Coordinated and locally supported AIDS response is warranted in India

AIDS conference to open in SGPGI Lucknow: 16-18 Dec
[हिंदी] The 4th National Conference of AIDS Society of India (ASICON) will take place in Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS) Convention Centre during 16-18 December 2011. Dr Ishwar S Gilada, Chair of the 4th ASICON said that this congress will bring together 15 international medical experts and 70 national medical experts who will be speaking on issues related to HIV prevention, treatment, care and support. More than 150 doctors including those from rural parts of the country have received scholarship support to attend this academic congress on clinical management of HIV.

Dr Tapan Dhole, Co-Chair of 4th ASICON said that India’s noted HIV experts and international faculty will deliberate on a range of issues around HIV such as HIV prevention, HIV diagnostics, antiretroviral therapy (ART), co-infections associated with HIV like tuberculosis (TB), Hepatitis C virus (HCV) or Hepatitis B virus (HBV), HIV-associated cancers, drug resistance to medicines used in ART, genetic factors in susceptibility and HIV disease progression, Isoniazid (INH) preventive therapy and TB prevention among people living with HIV (PLHIV), HIV and Herpes, challenges in integrating sexual and reproductive health services for PLHIV in healthcare, gender issues, neurological involvement, eye complications associated with HIV, among others. Meet the experts, speed-learning, skills-building and tele-medicine will feature in this conference. No Alcohol and No Smoking if Official Conference policy, first such thing in any of medical conferences.

The global AIDS epidemic has completed 30 years of its devastating presence. India’s first AIDS awareness campaign has completed 26 years and crossed 25 years of diagnosing the first AIDS case in 1986. 

Though India ranks high in HIV numbers, but because of its affordable ART drugs it plays a saviour globally by supplying over 80% of ART drugs to the world, thereby preventing deaths and ameliorating the sufferings of millions of PLHIV. Ironically we save millions globally but loose thousands to HIV nationally.Admittedly,the National AIDS Control Organisation (NACO) said India recorded 18,000 children getting HIV from 65,000 HIV+ve mothers in 2009, where as there are strategies to prevent them. HIV+ve women received a single-dose nevirapine, an outdated strategy meant for Africa. However, ASI will prevail upon NACO to rethink on this through ASICON.

A ghastly-devastating disease of early 1990s has become a chronic manageable disorder now. Treatment for only richer countries and the rich in poorer countries has become affordable to most countries. India is at crossroads vis-à-vis HIV that it makes imperative to look back in the recent past, take stock of what has been achieved and what has been amiss in order to decide future plan for a better tomorrow. The UNAIDS has termed India as the third worst HIV-affected country after South Africa (5.5 million) and Nigeria (2.9 million). How can one compare India to a nation less than the size of one of her states but with 30 times more HIV prevalence? 

What has saved the larger Indian population from HIV is the Indian culture, the responsiveness of its youth, efforts of NGOs and medical caregivers and yeomen contribution of our pharma. 

Treasure India’s Asset: India’s clinically oriented, conservative, comprehensive and holistic care has earned accolades. Its wait-n-watch approach in starting ART is indeed a blessing in disguise for HIV patients (as against ‘Hit-Early, Hit-Hard’ approach of the West). It improves quality of life, increases survival, reduces cost and spares them of impending drug-resistance. Indian culture of joint families and lasting marriages with integrity in women folks have been an asset in providing psycho-social support and reduced transmission. The age of the first sexual experience is higher in India. 

“One Tablet a Day: Keeps HIV at Bay!” treatment invented in India made ART cheaper, safer and easier. Ironically, the MNCs made hue and cry, calling Indian Generics copy-cats! When the ‘West copies the East’ in making ‘combo’ medicines, why apply different yardsticks? Indian pharma took a lead, risking litigations, circumvented patents by producing generic copies using reverse engineering and brought down the prices to 1%, with 100% bio-equivalence (quality). The yearly cost of cheapest combo has come down from US$ 11452/- per patient to $69. Indian Pharma must be lauded for saving millions. 

What is amiss? Less than 10% of the pregnant HIV+ve women received PPTCT and that too only single-dose nevirapine; only 56% of sex workers are reached with HIV prevention program and 38% of them identify correct ways of prevention methods. Only 20% of the infections are recorded at NACO, due to inherent flaws in the reporting system. More than half of the infected people do not know their HIV status. Our efforts to make the risk-takers understand their vulnerability have been inadequate. Only 30% adults with advanced HIV infection are receiving ART (up from 6% in 2005); while 20% patients at free roll out are dead, 12.5% have lost to follow-up or stopped ART in 2 years. We are facing an extremely challenging situation with Multi-drug resistant and extremely drug resistant (MDR/XDR) TB and HIV, Immune Reconstitution Inflammatory Syndrome (IRIS) – a serious disease situation caused by regaining the lost immunity following successful ART, HIV+ alliances, jobs for recovered people and mediclaim for HIV patients. Vaccine and Microbicide is a distant dream. 

More such in-depth reviews and dialogue on issues around HIV response in India will be hosted during the ASICON. ICMR, Medical Council of India, Dept. of Bio-Technology, Govt. of India, SGPGI, NACO and Peoples Health Organisation are co-sponsors, where as it is Co-Funded by the prestigious National Institutes of Health (NIH), USA through Office of AIDS Research. There will be a large Pharma Exhibition at the conference about 55 poster will be displayed from all over India.

Bobby Ramakant - CNS