Is the path set for a HIV free world?
December is a month dedicated to the fight against HIV and AIDS. NT NETWORK gives its readers a glimpse of the battle and how equipped we are to a world free from the virus
Janice Savina Rodrigues| NT Network
The sustainable development goals set by the UN aimed at ending HIV AIDS by 2030. On the World Aids Day’s 30th anniversary last weekend, the UNAIDS stressed on the theme of ‘know your status’ and has been leaving no stone unturned in propagating the importance of testing – self testing or at a medical facility.
We are indeed, on a path of destroying the virus with the tools at our disposal. But with a seemingly small, nonetheless alarming number of new cases detected in 2018, it sure feels that we are miles behind in our fight against the virus. In India, there were 87,580 new HIV infections recorded in 2017. Though this 85 per cent decline in the number of new cases annually as compared to 1995 is a ray of hope, the sheer number stands contradictory to the number of tools and awareness drives we have at our disposal now.
Coming back to testing, in the Goan scenario out of the 57,525 people who were tested for HIV, a total of 220 individuals were tested positive in 2018 (uptil September) alone. The numbers could be higher considering that not everyone wants to get tested voluntarily.
“To end the epidemic by 2030 there are a lot of challenges that we face. A lot of hard work is required, not only the government, but the NGOs and community too, all have to be on the same page and work together,” says Jose D‘Sa, project director at Goa State AIDS Control Society (GSACS). He further states that the basic challenge faced in the achievement of the goal is that of non-compliance of the general public. “There is still a very big stigma attached to testing. People don’t come forward for testing, we as medical professionals are trying to build awareness and there has been some progress through the community testings that we send our doctors for. One should remember that getting tested is not a question of morality, it has to be seen as a regular health check up,” he says.
The WHO has in fact recommended HIV self-testing be offered as an additional approach especially for populations with low access and those at higher risk that would otherwise not get tested. While 23 countries across the world have policies in place for HIV self testing, India, however, hasn’t adopted it in their policy and hence it cannot be implemented. The reasons cited by the officials include unpreparedness of the system for such a programme and issues of funding for free self-test kits.
But it is sad to note that though the GSACS has been relentlessly propagating the zero transmission from mother-to-child, there were still 9 out of the 220 cases that presented in antenatal clinics. This is despite the fact that all pregnant women are compulsorily tested, at least in GMC. “If they are tested positive, they are directed to the ART (antiretroviral therapy) centre, where treatment is started as soon as possible. This prevents the placental transmission of the virus. The cases of antenatal transmission is generally because of the migration happening here in Goa. Some migrant women, come for the delivery into the state and this is what causes the problem, they don’t take treatment, they don’t even do the six week test in some cases, and leave the moment they are fit to move,” says a GMC personnel.
The 90-90-90 campaign
In a bid to reach closer to the promised 2030 UN sustainable development goal to end AIDS, the governments of over 190 nations, including India, have moved towards the path of the 90:90:90 target by 2020. “Our National Health Policy 2017, promises to achieve the global target of 90:90:90 for HIV/AIDS by 2020, that is, 90 per cent of all people living with HIV will know their HIV status, 90 per cent of all people diagnosed with HIV infection will receive sustained antiretroviral therapy (ART) and 90 per cent of those receiving ART will have viral suppression,” states D’Sa citing the policy statement.
However, the current data and trends of HIV pose serious concerns on whether we are on track to achieve the goal by 2030. Data from UNAIDS states that 79 per cent of the general population knows their status, out of which only 71 per cent are on treatment, that means only 56 per cent of people living with the virus are on treatment, and further there is no data collected to show figures for the viral suppression.
To reach the target, there are country-specific challenges and barriers. “Stigma is a barrier to the achievement of the 90-90-90 goals.” says D’Sa. Besides this, access to routine viral load and monitoring, is a hindrance.
“A human rights-based approach is essential to ending AIDS as a public health threat. Rights-based approaches create an enabling environment for successful HIV responses and affirm the dignity of people living with, or vulnerable to HIV,” says an activist working in the sphere of HIV.
The fight against HIV and the epidemic is a very real one. “That we haven’t beaten the epidemic boils down to one simple fact: We value some lives more than others and thus access to treatment and awareness is what is required. The virus does not discriminate on its own. It has no biological preference for women, gay or youth, migrant, Goan or the poor. It doesn’t single out the vulnerable, the oppressed, or the abused. It is we who single out the vulnerable, the oppressed, and the abused. We ignore them, we let them suffer and then we let them die,” adds the activist.