fight-against-aids

Context

Assessing and taking stock of anti- aids fight with the various targets in this regard to be achieved.

Achievements in combating Aids 

  • Globally, there has been  a reduction in new HIV infections by 37? between 2000 and 2018. 
  • HIV-related deaths fell by 45%, with 13.6 million lives saved due to Antiretroviral Therapy (ART). 
  • HIV-related deaths declined by 71% between 2005 and 2017. 
  • HIV infection now affects 22 out of 10,000 Indians, compared to 38 out of 10,000 in 2001-03.
  • According to a recent report by UNAIDS, of the 38 million people now living with HIV, 24 million are receiving ART, as compared to only 7 million nine years ago.

The following component has helped in reduction in the cases of  Aids 

  • Efficacy of ART therapy: HIV-related deaths fell by 45%, with 13.6 million lives saved due to Antiretroviral Therapy (ART).
  • Easy availability of the drug: they  became widely available due to generic versions generously made available by Indian generic manufacturers.
  • Flow of funds: the rush of public and private financing flowed forth in a world panicked by the pandemic.
  • Tackling stigma: Ignorance and stigma were vigorously combated by coalitions of HIV-affected persons who were energetically supported by enlightened sections of civil society and the media.
  • Adoption of right-based approach: The rallying cry of world of global health has helped for adoption of  a rights-based approach and assuring access to life-saving treatments
  • The success of drug treatment to prevent mother-to-child transmission, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and male circumcision, especially among MSM population, is well-documented..

Ambitious target to be achieved 

  • The Sustainable Development Goals (SDG), adopted by the member countries of the United Nations in 2015, set a target of ending the epidemics of AIDS, Tuberculosis and Malaria by 2030 (SDG 3.3). 
  • The key indicator chosen to track progress in achieving the target for HIV-AIDS is “the number of new HIV infections per 1,000 uninfected population, by sex, age and key populations”.
  • The “90-90-90” target stated that by 2020, 90% of those living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people on such therapy will have viral suppression.

Actual status in achieving the target

  • Due to gaps in service provision, 770,000 HIV-affected persons died in 2018 and 1.7 million persons were newly affected. 
  • There are worryingly high rates of new infection in several parts of the world, especially among young people.
  •  Only 19 countries are on track to reach the 2030 target
  • Some regions including southern Africa, central Asia and eastern Europe have had a setback, with more than 95% of the new infections in those regions occurring among the ‘key populations’.
  •  Risk of acquiring HIV infection is 22 times higher in homosexual men and intravenous drug users, 21 times higher in in sex workers and 12 times more in transgender persons.

Vulnerabilities in achieving the target

  • The expanded health agenda in the SDGs stretched the resources of national health systems, even as global funding streams started identifying other priorities.
  • Improved survival rates reduced the fear of what was seen earlier as dreaded death and pushed the disease out of the headlines.
  •  The information dissemination blitz that successfully elevated public awareness on HIV prevention did not continue to pass on the risk-related knowledge and strong messaging on prevention-oriented behaviours to a new generation of young people.
  •  Vulnerability of adolescent girls to sexual exploitation by older men and domineering male behaviours inflicting HIV infection on unprotected women have been seen as factors contributing to new infections in Africa.
  • Even the improved survival rates in persons with HIV bring forth other health problems that demand attention. 
  • Risk factors for cardiovascular disease are high among survivors as they age, with antiretroviral drugs increasing the risk of atherosclerosis. 
  • Other infectious diseases, such as tuberculosis can co-exist and cannot be addressed by a siloed programme.
  •  Mental health disorders are a challenge in persons who are on lifelong therapy for a serious disease that requires constant monitoring and often carries a stigma.
  • Drug treatment of HIV is now well founded with an array of established and new antiviral drugs. 
  • India has an estimated 2.14 million persons living with HIV .
  • It records 87,000 estimated new infections and 69,000 AIDS-related deaths annually.
  •  Nine States have rates higher than the national prevalence figure
  • Mizoram leads with 204 out of 10,000 persons affected. 
  • The total number of persons affected in India is estimated to be 21.40 lakh, with females accounting for 8.79 lakh
  • Assam, Mizoram, Meghalaya and Uttarakhand showed an increase in numbers of annual new infections. 

Way-forward

  • The theme of the World AIDS day this year “Ending the HIV/AIDS Epidemic: Community by Community is a timely reminder that community wide coalitions are needed even as highly vulnerable sections of the community are targeted for protection in the next phase of the global response
  • The strength of India’s well established National AIDS Control Programme, with a cogent combination of prevention and case management strategies, must be preserved.
  • Given the wide diversity of the HIV virus strains, development of a vaccine is a must in the scene

The mere technical solution wont help but a fresh surge of high-level political commitment, financial support, health system thrust, public education, civil society engagement and advocacy by affected groups  all of which were part of the recipe for rapid progress in the early part of this century

Source:https://www.thehindu.com/opinion/lead/taking-stock-of-the-anti-aids-fight/article30142280.ece