New figures indicate that new HIV infections and AIDS-related deaths are on the decline in India. However, the drop in numbers affords us no place for complacency as the number of new HIV infections are stable, or even rising, in some locations in the country, according to India HIV Estimations 2017 by National AIDS Control Organization & ICMR-National Institute of Medical Statistics, Ministry of Health & Family Welfare, Govt of India.
New HIV infections have declined by more than 60% since 2000, but the rate of decline has been much slower in recent years, and well short of what is required to reach the country’s 2020 target.
Between 2010 and 2017, new infections declined only by 27%. While this is better than the global average of 16%, India has to fast-tract itsHIV prevention efforts to achieve the target of a 75% reduction in new infections by 2020 vs 2010, according to the report.
This is despite the fact that globally, a scaling up of ART has resulted in a 48% decline in deaths from AIDS from the peak, while in India, AIDS-related deaths have declined by almost 71%.
HIV incidence per 1,000 uninfected population is estimated to have declined from 0.64 in 1995 to 0.07 in 2017. However, the pace of decline in HIV incidence has been slow of late, dropping from 0.10 in 2010 to 0.07 in 2017.
Even though HIV incidence has been declining at the national level, there are significant inter-state variations. At 1.32%, India’s north-eastern state of Mizoram had the highest incidence of HIV in 2017, followed by Nagaland (0.59) and Manipur (0.58).
HIV incidence also continues to be much higher in female sex workers, men who have sex with men, injecting drug users and hijra/transgender people.
India has remodelled its HIV prevention approach and expanded it to target and cover a wider group of people at risk of HIV. It is also scaling up community-based screening to reach the unreached vulnerable populations and link them to a comprehensive package of prevention, detection and treatment services.
Prevention and treatment services have newly been introduced in prisons and other closed settings. Testing for HIV and syphilis among pregnant women has been intensified for the elimination of mother-to-child transmission of the diseases.
The government of India has also integrated its HIV programme with itsTB programme. A package of services for hepatitis C is also being added into the national AIDS programme.
The Sustainable Development Goals (SDGs) aim to eliminate AIDS as a public health threat by 2030.
As a signatory, India is committed to achieve this goal through its National AIDS Control Programme, National Health Policy (NHP 2017) and National Strategic Plan for HIV/AIDS and STI 2017-2024 through medium-term targets for 2020.
The 2020 targets are:
(i) to attain a reduction in new HIV infections by 75% from the baseline value of 2010
(ii) to attain treatment target of 90-90-90
(iii) to eliminate mother-to-child transmission of HIV and syphilis by 2020, and
(iv) to eliminate HIV/AIDS-related stigma & discrimination by 2020.
Stigma and discrimination against people affected with HIV/AIDS continues to remain a major challenge to eradication efforts.
India brought HIV and AIDS (Prevention & Control) Act 2017 into force from September 2018.
The legislation empowers PLHIV to report discrimination faced in various facets of day-to-day living, such as employment, education, healthcare, property rights, insurance etc..
The act prohibits isolation or segregation of an HIV positive person and makes discrimination against HIV/AIDS a punishable offence.
Despite the enactment, the vast majority of the HIV-infected are yet to benefit from the legislation.
“The HIV and AIDS (Prevention & Control) Act 2017 is certainly a big step towards protecting the rights of the people living with HIV/AIDS,” says Viswanathan Arumugam, Manager, Strategic Information, India HIV/AIDS Alliance — a not-for-profit organisation based in New Delhi. “But most people don’t know much about the new law. As an organisation working with HIV/AIDS groups, creating awareness about the law is one of our key priorities.”