30 years of HIV in India: Progress in UP but daunting challenges remain

[हिंदी] Dr Ishwar Gilada, President of AIDS Society of India (ASI), who was among the first clinicians to come forward when first HIV case got diagnosed in India in 1985, was the guest keynote speaker at a seminar on “30 years of HIV in India” organized by Department of Microbiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS), ASI, People’s Health Organization and CNS in SGPGIMS on Tuesday, 15th December 2015.

A primer summary was released in National Health Mission (NHM) UP state-office by Family Planning Association of India (FPA India) on 11th December. It highlighted that India along with other countries have adopted the UN Sustainable Development Goals (SDGs), of which the SDG 3.3 is “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.”

“In Uttar Pradesh (UP) are we progressing fast enough to end AIDS by 2030? We can end AIDS now – we do not have to wait till 2030 if political commitment and effective multi-sectoral partnerships work optimally” said Dr Ishwar Gilada.


Dr Gilada added: “This year marks 30 years of India’s fight against AIDS; also this is the first time we are witnessing strongest evidence-based WHO HIV guidelines to provide antiretroviral therapy (ART) treatment to all those testing positive for HIV, regardless of the CD4 count. In UP and in all other states of India, government and private sector must follow strong scientific evidence-based guidelines of WHO and provide ART to all those testing positive for HIV without delay – this will not only help keep all HIV positive people healthy and enable them to live normal lifespans, but also drastically reduce the chance of any further HIV transmission. If we continue to use outdated CD4 count cut-off then who will be responsible for negative health and development outcomes?”

According to UP SACS, free ART is being provided to 25578 PLHIV in UP (out of estimated 123,000 PLHIV in UP), only 20% on treatment in UP as against the National average of 36%. UP SACS data shows 77125 had registered though at some point with government programme, why did we lose these patients and denied them treatment? In UP annual HIV related deaths are 9436. “No one needs to die of AIDS. Also almost 80% of PLHIV in UP are yet to get treatment and government must do everything possible to test-and-treat as per the latest scientific evidence and WHO guidelines” said Dr Gilada.

“The global AIDS Epidemic has completed 34 years of its devastating presence, but has brought hope to millions, thanks to India and its pharmaceutical sector for making HIV- a chronic manageable and affordable disorder, like diabetes and hypertension. It is almost an embarrassment of riches because we know how to end AIDS but we are failing to match the scale of response required to do so! Also ironically we save millions globally but loose thousands to HIV locally” categorically stated Dr Gilada pointing towards only 36% of people living with HIV (PLHIV) in India who are receiving ART from government sector, and a whooping gap of 64% which is yet to be met!

Dr D Himanshu, ART nodal officer at King George’s Medical University (KGMU) shared the experience of rolling out ART in KGMU. Professor (Dr) Rama Kant, former head of Surgery department of KGMU whose team operated first on HIV positive patient in early 1990s, emphasized on how HIV related stigma and discrimination continues to lurk in public and private hospitals despite strong evidence exists how universal precaution guidelines are effective if followed in protecting healthcare providers. Dr Gilada added that post-exposure prophylaxis (PEP) should also be provided to victims of sexual assault just like it is being given to healthcare providers who may have accidentally exposed themselves to HIV transmission.

Professor (Dr) Tapan N Dhole, Head of Department of Microbiology at SGPGIMS spoke on how people living with HIV are thankfully staying healthy and normal if they are provided ART, but at risk of dying of HIV related coinfections and comorbidities. Prof Dhole emphasized on need for better TB and HIV collaborative activities in public and private sector, called upon not to neglect or delay diagnosis and care for non-tubercular mycobacteria, hepatitis, among others.

“From disease of young population it is moving towards issues of aging with HIV. Many age-associated diseases are more common in HIV patients than in age-matched uninfected persons. They include cardiovascular diseases, cancers, bone fractures and osteopenia, Liver failure, Kidney failure, Frailty, illnesses of degrading immunity and neurological diseases” added Prof Dhole, who is also on the governing council of ASI.

“We must critically evaluate the state-run and NGO programs, replicate best practices and shun the unsuccessful ones. We should provide three tiered (not free for all) ART with quality care and should move from ‘donor-dependence' to ‘self-reliance'. We should focus to reduce vulnerability of women and children and make PPTCT a national and state emergency with 100% coverage to achieve near 100% success so that no child gets HIV vertically. There should be a strong focus on youth and de-addiction as more than 50% new infections are among youth” said Dr Gilada.

(About the author: Dr Raghav Gattani, MBBS, Junior Consultant at Avadh Hospital and Heart Center is also the honorary Medical Correspondent for CNS - Citizen News Service)
15 December 2015