The endgame to HIV/Aids – The Mail & Guardian

‘Without continued support, patients may miss treatment, HIV infection rates may rise, and ultimately, more lives could be lost.’ Photo: Reuters

In the darkest days of Aids, an end to the pandemic seemed unthinkable. But today, we are closer than we have ever been — if the spirit of solidarity and cooperation can rule, says UNAids executive director Winnie Byanyima. 

When HIV/Aids emerged in the early 1980s, the disease was considered a virtual death sentence. Fear of prejudice caused depression and low self-esteem in isolated patients. Despite the approval of several antiretroviral drugs in the 1980s and introduction of protease inhibitors in 1995, access to medicines remained restricted to some high-income countries. Unaffordability and lack of universal access to treatment across geographical divides led to higher fatalities. 

Only a selected few could afford the “cocktail therapy” — a combination of three or more anti-retroviral drugs — because it cost $10,000 a year. Consequently, at the United Nations General Assembly’s Millennium Summit in 2000, world leaders set a specific goal of stopping and reversing the spread of HIV. The Global Fund to confront Aids, Tuberculosis and Malaria was created in 2002, which advocated universal access to HIV prevention, treatment, care and support services. The World Health Organisation on its part announced the ambitious “3 by 5” initiative with the aim of providing HIV treatment to three million people in low and middle-income countries by 2005. 

Thereafter, to get an upper hand over the epidemic, the “90-90-90” targets were launched in 2014 to ensure that by 2022 90% of all people living with HIV will know their HIV status; 90% of all people diagnosed with HIV infection will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will achieve viral suppression. The target was extended to 95-95-95 by 2025

It now seems the United States’ shutdown of HIV/Aids funding will harm global Aids programmes irreparably, jeopardising millions of lives and putting HIV prevention at risk. 

As eminent South African physician and HIV/Aids expert Dr Glenda Gray contends: “There’s still the looming fear that without continued support, patients may miss treatment, HIV infection rates may rise, and ultimately, more lives could be lost.”

The fight against HIV/Aids is not over yet, because humanity is up against a stubborn virus. In 2023, about 630,000 people died from Aids-related illnesses globally, a 69% reduction from the peak in 2004, when 2.1 million people perished. At the end of 2023, about 39.9 million people were living with HIV worldwide, with 53% being women and girls. An estimated 1.3 million people became newly infected with HIV, which is more than three times the target of fewer than 370,000 by 2025, but marking a 39% decline in new HIV infections since 2010 and a 60% fall since the peak in 1995. 

UNAids has been consistently calling for bold and ambitious action to end Aids as a public health threat by 2030. But the rate of new infections and deaths are not falling rapidly enough to meet that target. UNAids believes Indian effort is crucial to end Aids as a global public health threat by 2030. Without India doing a large part of the heavy lifting, it is unlikely that the world will meet the target. And there is a reason for it. India is estimated to have the second largest number of people living with HIV globally, after South Africa. 

The Aids epidemic in India has been on a decline after it peaked in 2000. Though widely celebrated for its success in the Aids control mission, since 2020 people living with HIV and annual new HIV infections have been rising slowly but steadily. As per National Aids Control Organisation data, India had about 2.54 million people living with HIV in 2023, up from nearly 2.46 million in 2022. The country quietly registered 68,451 new HIV infections in 2023, equivalent to 187 infections a day, and 35,866 Aids-related deaths, which is one death every 15 minutes. 

This was despite a decline of 44% in total annual new infections in 2023 compared to 2010, while Aids-related deaths came down by a whopping 79% during this period. There is certainly cause for concern as the recorded rise in annual new HIV infections has been as high as 116% to 524% in some provinces. The worst part of this development is that more than 70% of new HIV infections are in marginalised communities, already facing an extreme degree of stigma and discrimination. 

Renowned infectious disease expert and Aids Society of India’s secretary general, Dr N Kumarasamy, says that at least 0.86 million people in India still need to be linked to treatment, and suggests extensive testing coupled with enhanced public awareness through community involvement. 

“More HIV testing is needed among antenatal mothers in rural areas and among mothers delivering at homes,” he said.

To achieve the goal of ending Aids as a public health threat by 2030, lowering new infections along with proper diagnosis and successful treatment is the key. Every new infection means a person requiring treatment for life. So, for a sustainable HIV response the focus should be on prevention apart from involving the larger community in implementation of projects. 

Although some parts of India’s Aids figures do not look good, UNAids is happy with the overall progress. More people are gaining access to life saving HIV treatment and the cumulative number of people living with HIV who are on treatment is increasing. 

But there is no room for complacency. David Bridger, UNAids country director in India, said: “It’s clear that the pace of decline in new HIV infections nationally is plateauing. The real big challenge ahead for India’s HIV response will be to find new and innovative ways of increasing HIV prevention options for people going forward, in order to accelerate the decline in new infections.” 

Besides, India accounts for a sizable proportion of the HIV epidemic estimated in Asia and the Pacific region. What happens in India in terms of securing further decline in new HIV infections will therefore affect regional averages and, in turn, global averages. 

“India has therefore been advised to adopt newer strategies from within apart from considering globally used technologies, such as pre-exposure prophylaxis and HIV self-testing,” says Bridger. 

The Global Aids Strategy calls for 30% of HIV testing and treatment services and 80% of prevention services to be delivered by community-led organisations. These organisations are best placed to reach key populations, so they need the space and resources to lead. 

India is in a solid position as the foundations of the response are strong. It has achieved financial self-sufficiency in its Aids response, with 94% of funding for the National Aids and STIs Control Programme coming from the government. The goal of ending Aids as a public health threat by 2030, could be a reality in India. The next three to five years will be crucial. If India can end Aids as a public health threat, then the world surely can.

Seema Sengupta is a Kolkata based journalist and columnist.