HIV on the wane but high risk groups still cause for concern

Mumbai: When World AIDS Day is observed across the globe on December 1, India will enter the third—and perhaps the most perplexing—decade of its HIV/AIDS epidemic.

The first 29 years were marked with victory as the human immunodeficiency virus (HIV) metamorphosed from being the deadliest word in public health to just another chronic disease such as diabetes or hypertension that can be managed well with medicines. But experts warn that complacency—accompanied by a sharp drop in funding—could prove to be costly for India.

Consider Mumbai, for instance. HIV among the city’s general population fell from 3.6% in 2013-14 to 3% in 2014-15. But the Mumbai District AIDS Control Society (MDACS) that manages health programmes for HIV/AIDS people has been managing with a third of its annual budget of Rs 25 crore.

“Medicines have had a marvellous effect on the HIV/AIDS epidemic so far. Every patient who has managed to get these medicines has not done poorly but we could head for big trouble if patients don’t adhere to drugs or fail to get it in time,” said infectious diseases specialist Dr George Oomen. The country has faced a stockout of HIV drugs in the past few years.

Indeed, while year-on-year, incidence of new infection among the general population and pregnant women has shown a significant decline, that among risk groups continue to be a cause for concern. As per the HIV sentinel surveillance data of 2010-11, HIV among female sex workers in the city was around 6%, way higher than the national prevalence of 2.7%.

However, the main sentiment on the eve of World AIDS Day is of positivity. “What is the difference between HIV in 1985 and 2015? HIV-positive people don’t really frighten others anymore,” said Ashok Row Kavi of Humsafar Trust, one of the first organizations started in the country to advocate for rights of men who have sex with men (MSM). “People are living a prolonged life with antiretroviral therapy (ART). Our biggest achievement is that we have killed the fear.”

Dr Shrikala Acharya, additional project director, MDACS, said, “We have come from a stage when HIV prevalence in Kamathipura was 54.3% in 2003. Today, the awareness is massive and everyone knows about ways of prevention.” Mumbai currently has over 30,000 people living with the disease. A senior NGO member who worked with FSWs in Kamathipura, said the disease is no longer a death sentence. “We probably don’t even know how many women must have died of AIDS. It is a rare thing today.”

But a doctor said the Indian program faces problems that government officials aren’t ready to accept so far. “Less than a tenth of those who need second -line HIV drugs access them under the government programme. These patients will not only develop further resistance but even spread the disease in the community.” He added the happy picture could crumble in a few years at the rate it’s progressing. “The Centre has washed it hands of funding HIV/AIDS programmes and states haven’t realized their importance. So 30 years on, we have no reason to rest but work on.”

by Malathy Iyer & Sumitra Deb Roy, TNN
Source – The Times of India