HIV Specialist - June 2021 - 44

DR. MATIN AHMAD KHAN
Around 69,200 (37,000 - 121,000 thousand)
people were estimated to be newly
infected with HIV in 2019. This is almost 37
percent lower than new infections in 2010 in
comparison to the global average of 23 percent,
but still, more than twice the envisaged
2020 milestone (75% reductions since 2010).
While the number of new infections declined
by 44 percent or more in high burden States
of Karnataka, Andhra Pradesh, Telangana and
Tamil Nadu, this number has been stable or is
rising in the States of Mizoram, West Bengal,
Chhattisgarh, Uttar Pradesh and Tripura.
Around 58.96 thousand (33.61 thousand-102.16
thousand) PWH population died
due to AIDS-related illnesses nationally in
2019. A reduction of 66 percent was achieved
since 2010 against the 2020 fast-track target
of achieving 75 percent reductions by 2020.
The decline has been more than the national
average in many of the high-burden states
including Andhra Pradesh, Maharashtra,
Karnataka, Telangana, Tamil Nadu and West
Bengal. Globally, the decline due to AIDSrelated
illnesses has been 39 percent.
Nearly three in four (around 76%) PWH
nationally knew their HIV status as of March
2020. Among the PWH who knew their HIV
status, around 84 percent were on ART.
Among PWH on ART, who were tested for
viral load, 84 percent were found virally suppressed.
Globally, in 2019, 81 percent of the
estimated PLHIV were aware of their HIV
status, 83 percent of PLHIV who knew their
HIV status were on ART and 88% of PLHIV
on ART had viral suppression.
Who is most at risk of
acquiring HIV in India?
The HIV epidemic in India is highly heterogeneous.
It is concentrated in specific regions of
the country and in high-risk groups (HRGs)
such as people who inject drugs (PWID),
female sex workers (FSW), men who have
sex with men (MSM) and transgender people.
HIV prevalence among Injecting Drug Users
(IDU) is almost 28 times higher than that
of overall adult prevalence. Similarly, HIV
prevalence among Hijra/Transgender (H/
TG) people, MSM and FSW is six to 13 times
higher than the adult prevalence. Among
inmates in central jails, where the population
with high-risk behaviour is over-represented,
44 JUNE 2021 HIVSPECIALIST WWW.AAHIVM.ORG
HIV prevalence is almost 9 times higher than the adult prevalence.
However, the main mode of transmission in India is heterosexual
activity with the most at-risk population being males of reproductive
age group who acquire HIV through sexual contact with commercial
sex workers. They then, in turn, pass the virus to their wives.
Heterosexual activity accounts for almost 837 of every 1,000 new
HIV detections in 2019-20 reported so far. In contrast, almost half
(48%) of newly diagnosed cases in Punjab reported acquiring HIV infections
through infected syringes and needles followed by 39 percent
in Tripura and Mizoram and 25 percent in Manipur.
What are the greatest barriers to care in India?
There are many. And we have to address the all in order to have true
progress.
Stigma and discrimination
As I stated earlier, I have seen a reduction in stigma in my personal
observation, especially since the passage of the Human
Immunodeficiency Virus and Acquired Immune Deficiency
Syndrome (Prevention and Control) Act 2017, which provides for
safeguarding human rights, legal rights and reinforcing constitutional
rights of PWH. However, despite the Act's passage, PWH
continue to experience moderate levels of discrimination. In 2016,
a third of adults demonstrated a discriminatory attitude towards
people living with HIV. This is a similar level recorded a decade
earlier in 2006, suggesting current stigma-reduction activities are
not working.
Stigma and discrimination are very common within the healthcare
sector. A 2013 study of doctors, nurses and ward staff in government
and non-government clinics in Mumbai and Bengaluru found
discriminatory attitudes were common. This included a willingness
to prohibit women living with HIV from having children (55 to 80%),
endorsement of mandatory testing for female sex workers (94 to 97%)
Dr. Khan at a guest
lecture at Department
of Community Medicine
at Kasturba Medical
College, Mangalore,
Karnataka, India
http://WWW.AAHIVM.ORG

HIV Specialist - June 2021

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