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Achieving UNAIDS’ 90-90-90: A tall task

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Merely having an HIV/AIDS Act or NACO’s strategic plan will not help because as NACO’s Director Alok Saxena puts it, human behaviour is at the forefront of this epidemic

This December 1 marks three decades since the first World AIDS Day. The theme of this year’s World Aids Day campaign is ‘Know your status’, a challenge to focus attention on the need to test for the condition as early as possible. The theme is to push forward on the 90–90–90 Targets, an ambitious treatment target set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) in January 2017 to help end the AIDS epidemic. The target is that by 2020, 90 per cent of all people living with HIV will know their HIV status, 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral (ARV) therapy and  90 per cent of all people receiving ARV therapy will have viral suppression.

We have a long way to go, because in September 2018, UNAIDS estimated that more than 9.4 million people living with HIV still did not know their status. This is clearly a call that needs to be heeded, by governments, public health workers as well as the general population across the world. The asymptomatic phase of HIV infection, when the virus is in gestation, but still transferable, is the reason why the spread continues undetected until too late.

How has India fared when it comes to tackling AIDS? Since 2010, new HIV infections have decreased by 46 per cent and AIDS-related deaths have decreased by 22 per cent. As per UNAIDS statistics, in 2016, India had 80000 new HIV infections and 62000 AIDS-related deaths. There were 2100000 people living with HIV in 2016, among whom 49 per cent were accessing antiretroviral therapy. The key populations most affected by HIV in India are people who inject drugs (with an HIV prevalence of 9.9 per cent), transgender people (7.2 per cent), gay men and other men who have sex with men (4.3 per cent), and sex workers (2.2 per cent).

Much of our future progress to contain HIV/AIDS depends on the efficient implementation of policies. On World AIDS Day last year, the National  AIDS Control Organisation (NACO) launched the National Strategic Plan for HIV/AIDS and STI 2017 – 2024. Titled, Paving Way For An AIDS Free India, the document is prefaced by a letter from Health Minister Jagat Prakash Nadda, who asks all States and Union Territories to ensure efficient implementation of the plan.

This was followed by the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017 which came into force from September 10 this year. At least on paper, the Act provides the legal framework for prevention and control of the spread of HIV and AIDS and for the protection of the rights of people living with HIV/AIDS as well as health providers associated with the disease.

Other laws too need to be changed to wipe out HIV/AIDS. For instance, the Supreme Court’s decision to annul key provisions of Section 377 of the Indian Penal Code which criminalised sexual relations between lesbian, gay, bisexual, transgender and intersex (LGBTI) people, should hopefully go a long way towards encouraging this community to test earlier and seek treatment, without fear of discrimination.

But, merely having an HIV/AIDS Act or NACO’s strategic plan will not help because as NACO’s Director Alok Saxena puts it, human behaviour is at the forefront of this epidemic. As Joint Secretary in the Ministry of Health & Family Welfare looking after NACO as well as on the team implementing Ayushman Bharat-National Health Protection Mission (AB- NHPM), he has to ensure that the epidemic does not bounce back again in India. In his letter prefacing the National Strategic Plan for HIV/AIDS and STI 2017 – 2024, Saxena makes the point that India’s epidemic has grown much more complex as HIV risk and vulnerabilities are rapidly changing. Thus, besides visible populations, we also need to bring into the fold populations who are hard-to-reach and invisible. He advocates a decentralised and bottom-up programming approach, development of localised differentiated prevention and care and treatment models, along with synergised and concerted efforts. Let us hope that these laws and plans translate from paper into action sooner rather than later.

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