|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 12 | Page : 575-576
HIV/AIDS prevention and control in India: Achievements and future Challenges
Harshal T Pandve1, Purushottam A Giri2
1 Department of Community Medicine (PSM), Smt. Kashibai Navale Medical College, Pune, Maharashtra, India
2 Department of Community Medicine (PSM), JIIU's Indian Institute of Medical Science and Research Medical College, Badnapur, Jalna, Maharashtra, India
|Date of Web Publication||30-Dec-2015|
Purushottam A Giri
Department of Community Medicine (PSM), JIIU's Indian Institute of Medical Science and Research Medical College, Badnapur, Jalna, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pandve HT, Giri PA. HIV/AIDS prevention and control in India: Achievements and future Challenges. North Am J Med Sci 2015;7:575-6
|How to cite this URL:|
Pandve HT, Giri PA. HIV/AIDS prevention and control in India: Achievements and future Challenges. North Am J Med Sci [serial online] 2015 [cited 2019 Nov 18];7:575-6. Available from: http://www.najms.org/text.asp?2015/7/12/575/172853
As per the World Health Organization (WHO), human immunodeficiency virus (HIV) continues to be a major global public health issue, having claimed more than 39 million lives so far. In 2013, 1.5 million people died from HIV-related causes globally. There were approximately 35.0 million people living with HIV at the end of 2013, with 2.1 (1.9-2.4) million people becoming newly infected with HIV in 2013 globally.  India has the third largest HIV epidemic in the world. In 2013, HIV prevalence in India was an estimated 0.3%.  This article briefly discuses the achievements of India in prevention and control of HIV/AIDS, as well as future challenges for India.
| India's Achievements in Prevention and Control of HIV/AIDS|| |
Over the past decade, India has made significant progress in tackling its HIV epidemic, especially in comparison with other countries in the region. Overall, India's HIV epidemic is slowing down, with a 57% decline in new HIV infections between 2000 and 2011, and a 29% decline in acquired immune deficiency syndrome (AIDS)-related deaths between 2007 and 2011.  The trend in annual AIDS deaths has shown a steady decline since the rollout of the free antiretroviral therapy (ART) program in India in 2004. It is estimated that around 1,50,000 lives have been saved due to ART as of 2011. As of March 2014, 7,68,000 people living with HIV (PLWHIV) were on first-line ART at 425 ART centers. Nearly 1,00,000 children living with HIV/AIDS are registered for HIV treatment and care services at these ART centers and 42,015 of these are receiving free ART.  Initiation of first-line ART is done on the basis of cluster of differentiation (CD)4 counts. About 254 CD4 counting machines are functional in the country, and over 1.5 million CD4 tests have been performed during 2013-2014. According to HIV Sentinel Surveillance (HSS) 2012-13, an overall decline in HIV prevalence among antenatal care (ANC) attendees (considered proxy for prevalence in the general population) was noted at the national level. The declining trend for ANC attendees is consistent with India's story of large-scale implementation and high coverage during the National AIDS Control Programme-III (NACP-III).  The focus of information, education, and communication (IEC) activities has been on promoting safe behaviors, reducing HIV stigma and discrimination, demanding generation of HIV/AIDS services, and promoting condom use. A folk media campaign was scaled up in 32 states, which reached out to 15 million people through folk performances during 2013-14. The Adolescence Education Programme is being implemented in 23 states covering around 49,000 schools. Red Ribbon Clubs (RRCs) are functional in around 14,000 colleges; these include 1,700 new RRCs formed in 2013-14.  Of the Millennium Development Goals (MDGs), the sixth target or MDG-6 is to combat HIV/AIDS, malaria, and other diseases. Target 6A is to have halted by 2015 and begun to reverse the spread of HIV/AIDS and Target 6B is to have achieved, by 2010, universal access to treatment for HIV/AIDS for all those who need it.  India has made substantial progress in achieving targets related to HIV/AIDS.  A major reason for the country's success has been the sustained commitment of the Indian government through National AIDS Control Organisation (NACO) and its NACP. The NACP-III has been particularly effective at targeting high-risk groups such as males having sex with males (MSM), sex workers, and people who inject drugs (PWID), in aiming to stem the wider epidemic. 
As rightly mentioned by Claeson and Alexander, there are no real "innovations" in India's approach to HIV prevention planning; rather, there is a strategy of sound policy-making, investment in good data to make informed decisions, analysis of the data to determine the epidemic drivers, and comprehensive plans and budgets for scaling up known interventions directed at those populations with behaviors that are responsible for the most exposure to HIV, without moral undertones. The world has much to learn from India's approach. 
| Future Challenges for India in Prevention and Control of HIV/AIDS|| |
It is noteworthy that newer pockets of high HIV prevalence among different risk groups in low-prevalence states have emerged over the past decade. Transgender people are emerging as a risk group with high vulnerability and high levels of HIV. Additionally, in certain regions of the country, evidence indicates the possible role of bridge populations including high-risk migrants and long-distance truckers in fueling the HIV epidemic. Better HIV surveillance and targeted interventions are needed for these risk groups. Stigma and discrimination remain a significant barrier, preventing key affected groups and those at high risk of HIV transmission from accessing vital health care services. While ART is free, uptake remains low and requires a dramatic scaling up, especially in the wake of the new 2013 WHO treatment guidelines.  Resistance to antiretroviral drugs is another important issue that can pose a major challenges.  There is also a great need for HIV prevention and control efforts among older populations. As HIV-positive people get older and people acquire HIV at an older age, the medical, emotional, and social issues typically associated with aging are compounded by HIV-related challenges.  Another emerging but highly ignored issue in HIV/AIDS is that of children orphaned by the disease. Children orphaned by AIDS are those under the age of 18 who have lost one or both parents to the disease. Today, India is home to a large number of AIDS orphans and may thus be the next epicenter of the AIDS orphan crisis. 
| Conclusion|| |
As per Claeson and Alexander, given the complexity and heterogeneity of HIV, India will need to be flexible to address the changing environment, including the growing economy and income inequities that influence rural-to-urban migration, knowledge, attitudes, and risk-taking practices and the interrelated changes in sexual mores.  To conclude, the achievements of India in prevention and control of HIV/AIDS are truly noteworthy. To continue such achievements, India needs to strategically focus on current and future challenges with an eye to sustainability.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
HIV/AIDS. (Accessed April 20, 2015, at http://www.who.int/mediacentre/factsheets/fs360/en/).
HIV/AIDS in India. (Accessed April 20, 2015, at http://www.avert.org/hiv-aids-india.htm).
Department of AIDS Control, Ministry of Health and Family Welfare. Annual Report 2013-14. (Accessed April 20, 2015, at http://www.naco.gov.in/upload/2014%20mslns/NACO_English%202013-14.pdf).
Millenium Development Goals. (Accessed April 20, 2015, at http://www.who.int/topics/millennium_development_goals/diseases/en/).
Nath A. India's progress toward achieving the millennium development goals. Indian J Community Med 2011;36:85-92.
Claeson M, Alexander A. Tackling HIV in India: Evidence Based Priority Setting and Programming. (Accessed April 20, 2015, at http://content.healthaffairs.org/content/27/4/1091.full).
Pandve HT, Bhawalkar JS, Bhuyar PA. Emerging issues in HIV infection. Indian J Dermatol Venereol Leprol 2008;74:266-7.
Nekkanti M. Aging and HIV: Emerging Issues in Research, Treatment, and Care. (Accessed April 20, 2015, at http://www.hivsharespace.net/node/1336).
Pandve HT, Bhawalkar JS, Bhuyar PA. AIDS orphans: An ignored issue in India. Indian J Sex Transm Dis 2008;29:47-8.