We are better placed today than earlier #endAIDS! - Dr Ishwar Gilada

On 1 December, WHO joins partners and communities to commemorate 36th World AIDS Day (WAD)2024 under the theme “Take the rights path: My health, my right!” WAD is an occasion to take stock and reflect upon what has been achieved towards the prevention, control and management of HIV and where do we lag behind. The achievements have been great in saving millions of lives and several more from getting HIV infections globally during past two decades.

Can you imagine Global AIDS Scenario minus India? WAD is also an occasion to portray India as global saviour. India has played a heroic role in normalising the AIDS Pandemic. It is indeed very important to do Research and Development for treating diseases, but it is more important to reach the R&D fruits to larger humanity. And that is done by India.

Today, HIV is a chronic manageable disorder, even better than diabetes. United Nations, WHO, UNAIDS - deliberately shy away from acknowledging India’s contribution in making anti-retroviral therapy (ART) affordable and accessible to 92% of people living with HIV (PLHIV) globally.

Though we have set our goals high, we are little far from achieving the targets. New targets- Zero New Infections, Zero Deaths and Zero Discrimination against PLHIV by 2030! PLHIV must have access to HIV testing and treatment.

Laws and policies should help end stigma and discrimination faced by them and by key populations. India’s HIV/AIDS ACT 2017 should not remain a toothless weapon, looking at the theme of this WAD.

It is well established that we have adequate and efficient tools to end AIDS - be it the science-backed tools and approaches to prevent HIV transmission, or diagnosing and treating PLHIV so that they can live healthy, fulfilling lives.

But an array of ‘missed opportunities’ is plaguing the AIDS response globally. Factors like lack of accountability, sub-optimal programme effectiveness, and complacency are slowing us down from reaching the goal of an AIDS-free world. Covid-19 pandemic did play spoilsports, but we cannot continue that excuse forever.

There is no cure for HIV, however, with access to effective prevention, diagnosis, treatment and care, HIV has become a manageable chronic condition, enabling PLHIV to lead long and healthy lives. ART can result in undetectable viral load within a couple of months. ‘Undetectable is Untransmittable’ or U=U and one step beyond-

Untransmittable means Zero. U=U=0! So, each new HIV case is a ‘missed opportunity’ where a range of combination prevention options could have helped prevent the person from getting infected. Every AIDS-related death is a grim reminder that it could have been averted because we have proven tools to make ‘AIDSdeath’ a history.

We should ensure that full HIV combination prevention spectrum and complete care and support services are reaching everyone, including the key populations with sense of purpose and urgency.

India had 2.5 million PLHIV in 2022 (including 70,000 children). Alarmingly, 66,000 people were newly infected in 2022, 180 new infections daily, slight increase since 2021.

Sadly, there were 32,000 AIDS-related deaths in 2022, four every hour, though it has reduced by 25% in a year. In the journey towards #endAIDS goals, one of the earlier milestones has to be elimination of parent to child or vertical transmission of HIV, as that doesn’t even need change in behaviour unlike sexual mode of transmission. India, despite progress, is yet to achieve this goal.

Coverage of pregnant women who receive medicines to prevent HIV transmission to the unborn child was 64%. Vertical transmission rate, including during breastfeeding, is 24.3%. This is another ‘missed opportunity’ which we cannot afford to ignore, rather we should completely eliminate vertical transmission of HIV by 2030.

India's HIV prevalence peaked in 2000, showing a continuous decline during past two decades with 0.55% in 2000, to 0.32% in 2010 and 0.21% in 2021. However, we have seen a resurgence in HIV with increasing number of new infections, especially in young people along with rising trend in Sexually Transmitted Infections (STIs) with

Human Papilloma Virus-HPV, Hepatitis B and Syphilis leading. Fortunately, Syphilis is curable, and its cure is affordable. Though HBV and HPV are incurable, but are fully vaccine preventable, with HBV vaccines available at pittance of cost.

We cannot remain only HIV-centric and need to focus on other STDs. Data-backed science has long raised the alarm on low coverage of HIV services among those who are most at risk - the key populations. We have to scale up the HIV response for them.

While overall HIV prevalence in adults in India is 0.25%, HIV prevalence in sex workers is 1.9%; in gay men and other men who have sex with men (MSM)- 3.3%; in transgender people- 3.85%, and in injecting drug users (IDU)- 9%. Whereas, HIV prevalence in prisoners is 1.9%, but coverage of ART is only 28.7% in prisoners.

Pre-Exposure Prophylaxis (PrEP) and HIV Self-Test (HIVST) are not yet part of National AIDS Control Program (NACP) and if included, would help prevent several new infections and detect undiagnosed cases that can bridge the gap in first 95 target – 95% people with HIV should know their status.

We have time-tested and proven capacity to manufacture HIV diagnostics, medicines and robust supply chain mechanisms to deliver them worldwide sustainably. But are HIV programmes worldwide strong enough to ensure that HIV prevention, diagnostics, treatment, care and support services are reaching everyone in need?

The next best opportunity to eliminate the difference between “what we know works” and “what we do” is now. We know how to prevent HIV, diagnose HIV, treat and support PLHIV. But the gap between - where we are and where we need to be is a chasm, we cannot afford to have anymore. Bridge the gap to end AIDS and check other STIs.