Syllabus
GS Paper 2 – Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Applications where to apply?
When asked about
– Communicable Diseases
– Targeted Health Interventions
– Public Health
Context
On April 1, 2004, a significant milestone was marked in India’s battle against HIV/AIDS with the launch of Free Antiretroviral Therapy (ART) for Persons living with HIV (PLHIV).
Source
The Hindu | Editorial dated 1st April 2024
The ART of India’s HIV/AIDS response
The emergence of HIV/AIDS led to a crisis marked by fear, stigma, and a lack of effective treatment options. Despite the development of antiretroviral drugs, access to these medications remained restricted, particularly in low and middle-income countries like India. However, recognizing the urgency of the situation, global and efforts paved the way for access to HIV prevention and treatment services.
HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) are closely related but distinct terms.
HIV
- A virus that attacks the body’s immune system, specifically CD4 cells, which help fight infections.
- HIV weakens the immune system over time, making the body more susceptible to illnesses it wouldn’t normally get sick from.
- There is no cure for HIV, but effective treatment with antiretroviral therapy (ART) can suppress the virus to undetectable levels. With proper treatment, people with HIV can live long and healthy lives.
- HIV is spread through specific bodily fluids, including blood, breast milk, semen, and vaginal fluids. It is not transmitted through casual contact like hugging, shaking hands, or sharing utensils.
AIDS
- The most advanced stage of HIV infection. It occurs when the immune system is severely damaged due to the long-term effects of HIV.
- People with AIDS have a very low CD4 cell count and are prone to opportunistic infections (infections that wouldn’t normally occur in a healthy person) and other serious illnesses.
- Without treatment, people with AIDS typically survive about three years.
Antiretroviral therapy (ART)
- It is a well-established treatment regimen that utilizes a combination of medications to suppress the replication of HIV.
- By effectively inhibiting viral multiplication, ART safeguards CD4+ T-lymphocytes, a critical population of immune cells responsible for combating infections.
- This suppression of viral activity prevents the progression of HIV infection to Acquired Immunodeficiency Syndrome (AIDS), a severe condition that compromises the immune system.
- The first ART medication, Zidovudine (AZT), received approval from the United States Food and Drug Administration (FDA) in March 1987.
Evolution to ART
- The UN General Assembly’s Millennium Summit(2000): issued the declaration to stop and reverse the spread of HIV.
- The Global Fund to Fight AIDS, Tuberculosis and Malaria was created in 2002 which advocated universal access to HIV prevention, treatment, care and support services.
- In 2004, the number of PLHIV in India was estimated to be 5.1 million, with a population prevalence of 0.4%.
- The ‘cocktail therapy’ or HAART (highly active antiretroviral therapy), became available starting in 1996, but costs were prohibitively high.
- In 2006, the free ART was made available for children as well.
Other steps taken by India
- “Treat All” Approach (2017): This strategy ensures immediate ART initiation for all diagnosed individuals, regardless of CD4 count.
- This has significantly reduced viral transmission rates at both individual and community levels.
- Free Viral Load Testing: Regular monitoring of viral load helps assess treatment effectiveness and guide adjustments if needed.
- Extended ART Refills: Providing two to three months’ worth of medication to stable patients reduces clinic visits, saving time and money for patients.
- In 2021, India adopted a policy of rapid ART initiation in which a person was started on ART within seven days of HIV diagnosis, and in some cases, even the same day.
National Action Plan: NACP Phase V
India’s ongoing National AIDS Control Programme (NACP) in its fifth phase has set ambitious goals to be achieved by 2025:
- Reduction in New Infections: Aims for an 80% decrease in annual new HIV infections.
- Lowering AIDS-related Deaths: Targets an 80% reduction in AIDS-related mortality.
- Eliminating Vertical Transmission: Strives to completely eliminate the transmission of HIV and syphilis from mother to child.
Reaching the 95-95-95 Targets
NACP Phase V emphasizes achieving the ambitious 95-95-95 targets by 2025:
- 95% Diagnosed: 95% of people living with HIV know their status.
- 95% on Treatment: 95% of diagnosed individuals receive continuous antiretroviral therapy (ART).
- 95% Virally Suppressed: 95% of those on ART achieve viral suppression, significantly reducing transmission risk.
By implementing these multifaceted strategies, India is working diligently to control the HIV/AIDS epidemic and improve the lives of those affected.
Positive impact of government initiatives
- Expansion of Treatment:
- The number of ART centers has undergone a substantial increase, from less than 10 to a remarkable 700.
- Additionally, over 1,200 Link ART centers ensure free ART medication reaches roughly 8 million people living with HIV (PLHIV) who are currently undergoing treatment.
- Reduced HIV Prevalence: The prevalence of HIV among the crucial 15-49 year old age group has demonstrably decreased to just 0.20% (with a confidence interval of 0.17%-0.25%).
- Decreased Disease Burden: Estimates suggest the total number of PLHIV in India has declined considerably, to around 4 million, reflecting a reduction in the overall disease burden.
- India’s share of PLHIV globally has shrunk, from around 10% two decades ago to a much lower level of 6.3% currently.
- Reduced New Infections: Compared to the 2010 baseline, new HIV infections in India have seen a noteworthy decline of 48%, exceeding the global average reduction of 31%.
- Similarly, AIDS-related deaths have witnessed a substantial drop of 82%, far outpacing the global average decrease of 47%.
Challenges in India’s HIV/AIDS Response
- Delayed Enrollment and Treatment Adherence:
- A significant proportion of patients enter ART facilities with critically low CD4 counts, indicating delayed enrollment in care.
- Once on ART and feeling better, some patients miss medication doses or abandon treatment altogether, leading to drug resistance.
- Uneven Access to ART:
- Ensuring a reliable and consistent supply of ART medication across all regions, especially in remote areas with difficult terrain.
- Limited Workforce Capacity:
- There is a need for healthcare workers to keep pace with evolving HIV treatment protocols and best practices.
Solutions to Strengthen India’s HIV/AIDS Response
- Early Diagnosis and Patient Support:
- Strengthening outreach programs to encourage earlier HIV testing and diagnosis.
- Implementing patient support systems, including adherence counselling, to address the reasons behind missed doses and dropouts.
- Strengthening Supply Chain and Infrastructure:
- Investing in cold chain logistics and transportation networks to guarantee consistent ART availability throughout the country.
- Exploring partnerships with the private sector to expand access to ART services in underserved regions.
- Continuous Training and Skill Development:
- Implementing regular training programs for healthcare staff, emphasizing practical, hands-on approaches to managing HIV patients.
- Holistic Care Approach:
- Fostering collaboration between HIV programs and other healthcare initiatives to provide comprehensive treatment for PLHIV’s overall well-being.
- Improved Monitoring and Diagnostics:
- Implementing systematic death reviews to understand and prevent mortality.
- Expanding access to advanced diagnostic tools for early detection and treatment of opportunistic infections and other health complications.
Conclusion
The journey of Free ART in India reflects a remarkable triumph of political will, sustained funding, community engagement, and programmatic adaptability. It not only underscores the effectiveness of public health interventions but also serves as a beacon of hope in the fight against HIV/AIDS globally. As India continues its efforts towards achieving ambitious targets under the National AIDS Control Programme, the learnings from the Free ART initiative stand as a testament to the power of collective action and perseverance in combating infectious diseases.
Related Topics
National AIDS Control Programme (NACP)
Launched in 1992 as a comprehensive HIV/AIDS prevention and control program in India. Focus has evolved from awareness raising to behaviour change and decentralized response.
Phases:
- NACP I (1992): Slowing the spread of HIV.
- NACP II (1999): Reducing spread and increasing long-term response capacity.
- NACP III (2007): Halting and reversing the epidemic.
- NACP IV (2012): Accelerating reversal and strengthening response.
- NACP V (2021-2026): Ending HIV/AIDS as a public health threat by 2030.
Strategies
- Intensifying and consolidating prevention services, with a focus on HIgh Risk Groups (HRGs) and vulnerable population.
- Increasing access and promoting comprehensive care, support and treatment
- Expanding Information, Education & Communication services for (a) general population and (b) high risk groups with a focus on behaviour change and demand generation.
- Building capacities at national, state, district and facility levels
- Strengthening Strategic Information Management System
References
Practice Question
Examine the role of government initiatives in the fight against HIV/AIDS. [150 words]
How to approach this question?
Introduction:
- Start with a brief overview of HIV/AIDS as a global health issue.
- Highlight the importance of government initiatives in combating this issue.
Body:
- Role of Government Initiatives Globally:
- Discuss the roles of governments in the fight against HIV/AIDS. Mention how governments have taken center roles in establishing organizations to fight the pandemic and funding other private organizations.
- Discuss specific examples of government initiatives such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Federal Initiative to Address HIV/AIDS in Canada.
- Role of Government Initiatives in India:
- Discuss the Free Antiretroviral Therapy (ART) initiative launched by the Indian government. Highlight how this initiative has been a key intervention in the fight against HIV/AIDS in India.
- Discuss the expansion of facilities offering ART and the number of people receiving free ART drugs.
- Impact of Government Initiatives:
- Discuss the impact of these initiatives on the reduction of new HIV/AIDS infections and death rates.
- Discuss the challenges faced in implementing these initiatives and the strategies used to overcome them.
Conclusion:
- Summarize the key points discussed in the body.
- Conclude by emphasizing the crucial role of government initiatives in the fight against HIV/AIDS and the need for continued efforts in this direction.
Remember to provide a balanced answer, incorporating relevant facts and figures, and propose feasible solutions. Structure your answer well, with a clear introduction, body, and conclusion. Also, ensure that your answer is within the word limit specified for the exam. Good luck!