For the first time since the global onset of the HIV/AIDS epidemic in the 1980s, more than half of all People Living with HIV (PLHIV) now have access to HIV treatment. Globally, AIDS-related deaths have almost halved since 2005, according to the latest UNAIDS report released this week. In India, the last decade saw the incidence of deaths due to AIDS fall by a staggering 58%. However, India now faces a concentrated epidemic of HIV and is one of 10 countries contributing to over 95% of new HIV infections annually. The Hindu spoke to Eamonn Murphy, Director of UNAIDS Regional Support Team for Asia-Pacific, on the challenges ahead.
Is it misplaced to say this is the end of AIDS?
That is a misplaced assumption. This kind of complacency is one of the challenges facing the HIV movement globally. The AIDS programme has become a victim of its own success. The truth is that in Asia and the Pacific, we are seeing slowing down in the decline in new infections. The region has taken the foot off the pedal and we now have concentrated epidemics. HIV does not take a vacation. It exploits these weaknesses and India shoulders a significant HIV burden. The government programme is not reaching all the people in need. Eastern and Southern African countries are miles ahead with countries showing 50% decline.
In the Indian context, what are the challenges that lie ahead?
India is a complicated country as there are huge intra-State variances. Implementing a programme in India is not as easy as in other countries. Emergence of infections in new areas is a challenge and as things stand, the focus on prevention is not too good.
Sometimes centralised policy causes trouble in it being implemented at [the] State level.
Targeting high-risk groups like injecting drug users or men who have sex with men (MSM) is difficult and we need to change to a model of self-testing. It will help reaching high-risk groups that face discrimination. However, the country is close to reaching its first target. Nearly 77% HIV+ people know their status. That shows the goal is within reach. Dealing with stigma and discrimination is critical too if we are to succeed. The science is there and we need political commitment.
How important is it that India continue to play its role as the pharmacy-of-the-world?
India is a critical partner for the world in ensuring patients have access to affordable medicines. India played a central role in the global AIDS response and now with making a generic version of the Hepatitis C drug. For this reason, it is important that the Indian government protects its capacity to utilise provisions under [the] TRIPS agreement to make and export affordable generic medicines. Low- and middle-income countries depend on India to remain the pharmacy of the world.
It is ironic that while India supplies medicines to the world, our own HIV community is facing stock-outs for drugs and testing kits.
The real issue in India is about the supply chain and making sure that drugs do not run out. Some areas, States have too much and other don’t have any medicines. UNAIDS has partnered with the Indian government to adopt a situation room model. We are developing a single information system for the HIV programme which will give authorities real-time information and ensure that States and provinces synchronise.
The Indian government has increased its budget allocation for HIV and now funds almost 80% of the budget domestically. This makes the programme robust and sustainable. The government just needs to address the supply and distribution systems.
Do you think it is necessary for India to bring together the TB and HIV programmes?
Tuberculosis is a leading cause of death for people with HIV. Simple economics dictates that these two programmes be brought together so [that] patients can be screened for both diseases at the same public health facility. It makes a lot of sense for the delivery system as well. Merging HIV and TB programmes is good public health and good economics. These two programmes cannot be implemented in separate silos. In fact, the biggest multilateral donor, The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), is encouraging joint funding proposals for TB-HIV because of this rationale. The tuberculosis programme can learnt a lot from the HIV response.
How important is it for India to redouble its investments in the AIDS response?
We’ve seen all sorts of countries reach HIV targets. India has the resources and the expertise; it needs the political commitment. The epidemic needs to be addressed where it is happening. It is important to empower patients and communities. The government needs to focus on testing and treatment options as early as possible. Otherwise, we will annually just keep adding more people to the pool of those who need treatment.
This article has been corrected for a factual error.
~ Salvador Dali