Human Immunodeficiency Virus (HIV)

Context:

Recently, a US patient with leukemia has become the first woman and the third person to date to be cured of HIV after receiving a stem cell transplant from a donor who was naturally resistant to the virus that causes Acquired ImmunoDeficiency Syndrome (AIDS).

About Human Immunodeficiency Virus:

• The human immunodeficiency viruses (HIV) are two species of Lentivirus (a subgroup of retrovirus) that infect humans.
• First identified in 1981, HIV is the cause of one of humanity’s deadliest and most persistent epidemics.
• Over time, they cause acquired immunodeficiency syndrome (AIDS),
  •  a condition in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive.
  • Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype.
• In most cases, HIV is a sexually transmitted infection and occurs by contact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids.
• Research has shown (for both same-sex and opposite-sex couples) that HIV is untransmittable through condomless sexual intercourse if the HIV-positive partner has a consistently undetectable viral load.
• Non-sexual transmission can occur from an infected mother to her infant during pregnancy, during childbirth by exposure to her blood or vaginal fluid, and through breast milk.
  • Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells.
• HIV infects vital cells in the human immune system, such as helper T cells (specifically CD4⁺ T cells), macrophages, and dendritic cells.
• HIV infection leads to low levels of CD4⁺ T cells through a number of mechanisms, including pyroptosis of abortively infected T cells,apoptosis of uninfected bystander cells, direct viral killing of infected cells, and killing of infected CD4⁺ T cells by CD8⁺ cytotoxic lymphocytes that recognize infected cells.
• When CD4⁺ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections, leading to the development of AIDS.

HIV in India

The first case of Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/ AIDS) was reported in Tamil Nadu, India in 1986. Since then the virus has spread from the high risk groups to the general population very fast. Today, as per the recently released, India HIV Estimation 2017 report, the total number of people living with HIV (PLHIV) in India is estimated at 21.40 lakhs in 2017. Further, national adult (15–49 years) HIV prevalence in India is estimated at 0.22% in 2017. In 2017, adult HIV prevalence is estimated at 0.25% among males and at 0.19% among females. The adult HIV prevalence at national level has continued its steady decline from an estimated peak of 0.38% in 2001-03 through 0.34% in 2007, 0.28% in 2012 and 0.26% in 2015 to 0.22% in 2017.

Among the States/UTs, in 2017, Mizoram has shown the highest estimated adult HIV prevalence of 2.04%, followed by Manipur (1.43%), Nagaland (1.15%), Telangana (0.70%) and Andhra Pradesh (0.63%). Besides these states, Karnataka (0.47%), Goa (0.42%), Maharashtra (0.33%) and Delhi (0.30%) have shown estimated adult HIV prevalence greater than the national prevalence (0.22%), while Tamil Nadu (0.22%) had point prevalence like the national average. All other states/UTs have levels of adult HIV prevalence below 0.22%.

India is estimated to have around 87.58 thousand new HIV infections in 2017, showing new HIV infection decline by 85% since the peak of 1995 and by 27% between 2010-2017. Women are accounted for 40% of annual new HIV infection in 2017. The new HIV infections are increasing in three states of the north-east region- Assam, Mzioram and Mgehalaya.

Since 2005, when the number of AIDS related deaths (ARD) started to show a declining trend, the annual number of AIDS related deaths has declined by almost 71%. Further, India is estimated to have had 22.67 thousand HIV positive women who gave birth in 2017.

Despite successes, old challenges remain and new threats continue to emerge. New pockets of infection have emerged in the north-eastern state Mizoram along with Gujarat, Bihar, Delhi, Chhattisgarh Rajasthan, Odisha, Uttar Pradesh and Jharkhand. If India took all proactive measures, including testing, anti-retroviral therapy and pre-exposure preventive treatment, in the vulnerable groups, it could hope to avert only about seven per cent of new HIV cases between now and 2028.

Types of HIV

Challenges in Fighting HIV

The Indian HIV programme has evolved, expanded and implemented various new initiatives over the years. The national HIV programme has, so far, been a success story, however, challenges and gaps remain, including drug resistance, financial constraints,stigma and discrimination and coverage access to testing services for people from certain sections of society. Some of these are discussed below:

• The major challenge is the emerging concentration of highrisk groups. These groups mostly living at the margins of the society and perceived by the rest to lead a wanton or ‘sinful’ lifestyle – sex workers (including transgenders), homosexuals (defined as MSM – men who have sex with men) and intravenous drug users. Migrant workers from rural to urban areas and truck drivers who lead a nomadic lifestyle are other groups with high vulnerability to HIV, who also act as a bridge population that carry the infection to the general population.
• Some of the newer challenges that face the National AIDS Control Programme (NACP) are the dual problems of the HIV epidemic, driven by unsafe sex and injecting drugs, not only in the North Eastern states but among emerging pockets in metros and some Northern states. Till now the interventions that have been rolled out were very focused toward particular high-risk behavior. Now newer interventions need to be envisaged that deal with more than one high-risk behavior.
• Many domestic and international organizations have contributed to India’s fight against HIV. As a result many “stand-alone” HIV control programs have come up both at national and regional levels. The major challenge is to integrate them and align them with the national program. Another major issue is integration of the HIV program with the general health system for long-term sustainability.
• The budget outlay for the National AIDS and STD Control Programme stagnated and HIV awareness hoardings were replaced with campaigns promoting immunisation, contraception and tuberculosis prevention and treatment. The majority of the budget allocation for HIV and AIDS is spent on counselling, testing and antiretroviral therapy (ART), which is given free to treat everyone who tests positive for HIV. There’s little money left for information, education and communication programmes that are central to prevention and olwering stigma.
• Gender inequality is also an issue. Women, particularly in rural areas, have little control or decision-making powers over important aspects of their lives. This means they are often unable to negotiate protection from risk of infection. This is an issue for the female partners of men from key populations particularly, given the concentrated nature of the epidemic. Women living with HIV are reluctant to access health care for fear of discrimination and marginalisation, leading to a disproportionate death rate in HIV women.

HIV/AIDS ACT 2017

It provides the legal recourse to protect the rights and interest of people suffering from HIV/AIDS.

Salient features of the Act:

• Prohibition of Discrimination- It lists various grounds on which discrimination against HIV positive persons and those living with them is prohibited.
• Informed consent- No HIV-affected person can be subject to medical treatment, medical interventions or research without informed consent.
• Disclosure of HIV status- No person is compelled to disclose his HIV status except by an order of the court.
• Confidentiality of data- Every establishment keeping the records of HIV-related information of protected persons shall adopt data protection measures in accordance with the guidelines to ensure that such information is protected from disclosure.
• Welfare Measures & protection of children- Apart from facilitating better access to welfare chemes to affected persons the government shall also take appropriate steps to protect the property of children affected by HIV or AIDS for the protection of property of child affected by HIV or AIDS.

National strategic plan (2017-24) and Mission SAMPARK

The Ministry of Health and Family Welfare has launched the plan with aim to eradicating HIV/AIDS by 2030. It is expected to pave a roadmap for achieving the target of 90:90:90. Target of 90:90:90-

• By 2020, 90% of all people living with HIV will know their HIV status.
• By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
• By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

Mission ‘SAMPARK’ aimed at tracing those who are HIV positive and are to be brought under antiretroviral therapy (ART) services

The Global Fund for AIDS TB and Malaria (GFTAM)

Recently, India has announced a contribution of $22 million to the Global Fund for AIDS, TB and Malaria (GFTAM) for the 6th replenishment cycle (2020-22). The Global Fund is a partnership designed to accelerate the end of AIDS, tuberculosis and malaria. As an international organization, the Global Fund mobilizes and invests more than $4 billion a year to support programs run by local experts in more than 100 countries.

HIV Sensitive social protection portal has been launched to help officials and ocunsellors.

Way Forward

India deserves applause for its significant achievements in fighting HIV-AIDS. De-stigmatisation of HIVAIDS is also important to fighting this deadly disease. India has the resources and the expertise; it needs the political commitment. The epidemic needs to be addressed where it is happening. It is important to empower patients and communities. The government needs to focus on testing and treatment options as early as possible. Otherwise, we will annually just keep adding more people to the pool of those who need treatment. The HIV response and the broader global health field must work together.

Source: The Hindu

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