End inequalities to meet the target of ending AIDS

December 11, 2021 0 By Gopakumar

Forty years after the first AIDS case was reported, and 35 years since the first case in India, HIV still threatens us. Today, the world is off track from delivering on the shared commitment to end AIDS by 2030.

Dr Ishwar Gilada

As the world observed the 34th World AIDS Day on Dec 1, it is time to take stock of the current world current scenario as far as our achievements and failures in containing the disease are concerned.  This will help us draw up a roadmap for what needs to be done next. 

India, like other nations, has a commmitment to end AIDS by 2030 under its 2017 National Health Policy as well as UN Sustainable Development Goals (SDGs) adopted by the country. However, akin to the maxim “Man proposes – God disposes’’, we are being put in a tight-spot. Grappling with Covid-19 pandemic for almost two years, we have ended up neglecting other crucial health issues like HIV, Tuberculosis, other infectious diseases and noninfectious health emergencies and exigencies. That resulted in the non-achievement of WHO target 90-90-90 by 2020; which meant that 90% of people with HIV should know their status, 90% of HIV infected people who know their status should be put on Antiretroviral Treatment (ART) and 90% of those on ART should have their HIV-Viral loads suppressed.

Thanks to scientific research and strong evidence, we today have tools to effectively prevent transmission of HIV, diagnose HIV, treat people living with HIV (PLHIV) so that they live fulfilling normal lives and manage co-morbidities as well as co-infections, but we have not satisfactorily leveraged this knowledge into action. That is why, in 2020 — when the world was reeling from the Covid-19 pandemic — 1.5 million people were newly infected with HIV, and 680,000 people died of AIDS-related illnesses globally.

Since most nations could not meet 2020 AIDS targets, now all eyes are set on the 2030 goal post of 95-95-95  (95% of people living with HIV know their status, 95% of them to be on ART, and 95% of these be virally suppressed).

Forty years after the first AIDS case was reported, and 35 years since the first case was reported in India, HIV still threatens us. Today, the world is off track from delivering on the shared commitment to end AIDS by 2030, but not because of lack of knowledge or tools to beat this disease, but because of structural inequalities that obstruct proven solutions to HIV prevention and treatment.

Economic, social, cultural and legal inequalities must be ended as a matter of urgency if we are to end AIDS by 2030. But ending inequalities requires transformative change. Political, economic and social policies are needed to protect the rights of everyone and pay attention to the needs of disadvantaged and marginalized communities.

India has made commendable progress since 7 April 2004, when it began the rollout of lifesaving antiretroviral therapy (ART) for people living with HIV, but formidable challenges remain. India, along with other nations, missed the target of zero discrimination by 2020. The milestone now has been shifted to 2030, albeit with a correction, “less than 10% discrimination by 2030”. 

India has a golden opportunity to end HIV related discrimination by fully implementing the HIV/AIDS (prevention and control) Act 2017. AIDS Society of India (ASI) worked hard to call for the law for ending all forms of HIV related stigma and discrimination. Now ASI is calling for ensuring that all social security measures which are part of our legal framework must be guaranteed to every person living with HIV so that progress towards HIV care and support be fully galvanized, to prevent the act being termed as a ‘toothless act’. Even four years after the enactment of HIV / AIDS Act 2017, there are no appointments of the state Ombudsman; which is a mandatory provision in the act. We are yet to see a single prosecution under the provisions of this act. It does not mean that violations have not happened. In fact, there is an urgent need to create awareness about the existence of the act and its provisions. PLHIV are denied mediclaim policies, and they still mention HIV in exclusion criteria. Life Insurance policies still have provisions to not allow PLHIV to take policies for insured sum of more than Rs 10 lacs. Despite ASI convincing the Insurance Regulatory and Development Authority of India and reaching an agreement with it, there has been no headway in this direction.

Similarly, despite the Transgender Persons (Protection of Rights) Act 2019, the transgender community continues to face denial and rejection in areas such as employment, health, and public services.

Without bold action against inequalities, India as well as other countries in the world risk missing the targets to end AIDS by 2030, just as we risk a prolonged Covid-19 pandemic and a spiraling social and economic crisis by not sharing Covid-19 vaccines to Low and Middle-income countries.

We know how to beat AIDS, we know what the inequalities obstructing progress are and we know how to tackle them. The policies to address inequalities can be implemented, but they require leaders to be bold and not cold! This World AIDS Day, ASI resolves to spearhead the movement to address the stigma and discrimination against PLHIVs and getting the HIV/AIDS Act 2017 implemented in the true sense. 

The author is President, AIDS Society of India, Governing Council Member, International AIDS Society, and a Senior Consultant in HIV/STDs, Unison Medicare & Research Centre, Mumbai.