In the recent few years there has been a receding response to HIV AIDS globally. From PEPFAR and Global Fund to Health Ministries in various countries including India - there seems to be a growing mindset that HIV AIDS has received greater attention than other diseases of greater importance and thus funding from the same needs to be diverted to other diseases or effective programs. On the other hand, developments in recent years have convinced AIDS activists, scientists and campaigners that it is possible to halt the AIDS epidemic by 2030. Advanced and effective antiretroviral medications against resistant strains with lesser side effects and simple tools like circumcision which have been proven to protect against infection have increased hopes for a world with zero new HIV infections.
While there are many diseases that require attention, the reason HIV/AIDS had such priority attention all these years was because of its potential to cause high mortality and rapid transmission without any intervention. As per UNAIDS, currently only 13.6 million people out of 35 million are on ART, which is far too low. Millions of people still die of AIDS-related causes every year because they cannot get the medicine they need. UNAIDS estimates that annually 1.6 million people die of AIDS-related causes and about 2.3 million people become newly infected. Thus, the total number of people living with HIV grows by 700,000 each year. If we bring the number of new infections closer to 0, we will have AIDS under control.
AIDS Healthcare Foundation’s 20×20 global campaign to scale up access to antiretroviral therapy (ART) for at least 20 million people by year 2020 aims to spark a renewed vision on this scenario —that investing in treatment scale up will yield humanitarian and economic benefits that far outweigh the initial costs. This campaign seeks to change the global mindset and reinterpret the AIDS response not as a burden, but as a smart long-term investment that will pave the way to ending AIDS, boosting economic growth and saving millions of lives.
At present the HIV infected community in India has greater woes than losing priority attention. The ART programme in India is facing a stock-out crisis in many states – from condoms in Haryana to ART in Delhi and Mumbai and HIV test kits in many others. Thousands on ART are receiving weekly supplies instead of monthly supplies and many who cannot cope with this inconvenience are missing out on their doses. The prevention efforts for parent to child transmission have been shaken by blows of frequent non-availability of Nevirapine syrup in many centres. From bad forecasting due to inadequate IT infrastructure for the same to delayed payment and MoU renewal with the logistical support (RITES) to procurement delays to cancellation of tenders to delayed approvals of contracts, the reasons for stock outs in the 17 year old National program are numerous. The bureaucratic delays in awarding contracts for procurement in the Ministry of Health add to the trouble. Unlike many developed countries, Health in general does not get its due in India with only 2% of the GDP being invested into the same.
While the Union health ministry is rolling out an online database of medicines stocked at government-run health centres and a centralized agency, the Central Medical Services Society (CMSS), for drug procurement and distribution which will replace RITES, it is yet to be seen how the central government sustains this programme financially and how they coordinate with state governments which actually look after procurements and distribution of drugs. Simply replacing an agency will not help, sensitivity to the impact on public health in absence of supply will have to be increased. Most state governments have poor drug procurement and distribution systems which need to be strengthened. One of the reasons for this is inadequate funding for drug procurement and distribution.
There have been recent instructions to State AIDS Control Societies in India to cut down on their expenditures. Clearly AIDS is no longer a priority for the government as there are more successful programs and chronic diseases that the funds are to be diverted to but what about those who have already been identified and those that have already been put on treatment? How does the fund crunch affect them? Will the lack of funds to procure essential medicines not affect availability of stocks for them in view of the recent stock-outs? Will we not create a greater public health hazard by allowing development of resistant strains of the virus due to the rampant non-adherence in absence of drugs? India has the 3rd largest population of estimated people living with HIV AIDS in the world. Of the estimated 2.1 Million people living with HIV AIDS in India, only 1.5 Million are aware of their status and registered for care and of these only 0.78 Million are on treatment. This means 2/3 of the estimated population still needs to be initiated on treatment and around 1/3 of the estimated population is not even aware that it is infected with the virus. Without identifying this population and initiating them on treatment, curbing the spread of the epidemic is a distant dream. Thus an equal focus to HIV testing as well as treatment needs to be continued to be able to curb the spread of the epidemic.
20×20 is not an abstraction: if we all commit to getting at least 20 million people on treatment by 2020, we will take a conscious, critical step toward ending AIDS.