AIDS war far from over

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AIDS war far from over

Friday, 07 December 2018 | Navneet Anand

Don’t be mistaken that the epidemic is under control. A WHO report says we can’t drop guard

For those who thought that AIDS had become a thing of the past, a report by the World Health Organisation (WHO) must serve as an eye-opener. The fact is that the epidemic demands more attention given that it was only recently, on December 1, that we observed the 30th anniversary of World AIDS Day, which served as a reminder of the scourge that still threatens modern humanity and medical science like never before. It is a day to raise awareness as to how HIV/AIDS epidemic is caused. Before we get into the insights of the WHO report, it will be pertinent to laud the Herculean efforts made by numerous scientists, doctors, Governments, civil society groups, media and agencies like WHO, who have been waging a concerted war for years against this dreaded disease and have also achieved substantial success — both in terms of discovering treatment protocols and driving awareness.

While India stands at a better position in terms of containing the disease and curbing the stigma attached to it, the WHO just served a reminder that we must not allow the momentum to slow down yet, given that threats linger still. The WHO released a note saying, Why the HIV epidemic is not over? It will be worthwhile for all of us to ponder over its findings. “Fear, stigma and ignorance. That is what defined the HIV epidemic that raged through the world in the 1980s, killing thousands of people who may only have had a few weeks or months from diagnosis to death — if they even managed to be diagnosed before they died,” said the introductory note of the report. “With no effective treatment available in the 1980s, there was little hope for those diagnosed with HIV, facing debilitating illness and certain death within years,” said Dr Gottfried Hirnschall, Director of the HIV department at WHO.

Ever since the dreaded disease came to the fore in 1988, according to WHO estimates, more than 70 million people have been infected with the HIV virus, and about 35 million people, or 50 per cent of them have died. Today, the infection has in its grip around 37 million people worldwide, of whom 22 million are undergoing treatment. “When World AIDS Day was first established in 1988, the world looked very different to how it is today. Now, we have easily accessible testing, treatment, a range of prevention options, including pre-exposure prophylaxis of PrEP, and services that can reach vulnerable communities,” said the report.

“In those early days, with no treatment on the horizon, extraordinary prevention, care and awareness-raising efforts were mobilised by communities around the world — research programmes were accelerated, condom access was expanded, harm reduction programmes were established and support services reached out to those who were sick,” said Dr Andrew Ball, senior adviser on HIV at WHO. It was due to the concerted efforts of all stakeholders that things changed gradually.

“The effort to develop effective treatment for HIV is remarkable in its speed and success. Clinical trials of antiretrovirals (ARVs) began in 1985 — the same year that the first HIV test was approved — and the first ARV was approved for use in 1987. However, a single drug was found to have only short-term benefits.  By 1995, ARVs were being prescribed in various combinations. A breakthrough in the HIV response was announced to the world at the 11th International AIDS Conference in Vancouver when the success of as highly active antiretroviral treatment (HAART) — a combination of three ARVs — was reported to reduce AIDS-related deaths by between 60 per cent and 80per cent,” said the report.

Despite continued, unprecedented expansion of access to HIV treatment in the early 2010s, there was a growing concern that we weren’t moving fast enough. In 2014, the “90-90-90” targets were launched to galvanise action. Th 2020 targets are: Ninety per cent of all people living with HIV will know their HIV status; 90 per cent of all people diagnosed with HIV infection will receive sustained antiretroviral therapy; and 90 per cent  of all people receiving antiretroviral therapy will achieve viral suppression. Efforts resulted in substantial success and by 2017, it was estimated that about 28 million people with HIV were able to access testing. However, the WHO warned “HIV is not an easy virus to defeat. Nearly a million people still die every year because they don’t know they have HIV and are not on treatment, or they start treatment late.”

Dr Naoko Yamamoto, Assistant Director-General for Universal Health Coverage and Health Systems, WHO, spelled out the way forward: “The future of the HIV response will also require looking beyond HIV care provision and ensuring that the disease response is embedded in universal health coverage. Ending AIDS is unlikely to ever happen without an integrated health system that provides HIV prevention, diagnosis, and treatment as well as care with other essential health services and support to other co-morbidities such as TB, NCDs and mental health at the community level. A people-centred, human rights based and holistic approach is crucial.”

(The writer is a strategic communications professional)

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