Urgent and accelerated HIV service delivery with equity and rights is critical to end AIDS
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Bobby Ramakant (CNS)
No one needs to get newly infected with HIV or die of AIDS-related illnesses because we have scientific evidence-based tools and proven approaches to prevent any further spread of infection or avert any untimely death due to AIDS. But despite this, over 1.3 million new people were diagnosed with HIV and 630,000 died of AIDS-related illnesses in 2023 globally.
“Despite commendable progress in India’s AIDS response, almost 200 new people got diagnosed with HIV every day and almost 100 died of AIDS-related illnesses every day in 2023. If HIV is a chronic manageable disease, then why 169,000 people living with HIV were lost to follow up by March 2024 (as per government’s latest 6th Sankalak Report),” said Dr Dilip Mathai, President of AIDS Society of India (ASI), a pan India network of HIV medical experts and researchers. Dr Mathai is a distinguished medical expert and researcher, former Professor and Head of Medicine Department, CMC Vellore, and former Dean of Apollo Institute of Medical Sciences and Research.
“HIV is now becoming a concern for primary healthcare workers, which implies that we have to ensure that the people who get educated and trained to serve at the primary healthcare level, must get adequately trained to help provide HIV care services. People who train them also need to be optimally trained on HIV care. If we do not address these issues, we will not be able to end AIDS,” said Dr Mathai in lead up to largest conference of HIV medical experts that would be held later this week in Ahmedabad, Gujarat state of India (16th National Conference of AIDS Society of India or ASICON 2025). Gujarat Chief Minister Bhupendra Patel would inaugurate the scientific meet which will be held in Gujarat for the first time.
Only 70 months left to keep the promise of #endAIDS by 2030
“All governments have promised to end AIDS by 2030. But we have the evidence-based tools to do so now! We can prevent all transmission of HIV, diagnose all those with HIV, provide lifesaving antiretroviral therapy and keep them virally suppressed – so that all those with HIV can lead healthy and fulfilling lives and no one gets newly infected with HIV. The World Health Organization (WHO) evidence strongly shows that if people living with HIV are virally suppressed then there is zero risk of any further HIV transmission from them. We need to do better to prevent HIV as well as care for those living with HIV,” said Dr Ishwar Gilada, President Emeritus of AIDS Society of India (ASI) and Governing Council member of International AIDS Society (IAS) and its regional Chair for Asia and the Pacific. He is the first medical doctor to begin HIV care in India when first case was diagnosed in 1986 and credited to establish country’s first HIV clinic in government’s JJ Hospital, Mumbai.
“Preventing HIV transmission means that we do 100% in ensuring access of everyone (especially those who are more at risk) to the full range of HIV combination prevention options. For example, India needs to rollout PrEP options in its public programmes without any further delay (PrEP was first approved by US FDA in 2012 and is only available in private sector in India. Pre-Exposure Pro-phylaxis is a medicine for people who are HIV negative to protect them from HIV acquisition). We need to do a lot more to find all those with HIV so rolling out proven approaches such as HIV self-testing is important. Regular treatment monitoring to ensure adherence and prevent advanced HIV disease, HIV related co-infections and co-morbi-dities, and address ageing related issues like non-communicable diseases, is also important,” added Dr Gilada.
Agrees Dr N Kumarasamy, Chief and Director of VHS Infectious Diseases Medical Centre, Chennai and Co-Chairperson of ASICON 2025: "HIV treatment is also prevention – when we treat people living with HIV their virus level comes down and they become less infectious to others. When people with HIV stay virally suppressed then the risk of HIV transmission is zero as per the WHO. Also, when it comes to HIV prevention, we need to ensure that all HIV combination prevention options are available and accessible to everyone, especially to the key populations (among which HIV risk and rate is very high). PrEP should become a part of our national programme."
Where are we on 95-95-95 targets for 2025?
The 95-95-95 targets to be achieved by 2025 mean that 95% of all people living with HIV should know their status, 95% of those who know their status should receive lifesaving antiretroviral therapy, and 95% of those on the treatment should be virally suppressed. In India, as of March 2024 (according to government’s 6th Sankalak Report 2024), 81% of people living with HIV in India knew their HIV status. Out of these, 88% were receiving antiretroviral therapy, and out of those receiving the treatment, 97% were virally suppressed. Globally, 86% people living with HIV knew their status, 89% were on antiretroviral therapy, and 93% of those on antiretroviral therapy were virally suppressed.
“We need to ensure 100% of those who know their HIV positive status must be on antiretroviral therapy and virally suppressed,” said Dr Mathai.
Out of those who were newly diagnosed with HIV in India, around 93% were initiated on lifesaving antiretroviral therapy. But in several states, the number of those on free treatment was lower (such as, Assam, Chandigarh, Delhi, Hima-chal Pradesh, Puducherry, and Sikkim). For example, initiation of antiretroviral therapy among newly diagnosed people, ranged be- tween around 47% in Puducherry and 76% in Assam. (To be contd)
No one needs to get newly infected with HIV or die of AIDS-related illnesses because we have scientific evidence-based tools and proven approaches to prevent any further spread of infection or avert any untimely death due to AIDS. But despite this, over 1.3 million new people were diagnosed with HIV and 630,000 died of AIDS-related illnesses in 2023 globally.
“Despite commendable progress in India’s AIDS response, almost 200 new people got diagnosed with HIV every day and almost 100 died of AIDS-related illnesses every day in 2023. If HIV is a chronic manageable disease, then why 169,000 people living with HIV were lost to follow up by March 2024 (as per government’s latest 6th Sankalak Report),” said Dr Dilip Mathai, President of AIDS Society of India (ASI), a pan India network of HIV medical experts and researchers. Dr Mathai is a distinguished medical expert and researcher, former Professor and Head of Medicine Department, CMC Vellore, and former Dean of Apollo Institute of Medical Sciences and Research.
“HIV is now becoming a concern for primary healthcare workers, which implies that we have to ensure that the people who get educated and trained to serve at the primary healthcare level, must get adequately trained to help provide HIV care services. People who train them also need to be optimally trained on HIV care. If we do not address these issues, we will not be able to end AIDS,” said Dr Mathai in lead up to largest conference of HIV medical experts that would be held later this week in Ahmedabad, Gujarat state of India (16th National Conference of AIDS Society of India or ASICON 2025). Gujarat Chief Minister Bhupendra Patel would inaugurate the scientific meet which will be held in Gujarat for the first time.
Only 70 months left to keep the promise of #endAIDS by 2030
“All governments have promised to end AIDS by 2030. But we have the evidence-based tools to do so now! We can prevent all transmission of HIV, diagnose all those with HIV, provide lifesaving antiretroviral therapy and keep them virally suppressed – so that all those with HIV can lead healthy and fulfilling lives and no one gets newly infected with HIV. The World Health Organization (WHO) evidence strongly shows that if people living with HIV are virally suppressed then there is zero risk of any further HIV transmission from them. We need to do better to prevent HIV as well as care for those living with HIV,” said Dr Ishwar Gilada, President Emeritus of AIDS Society of India (ASI) and Governing Council member of International AIDS Society (IAS) and its regional Chair for Asia and the Pacific. He is the first medical doctor to begin HIV care in India when first case was diagnosed in 1986 and credited to establish country’s first HIV clinic in government’s JJ Hospital, Mumbai.
“Preventing HIV transmission means that we do 100% in ensuring access of everyone (especially those who are more at risk) to the full range of HIV combination prevention options. For example, India needs to rollout PrEP options in its public programmes without any further delay (PrEP was first approved by US FDA in 2012 and is only available in private sector in India. Pre-Exposure Pro-phylaxis is a medicine for people who are HIV negative to protect them from HIV acquisition). We need to do a lot more to find all those with HIV so rolling out proven approaches such as HIV self-testing is important. Regular treatment monitoring to ensure adherence and prevent advanced HIV disease, HIV related co-infections and co-morbi-dities, and address ageing related issues like non-communicable diseases, is also important,” added Dr Gilada.
Agrees Dr N Kumarasamy, Chief and Director of VHS Infectious Diseases Medical Centre, Chennai and Co-Chairperson of ASICON 2025: "HIV treatment is also prevention – when we treat people living with HIV their virus level comes down and they become less infectious to others. When people with HIV stay virally suppressed then the risk of HIV transmission is zero as per the WHO. Also, when it comes to HIV prevention, we need to ensure that all HIV combination prevention options are available and accessible to everyone, especially to the key populations (among which HIV risk and rate is very high). PrEP should become a part of our national programme."
Where are we on 95-95-95 targets for 2025?
The 95-95-95 targets to be achieved by 2025 mean that 95% of all people living with HIV should know their status, 95% of those who know their status should receive lifesaving antiretroviral therapy, and 95% of those on the treatment should be virally suppressed. In India, as of March 2024 (according to government’s 6th Sankalak Report 2024), 81% of people living with HIV in India knew their HIV status. Out of these, 88% were receiving antiretroviral therapy, and out of those receiving the treatment, 97% were virally suppressed. Globally, 86% people living with HIV knew their status, 89% were on antiretroviral therapy, and 93% of those on antiretroviral therapy were virally suppressed.
“We need to ensure 100% of those who know their HIV positive status must be on antiretroviral therapy and virally suppressed,” said Dr Mathai.
Out of those who were newly diagnosed with HIV in India, around 93% were initiated on lifesaving antiretroviral therapy. But in several states, the number of those on free treatment was lower (such as, Assam, Chandigarh, Delhi, Hima-chal Pradesh, Puducherry, and Sikkim). For example, initiation of antiretroviral therapy among newly diagnosed people, ranged be- tween around 47% in Puducherry and 76% in Assam. (To be contd)