed HIV cases have been reported, and which has been labelled an “AIDS village”. People from the village have been ostracised and are being shunned by former friends and extended families, who want to have nothing to do with people they believe are “tainted” with HIV because of its association with unsafe commercial sex work and injecting drug use. No one seems to know that getting treated can keep them healthy and symptom free. The unlicensed medical practitioner accused of spreading the infection by using contaminated needles is guilty of quackery, but is highly unlikely to have been the cause of the high HIV prevalence in the village. Giving intradermal injections is unlikely to have caused an infection that spreads through body fluids such as blood, breast milk, semen and vaginal fluids through direct contact or through the use of an infected syringe or needle.
In India, unprotected sex with an infected person and injecting drug use are the leading causes of new infection, and not touching, saliva, tears, sweat, sharing toilets, sharing meals or insect bites. If prevention and ART is not used to contain infection in districts like Unnao, stigma will remain and India will not be able to shake loose the threat of an HIV resurgence.