Three northeastern States emerge as new HIV hotspots

Health Ministry attributes rise of incidence in Meghalaya, Mizoram and Tripura to injecting drug users and unsafe sexual practices

The good news is that there has been a steady decline in the number of HIV cases in India. The bad news is that Meghalaya, Mizoram and Tripura have emerged as the new hotspots for HIV, according to the Ministry of Health and Family Welfare.

Lok Sabha reply

In response to a question in the Lok Sabha on Friday, the Ministry attributed the reason for the rise in the incidence of HIV in the three northeastern States to the high-risk behaviour of Injecting Drug Users (IDUs), and unsafe sexual practices.

In four sites in Mizoram and one in Tripura, HIV prevalence was higher among IDUs, which for the rest of the country is 6.3%. At least in three places at Aizwal, Champhai and Kolasib, the prevalence of HIV in IDUs was 37.44%, 33.06% and 38.14% respectively.

HIV prevalence among female sex workers was higher at four sites — two in Tripura and one each in Mizoram and Meghlaya. At one site of Mizoram’s Aizwal district, the prevalence of HIV was as high as 24.68%, compared with 1.6% for other sites in the country.

In the case of pregnant women visiting ante-natal clinics (ANC), six centres in Mizoram, two in Meghalaya and one in Tripura recorded HIV prevalence of more than 1%, compared with HIV prevalence of 0.28% among pregnant women visiting ANCs in other places in India surveyed in December 2017.

The HIV Sentinel Surveillance (HSS), a biennial study conducted by the National AIDS Control Organisation (NACO), is one of the largest regular studies in the world dealing with HIV in high risk groups of the population.

The HSS had referred that HIV prevalence in the context of ANCs in the northeastern States of Mizoram (1.19%), Nagaland (0.82%), Meghalaya (0.73%), Tripura (0.56%) and Manipur (0.47%) were among the highest.

Samiran Panda, Director of the National AIDS Research Institute (NARI), said that the discussion on HIV prevalence has to be taken to the districts. “We need prevention and intervention strategies for the most-at-risk population in these pockets, with good coverage,” Dr. Panda said.

In terms of persons living with HIV (PLHIV) who are on Anti-Retroviral Treatment (ART), Dr. Panda said that almost 12.28 lakh people are covered under ART. According to him, the target is to bring 90% of the 21 lakh people living with the HIV infection in India under ART.

“Going by that target, we are still short of about 6 lakh patients. The challenge is to encourage more people to take the test and then provide them with ART,” he said.

ART’s efficacy

Interestingly, ART leads to effectively suppressing the virus and reducing the transmission of HIV from the infected person, Dr. Panda said.

Source: The Hindu, 6/08/2018

HIV: The self-test option

th the World Health Organisation releasing guidelines on HIV self-testing, a major obstacle in improving access to diagnosis has been cleared. Though much progress has been achieved in India in making HIV testing accessible and free of cost, many infected persons remain unaware of their status. Across the world, nearly 40 per cent of people with HIV are unaware of their infection and run the risk of unknowingly transmitting it. Besides going a long way in preventing new infections, early diagnosis will help in a prompt start to treatment and enable the infected to live longer and healthier. Though there has been a 66 per cent drop in incidence in 2015 in India compared with 2000, the number of new HIV infections last year was 86,000; children below 15 years of age alone account for 12 per cent of this number. In 2015, the total number of people with HIV in India was estimated to be 2.1 million. Of this, 1.5 million were detected and tested at integrated counselling and testing centres (ICTC) and about a million people are on treatment. This leaves about half a million who are unaware of their HIV status. The government has approved in principle the proposal to take HIV testing closer to those in need by starting community-based testing. This will soon become operational and will be in addition to institutional testing. India is also weighing the option of self-testing.

The WHO-approved OraQuick HIV self-testing is based on HIV antibodies present in oral and blood samples. The test can detect antibodies developed within three months of getting infected. It is a screening test, and a positive result should be reconfirmed though a blood-based test. Despite greater awareness, people with HIV still face stigma and discrimination. As a result, getting everyone at risk of HIV infection tested has been a challenge. The OraQuick self-testing makes diagnosis easier and faster, besides ensuring privacy and confidentiality, thus encouraging more people to get tested. But there are challenges in terms of counselling and sensitivity, with the accuracy of the tests pegged at around 93 per cent. Counselling has to be done through innovative ways, such as over the telephone, as in the case of the U.S. Unlike the conventional method of getting tested at ICTCs, people self-testing should be more aware about the possibility of false negatives. But the risk of not getting tested far outweighs the limitations posed by self-testing. Twenty-three countries have in place policies that support HIV self-testing. It is time India adopted it quickly to enable more people to test themselves and help break the transmission cycle.

Source: The Hindu

HIV Bill: Discrimination ends, time to promote awareness

Removing discrimination against those living with HIV/AIDS is an exceedingly slow and painful process. In many cases, the best hope the affected have is the law. So the amendments to a Bill cleared by the cabinet on HIV prevention and control that make discrimination in employment against those with HIV/AIDS punishable with two years in jail and a fine of Rs 1 lakh come as a positive step. The amendments also bar unfair treatment in educational institutions, healthcare, residing or renting property and standing for office.

The person affected also need not reveal his status unless required by the court. Confidentiality by employers will help the affected person’s chances at the workplace as it is here that he can be discriminated against the most in a manner which affects his livelihood. Remember Tom Hanks’ case in the iconic movie Philadelphia. At least Hanks was able to battle his case in court and win but here the affected are rarely able to do so for fear of further exposure or lack of support and money.

Another enabling provision is that the states are expected to provide anti-retroviral therapy and infection management, facilitate access to welfare schemes and formulate HIV education programmes that are gender-sensitive, age-appropriate and non-stigmatising. This is good news but for many of the 2.1 million people living with HIV/AIDS, it would make much more sense if the systems to deliver all this were in place.

For medical care to be delivered in time, the public health system needs to function properly. This is not the case here. However, at least anyone denied this will now find the law on his side. The extent and depth of the stigma crosses all socio-economic strata. Education does not necessarily mean that attitudes towards the affected will improve. One of the most famous cases of discrimination against children took place in highly educated Kerala, which ranks the highest in awareness about the disease. In 2003, two HIV positive children Bency and Benson came into the news when their grandfather fought to have them admitted to a school. The children had been kicked out of three schools after their status was revealed. It took the intervention of the chief minister and a protracted battle to get them readmitted. The school had pleaded helplessness as other parents objected. There are many cases where the environment turns hostile when a person’s status is revealed. Not everyone will be able to counter this.

It is important that state governments work to create awareness of these changes in the law. It is only when you know your rights that you can benefit from the law. That should be the next endeavour along with putting in place the mechanisms that will make these amendments really work for those with HIV/AIDS.

Source: Hindustan Times, 8-10-2016

AIDS deaths in India down 55% since 2007

Sushmi Dey

New Delhi:





Deaths caused by AIDS declined nearly 55% in India in the past eight years, whereas new HIV infections came down by 66% since 2000.In 2007, India had recorded 1,48,309 such deaths; in 2015, the figure stood at just 67,600, according to latest statistics presented by health minister J P Nadda at an ongoing highlevel United Nations meeting in New York. The conclave is evaluating the implementation of the United Nations AIDS control programme. Globally, such deaths declined 41% between 2005 and 2015.
Between 2000 and 2015, new HIV infections in India dropped from 2.51 lakh to 86,000 (66%) -compared with a global fall of just 35%.
The UN General Assembly has proposed to fast-track implementation of AIDS control strategies to end the epidemic across the world by 2030. Endorsing the proposal, Nadda said countries must adopt the target and collabo rate strategies to achieve it.
Highlighting the importance of affordable medicines to tackle the prevalence of AIDS and India's role in making such drugs available worldwide, Nadda asked the UN to ensure global access to affordable medicines. India, which faced the spectre of disastrous con sequences on account of AIDS epidemic 15 years back, has been able to manage the challenge effectively,“ Nadda told the UN meeting. “Targeted interventions based on close collaboration and empowerment of communities and civil society with appropriate funding from the gov ernment have helped deliver key life saving services to the affected population,“ Nadda said. Seeking higher investment from international public health agencies to end the epidemic, Nadda said, “The role of international assistance and cooperation cannot be underestimated.This is the time for developed countries to do more, not less, and enhance their commitments. We cannot afford to give the epidemic a chance to rebound.“
The National AIDS Con trol Programme has been walking a tightrope with international funds drying up over the last three years. This has led to fears about recurrence of new HIV cases. Estimates show a reduction of almost 90% in funding from various multilateral, bilateral and philanthropic donor organisations over the last three years. The government is, therefore, trying hard to seek continuous funding for the programme as it is currently at a critical juncture.
Indian firms like Cipla and Dr Reddy's Laboratories supply 80% of the generic drugs used worldwide for treatment of AIDS. However, many of them have been facing tough regulations in several countries because of patent litigations.

Source: Times of India, 10-06-2016

Over 2000 Indians got HIV due to unsafe blood transfusions in 18 months

Around 2000 Indians were infected with human immunodeficiency virus (HIV) after getting botched blood transfusions, in the last 18 months, according to data shared by the National AIDS Control Organisation (NACO) on Tuesday.

The NACO, in a reply to an RTI query sent by activist Chetan Kothari, said that 2,234 people from across India contracted the deadly virus, between October 2014 to March 2016, because of unsafe blood transfusion processes followed by hospitals in India.

About 16% (361 cases) of those affected hailed from Uttar Pradesh, making the state’s hospitals most unsafe among Indian states, followed by Guiarat with 13% (292 cases) and Maharastra 12% (276 cases).

Many union territories like Andaman & Nicobar Islands, Dadra & Nagar Haveli and few north-eastern states drew a blank. But according to Kothari it may be because their governments are not maintaining proper records.

Tripura, a state where HIV prevalence doubled between 2007-2015 while it dropped nation wide, also drew a blank in the list.

Remote places like Andaman, Meghalaya, Sikkim have not recorded even one case of this nature because they may lack adequate means to test blood during or after donation. Also, they may not even be aware of the cases of AIDS due to lack of proper labs,” Kothari told HT.

“A basic testing kit costs around Rs 1,200. But many hospitals do not follow proper procedure,” said Kothari.

However, NACO’s assistant director general, Dr Shobini Rajan, in a live chat with The Hindu , said, there is “no shortage of testing kits for all the blood banks supported through the NACO programme.”

“States and blood banks also have standing instructions to procure through their resources to mitigate stock outs so as to ensure mandatory blood testing,” Rajan said during the live chat.

Also, these figures need not worry those who donate blood, as there is no chance of them contracting the virus. “We can donate without fear, as that does not impose any risk whatsoever of transfusion transmitted infections. Needles are attached to the bag and cannot be reused,” Rajan said during the chat.

Source: Hindustan Times, 1-06-2016

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On World AIDS Day, resolve to fight HIV through preventive care

It is 27 years today since the global community recognised World AIDS Day. Since 1988, December 1 has provided an opportunity for people worldwide to unite in the fight against HIV, show support for people living with HIV and commemorate people who have died from AIDS. This day serves as a reminder for the public and policymakers that HIV has not gone away — there is still a need to sustain awareness and education, fight prejudice, and improve prevention and care efforts.

This World AIDS Day is particularly significant because in July we lost Suniti Solomon — a pioneer who documented the first cases of HIV in India and dedicated her life to a crusade against the virus. As a physician, scientist, humanitarian, mother and wife, she was passionate about combating the stigma and discrimination that keeps HIV in the shadows, allowing it to spread.

In 1993, this resolve led Solomon to establish the YR Gaitonde Centre for AIDS Research and Education (YRG CARE), which has been instrumental in shaping India’s comprehensive response to the HIV/AIDS challenge. Today, YRG CARE’s successful model of prevention programmes, laboratory services and support programmes have drawn international acclaim and measurably advanced efforts against HIV/AIDS.

I had the honour of working with Solomon for several years. In close partnership with the ministries of science and technology and health and family welfare, our collaborative efforts have helped to foster a unique end-to-end approach spanning a continuum of interrelated and integrated activities focused on community research preparedness, product and technology creation, and ensuring equitable access and care to those directly impacted by HIV/AIDS.

The insights we’ve gained from this work have proven beneficial for broader efforts against other poverty-related, tropical and neglected diseases. It has also fostered the development and coordination of an India network for biomedical research as well as a powerful suite of north-south and south-south collaborations that share knowledge, and strengthen capacity and capability in Sub-Saharan Africa as well as in India.

This systematic approach has been very fruitful. It has increased harmonisation between various stakeholders in support of result-oriented national priorities and led to the development of new strategies that are mitigating the health system constraints and advancing public health goals across a variety of diseases.

I’m certain that when Solomon identified the first HIV case, she could not have imagined how that discovery would inspire a nation and benefit society in so many ways.

Today, as we remember all those who have lost their lives to HIV and take stock of the progress we’ve made, Solomon’s legacy reminds us that even with the most intractable public health challenges, focus, commitment, partnerships and a clear vision are critical ingredients to making positive lasting change. We have to keep up the commitment to ensuring that her legacy continues to benefit the world far into the future.

Rajat Goyal is country director, International Aids Vaccine Initiative. The views expressed are personal

Source: Hindustan Times, 1-12-2015

Jan 30 2015 : The Times of India (Delhi)

HIV fears rise over dip in condom supplies

Sushmi Dey

New Delhi:





At least six states are facing a severe shortage of condoms distributed under the government's AIDS control programme, giving rise to a public health concern over the risk of HIV infections spreading.These shortages have been continuing for around eight months in states such as Haryana, Uttarakhand and MP , which have relatively high HIV prevalence. UP , Andhra Pradesh and Rajasthan also face a supply crisis.“While government manufacturer HLL Lifecare is un able to keep up with demand, negotiations with private players is a long-drawn process,“ a source said. Target intervention groups, which distrib ute condoms as part of public health programmes, have written to the State AIDS Prevention and Control Society (SACS) and other bodies, urgently seeking supplies, sources said.
The matter was recently raised with the Union health ministry , following which the health secretary met senior officials from the National AIDS Control Organisation (NACO) on Thursday .
“The issue has been brought to my notice. We have a meeting again tomorrow where we will analyse the situation and take measures to address the problem,“ health secretary Lov Verma told TOI.
Sources said the shortage Source: NACO factsheet, 2013-14 is primarily caused by bureaucratic delays. “Several target invention groups working in these states have written to us seeking supplies of condoms as there are shortages. We have reported the matter to the government in our recent meeting,“ said Nochiketa Mohanty, country program man ager at AIDS Healthcare Foundation India. AHF, a Los Angeles-based nonprofit organization, provides anti-retroviral medicines and advocacy in 36 countries.
The crisis is not limited to condoms. There is also a shortage of HIV testing kits as well as anti-retroviral medicines, mainly pediatric drugs, across the country , health activists working with HIV patients informed.
Medecins Sans Frontieres, another leading international group working with HIVAIDS patients, confirmed the shortages of condoms as well as anti-retroviral drugs and testing kits across many states.
The UN estimates that India currently has the third largest population of HIV infected people in the world.

New HIV cases down by 57 per cent

The number of new HIV infections in India has come down by 57 percent and related deaths by 25 per cent in the last decade.

On World AIDS Day, Union Health Minister J.P. Nadda sought people’s involvement in achieving the ambitious global goals of zero new infection and deaths.

Launching the helpline number — 1097, a digital resource centre and a supply chain management system for HIV patients, Mr. Nadda said, “It’s the work of every individual to come out and fight it (HIV) out. There should be zero discrimination against people with HIV. This should be our commitment.”

Stressing on the importance of “restraint” and “precaution”, he said it was time for people to consider their lifestyle, noting that preventive health care has become important after an era when it was considered that antibiotics can “cure everything”.

“We should be working on two fronts. We should be aware and put special emphasis on prevention and help those living with HIV and AIDS so that they face no discrimination,” he said.

Health Ministry, he said, had signed MoUs with 11 ministries for better coordination in tackling AIDS and MoUs with five more ministries are in pipeline.

The first HIV positive person was reported in 1986 in India which currently has 2.1 million affected people, the third highest in the world even as the country’s efforts in restricting its spread is considered a success by most.

Keywords: World Aids Day, December 1, HIV infections in India

ec 02 2014 : The Times of India (Delhi)

87% unaware of HIV+ status, may be infecting others

Sushmi Dey

New Delhi:





15,000 Testing Centres Fail To Check Spread

As many as 87% of HIV+ people are not even aware that they are suffering from the infection and may be unknowingly spreading the virus, according to government data.Estimates by National Aids Control Organization (Naco), which works under the ministry of health and family welfare, show over 22 million people were tested during 2013-14, of which 2,40,234 people were found HIV positive.
This included over 12,000 pregnant women who were diagnosed with the virus.
“The low level of awareness among HIV positive population is of concern because research shows that early diagnosis is crucial. It allows patients to start on treatment sooner, which can greatly reduce the risk of spreading the infection to partners. Detecting the virus early also improves health outcomes for infected patients,” said Gerald Schochetman, senior director, Infectious Diseases and Diagnostic Research, Abbott.
Government officials as well as health experts say the risk is more among the vulnerable population that practises high-risk behaviour or have higher chances of HIV prevalence. This includes sex workers, trans-genders and even long-distance truckers.
Over the years, counselling and testing centres across the country have increased with many private laboratories now offering HIV detection tests apart from the government centres. In 1997, there were just 67 HIV testing and counselling sites in India, whereas Naco data shows there over 15,000 healthcare facilities offering counselling and testing across India in 2014.
“Counselling and testing services are important components of prevention and con trol of AIDS in the country ,“ said Anand Grover, founderpresident of Lawyers Collective. Grover said instead of cutting corners with the vulnerable population by criminalizing them, government should counsel and provide them with proper care so that they do not transmit the disease further.
For the full report, log on to http:www.timesofindia.com

Dec 01 2014 : The Times of India (Delhi)

50% drop in new cases in three years





Andhra Pradesh, Telangana, Karnataka and Tamil Nadu account for 3.6 lakh HIV patients -around 50% of the country's 7.7 lakh cases reported as of May 2014. Around 1.7 lakh patients hail from Andhra and Telangana alone.Karnataka has a little over one lakh HIV patients, and Tamil Nadu, 80,685.
Maharashtra follows Andhra Pradesh, with 1.43 lakh patients. Andhra, Te langana, Maharashtra and Karnataka are the only states with HIV-infected population exceeding 1 lakh, according to the Union health ministry .
Health experts said the rising numbers in the south were due to increasingly efficient screening over the past few years. Besides, while cumulative numbers are high, the number of fresh cases reported every year has plunged since 2010. According to the health ministry , the number of new HIV cases reduced by almost 50% across the country in three years -from 3.1 lakh fresh cases in 2010-11 to 1.5 lakh cases in 2013-14.
Andhra Pradesh, Maharashtra, Tamil Nadu and Karnataka saw a sharp fall in the number of fresh cases reported every year.
The drop in fresh cases is due to increasing awareness among the public, especially the risk-prone communities of sex workers, homosexuals and transgenders, said Bakthavatchalam A, deputy director of Association for Rural Mass India.
After Tamil Nadu's 80,000-odd cases, Gujarat is listed with 40,121 cases.States such as UP, Rajasthan and MP, which are larger in area and population, have not recorded many cases, according to data from the Union health ministry .





India has 3rd-highest number of HIV-infected people: UN

India has the third-highest number of people living with HIV in the world with 2.1 million Indians accounting for about four out of 10 people infected with the deadly virus in the Asia—Pacific region, according to a UN report.

The report by UNAIDS, the United Nations programme on HIV/AIDS, said that 19 million of the 35 million people living with the virus globally do not know their HIV—positive status and so ending the AIDS epidemic by 2030 will require smart scale—up to close the gap.

The first—ever UNAIDS ‘Gap Report’ said after sub—Saharan Africa, the region with the largest number of people living with HIV is Asia and the Pacific.

At the end of 2013, there were an estimated 4.8 million people living with HIV across the region.

Six countries - China, India, Indonesia, Myanmar, Thailand, and Vietnam - account for more than 90 per cent of the people living with HIV in the region.

“India has the third largest number of people living with HIV in the world — 2.1 million at the end of 2013 — and accounts for about 4 out of 10 people living with HIV in the region,” the report said.

It said HIV treatment coverage is only 36 per cent in India, where 51 per cent of AIDS—related deaths occur.

In India, the numbers of new HIV infections declined by 19 per cent, yet it still accounted for 38 per cent of all new HIV infections in the region.

The proportions of people who do not have access to antiretroviral therapy treatment are 64 per cent in India.

In Asia and the Pacific, the number of AIDS—related deaths fell by 37 per cent between 2005 and 2013, the report said.

India recorded a 38 per cent decline in AIDS—related deaths between 2005 and 2013. During this period, there was a major scale up of access to HIV treatment, it said.

At the end of 2013, more than 700,000 people were on antiretroviral therapy, the second largest number of people on treatment in any single country.

In India, HIV prevalence among female sex workers dropped from 10.3 per cent to 2.7 per cent but it increased in the states of Assam, Bihar and Madhya Pradesh, the report said.

A look at the HIV prevalence among sex workers:

(Source: UN GAP report)

The estimated population size of sex workers is 868,000, of which 2.8 per cent is HIV—positive. In India, HIV prevalence among women who inject drugs was nearly twice that or more than the figures for their male counterparts, it said.

Keywords: UN AIDS, HIV infected people, India sex workers