Ending the HIV Epidemic?

Dr Madhu Oswal

It was on 5th June 1981 in California that 1st 5 cases of a new disease which was later

named as AIDS was diagnosed in homosexual men. No one had that time imagined that it

was a beginning of one of the worst epidemic affecting mankind which would infect 600

lakh people and kill more than 250 lakh people in 30 years.

According to UNAIDS estimates, there are approximately 35 million people currently living

with HIV with a global prevalence rate of 0.8%. In-spite of all the efforts and resources

poured in universally to fight the epidemic; there were about 2.3 million new infections in

2012 , i.e more than 6,300 new HIV infections per day. 1.6 million people died of AIDS in

the same year. Young people, between 15–24 yrs of age , account for approximately 39% of

new HIV infections and women represent about half (52%) of all people living with HIV

worldwide. India, with approx 21 lakh HIV infected people stands 3rd country with largest

number of HIV infection after South Africa and Nigeria. The high prevalence States are

Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu, Mizoram &

Goa. However, now some States in the North such as Odisha, Chhattisgarh, Jharkhand and

Uttarakhand, some in the North West region including Punjab, Chandigarh and Delhi, and

some low prevalence States of North East including Assam have shown rising trends in

adult HIV prevalence. With 4.5 lakh HIV infected people. Maharashtra is one of the hard hit

states in India.

But the good news is that country wide both new infections and death rate have gone down

by 57% and 29% respectively. But we need to have sustained efforts to keep this

downward trend. Some of the interventions which can help us reverse the epidemic and

one day end the epidemic are listed below.

HIV infection in general population is 0.27%. But the same is high Female Sex

Workers, MSM (homosexuals), intravenous drug users (IVDUS), long distant

truckers, migrants and STI patients. Our focus of preventive services should be in

these high risk groups and vulnerable population.

The therapy used for treating HIV infection is called Anti-retroviral therapy (ART).

This therapy is started when the immunity of the infected person as measured by

CD4 count goes down below 350 cells per ml. ART if started early and taken

regularly, helps one with HIV to live almost a normal life span. So maximum number

of people with HIV should be started with this life saving treatment. This treatment

is available free of cost in all the government medical centers. For this more and

more people who are at risk of HIV should voluntarily come forward and take HIV

test.

ART can be used as tool for prevention of HIV infection. We now know that ART can

reduce the rate of HIV transmission by sexual route, by up to 96%.So if one of the

partners is HIV positive and other is not, ART taken by the infected partner can

prevent HIV in the non infected partner.

Circumcision reduces the risk of HIV acquisition in men by 50 to 60%. So people at

risk of HIV can consider this option for prevention of HIV infection.

ART during pregnancy and breastfeeding can virtually eliminate the risk of HIV

transmission to newborn if started early enough in pregnancy. So if each and every

HIV positive pregnant women is given ART, HIV can be eliminated in our new

generation.

Pre-exposure prophylaxis (PrEP) with ART reduces the risk of HIV acquisition by

close to 50% when taken consistently. Those who cannot adapt ant other risk

reducing intervention can go for this option. But taking these drugs consistently is

very important.

The main cause of death in HIV infected person in India is tuberculosis. Intensified

case finding for tuberculosis in people living with HIV and its treatment in time can

reduce these deaths.

Use of Female Condom, which can give the control of HIV prevention in hands of

women and reduce their vulnerability.

Promote Needle-Syringe Exchange Programme and Opioid Substitution Therapy for

intravenous drug users.

Prevention & control of sexually transmitted infection which in turn will help

reduce HIV transmission and acquisition.

Ending AIDS will not be a simple or easy task and will require much more than political commitment or biomedical tools. Now more than ever, we cannot afford to lose momentum. With renewed global efforts, the end of AIDS is within our grasp. And each and every one of us should be a part of this fight. On the occasion of World AIDS Day, let’s together take the pledge to end the epidemic which has haunted mankind for 3 decades and aspire for an AIDS free generation.