It was on 5th June 1981 in California that 1st 5 cases of a new disease which was later named as AIDS was diagnosed in homosexual men. No one had that time imagined that it was a beginning of one of the worst epidemic affecting mankind which would infect 600 lakh people and kill more than 250 lakh people in 30 years. According to UNAIDS estimates, there are approximately 35 million people currently living with HIV with a global prevalence rate of 0.8%. In-spite of all the efforts and resources poured in universally to fight the epidemic; there were about 2.3 million new infections in 2012 , i.e more than 6,300 new HIV infections per day. 1.6 million people died of AIDS in the same year. Young people, between 15–24 yrs of age , account for approximately 39% of new HIV infections and women represent about half (52%) of all people living with HIV worldwide. India, with approx 21 lakh HIV infected people stands 3 rd country with largest number of HIV infection after South Africa and Nigeria. The high prevalence States are Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu, Mizoram & Goa. However, now some States in the North such as Odisha, Chhattisgarh, Jharkhand and Uttarakhand, some in the North West region including Punjab, Chandigarh and Delhi, and some low prevalence States of North East including Assam have shown rising trends in adult HIV prevalence. With 4.5 lakh HIV infected people. Maharashtra is one of the hard hit states in India. But the good news is that country wide both new infections and death rate have gone down by 57% and 29% respectively. But we need to have sustained efforts to keep this downward trend. Some of the interventions which can help us reverse the epidemic and one day end the epidemic are listed below.
• HIV infection in general population is 0.27%. But the same is high Female Sex Workers, MSM (homosexuals), intravenous drug users (IVDUS), long distant truckers, migrants and STI patients. Our focus of preventive services should be in these high risk groups and vulnerable population.2.
• The therapy used for treating HIV infection is called Anti-retroviral therapy (ART). This therapy is started when the immunity of the infected person as measured by CD4 count goes down below 350 cells per ml. ART if started early and taken regularly, helps one with HIV to live almost a normal life span. So maximum number of people with HIV should be started with this life saving treatment. This treatment is available free of cost in all the government medical centers. For this more and more people who are at risk of HIV should voluntarily come forward and take HIV test.
• ART can be used as tool for prevention of HIV infection. We now know that ART can reduce the rate of HIV transmission by sexual route, by up to 96%.So if one of the partners is HIV positive and other is not, ART taken by the infected partner can prevent HIV in the non infected partner. • Circumcision reduces the risk of HIV acquisition in men by 50 to 60%. So people at risk of HIV can consider this option for prevention of HIV infection.
• ART during pregnancy and breastfeeding can virtually eliminate the risk of HIV transmission to newborn if started early enough in pregnancy. So if each and every HIV positive pregnant women is given ART, HIV can be eliminated in our new generation. • Pre-exposure prophylaxis (PrEP) with ART reduces the risk of HIV acquisition by close to 50% when taken consistently. Those who cannot adapt ant other risk reducing intervention can go for this option. But taking these drugs consistently is very important.
• The main cause of death in HIV infected person in India is tuberculosis. Intensified case finding for tuberculosis in people living with HIV and its treatment in time can reduce these deaths.
• Use of Female Condom, which can give control of HIV prevention in hands of women and reduce their vulnerability.
• Promote Needle-Syringe Exchange Programme and Opioid Substitution Therapy for intravenous drug users.3. • Prevention & control of sexually transmitted infection which in turn will help reduce HIV transmission and acquisition. Ending AIDS will not be a simple or easy task and will require much more than political commitment or biomedical tools. Now more than ever, we cannot afford to lose momentum. With renewed global efforts, the end of AIDS is within our grasp. And each and every one of us should be a part of this fight. On the occasion of World AIDS Day, let’s together take the pledge to end the epidemic which has haunted mankind for 3 decades and aspire for an AIDS free generation.