“Give a child love, laughter and peace, not AIDS.” Nelson Mandela
No other disease in human history has been so intensely studied, feared and fought against as AIDS pandemic. It has been an elusive common enemy of humanity that infests the globe irrespective of age, status and gender. After 36 years of the global fight against HIV/AIDS (Human Immuno Deficiency Virus/ Aquired Immuno Difiency Syndrome) the global theme for World AIDS Day (December 1) this year the UNAIDS (United Nations Programme on HIV/AIDS) has launched the World AIDS Day-2017 campaign under the theme, ‘My Health, My Right’. According to the UNAIDS Data 2017, an estimated one million people worldwide died of AIDS-related illnesses in 2016.
India, the second most populated country in the world, home to an estimated 2.1 million people living with HIV (PLHIV) remains the country with the third largest population of people with HIV after South Africa and Nigeria. Highly heterogeneous in India, the HIV epidemic is concentrated in specific regions of the country and in high-risk groups as people who inject drugs, female sex workers, men who have sex with men and transgender people.
India's National AIDS Control Programme (NACP), started in 1992, with the objective of understanding the HIV disease burden and epidemiological trends implemented by the National AIDS Control Organization (NACO) under the Ministry of Health and Family Welfare has evolved into major public health prevention and treatment programme is one of the most successful public health programmes in India today.
Financially supported by the Global Fund and the World Bank (23%), the Government of India (63.4%), and other multilateral and bilateral agencies over the last two decades, four phases of the NACP have been implemented, each with duration of 5 years. The focus in each phase has been on improving coverage of comprehensive HIV prevention, care and treatment services nationwide. The NACP IV (2012–2017) was launched with the aim of consolidating gains made to date, accelerating the process of reversal and further strengthening the response to the epidemic in India. Its objectives include ‘reduction of new infections by 50% from the 2007 baseline of NACP III, provision of comprehensive care and support to all persons living with HIV/AIDS and medical treatment for all those who need it. HIV prevalence among all adults (15–49 years) has been declining steadily from 0.38% in 2001 to 0.26% in 2015. The 2017 National Health Policy has articulated to advance towards the Fast-Track Targets and eliminate mother-to-child transmission of HIV and syphilis by 2020. This scale-up has been also part of the recently finalized National Strategic Plan 2017–2024.
Over the period 2000–2016, the annual estimated number of new HIV infections has decreased by 66%, while the number of annual AIDS-related deaths has decreased by 54% since 2007. Shri J P Nadda, Union Minister of Health and Family Welfare addressing the audience at a function on World AIDS Day, 2016 organised by the NACO, had this to affirm: “Our concerted efforts and strategies have been able to see a success story of India. We can now safely say that we can end the HIV/AIDS epidemic by 2030.”
As per the recent UNAIDS report India presently has 2.1 million HIV cases with a 50% drop in new infections in past decade. New infections in India have fallen to 80,000 in 2016 from 150,000 in 2005 and the fall is expected to accelerate with India introducing the ‘test and treat’ policy earlier this year, where everyone who tests positive for HIV is put on treatment, which makes them less infectious.
However, India can’t afford to rest on a success story by half. New pockets of infection are emerging, there is rising trends in some low prevalence states like Orissa, Punjab, Jharkhand and states like Manipur, Nagaland, Mizoram, AP, Karnataka, Gujarat, Goa continue to have prevalence higher than national averages. A sheer 20% annual decline in new infections over the past few years is no big gain for meeting the Millennium goal by 2030. India has to go a long way for an " AIDS Free India" as the country still has about 2.5 million people, aged between 15 and 49, estimated to be living with HIV/ AIDS. Prevention and control of HIV/AIDS epidemic require organization of resources, technology and concerted effort both at local and global level. The costs of prevention and control are high. But then India is blessed with a number of international organisations working with the NACO in addressing HIV/AIDS issue by contributing their technical expertise and financial resources.
Ending HIV/AIDS by 2030 calls for building greater public awareness regarding various aspects of the disease, raising public expenditure on health care in proportion to country's GDP, putting in place more health care centres where also medical education is provided and make well equipped doctors available to the patients across the different regions of the country. The Indian government needs to align its policies and strategies with the global target. India can demonstrate that it is indeed possible to end AIDS by 2030 only after the completion of NACP IV in 2017, with additional well-led initiatives, honest political commitment, active engagement of civil society and additional funding accelerate the current efforts and scale up innovations as to bring about a change in the national response to the direction of combating HIV/AIDS.
HIV/AIDS education is an important component of preventing the spread of HIV as many people are dangerously ignorant about the virus. A recent survey found that a third of teens thought there was a 'cure' for AIDS. As Elizabeth Taylor aptly rues, “It is bad enough that people are dying of AIDS, but no one should die of ignorance.” When children are affected by Aids, they are bullied, isolated and shut out of school, missing out on education, love and medical care.
(Published on 04th December 2017, Volume XXIX, Issue 49)