This World AIDS Day, take a pledge to 'End Inequalities. End AIDS. End Pandemics.'
By Dr Manorama Bakshi and Dr Praveen Aggarwal
December 1 is World AIDS Day and throughout the day, there will be a buzz all around the world on HIV/AIDS statistics and estimates. The India HIV Estimation 2019 report notes that the estimated adult HIV prevalence rate in the 15-49 age group has been decreasing since the epidemic peaked in the year 2000 and has been stabilising in recent years. India's epidemic has been limited to key affected populations, including sex workers and men who have sex with men and intravenous drug users. Based on these statistical measures, states are ranked. Rather than naming and shaming persons, groups and states, it is better to provide care and support to people living with HIV. The question is not how someone has acquired HIV, but the concern is how we can provide care and treatment, including antiretroviral therapy, to the affected people, and how we can prevent HIV transmission from one person to another. The National AIDS Control Programme has made particular efforts to reach high-risk groups with HIV interventions. Compared with neighbouring countries, India has made good progress in reducing new HIV infections by half since 2000. Despite efforts to develop non-discriminatory policies and educational programmes, people living with HIV still experience discrimination -- within families, in healthcare settings, and at workplaces and educational institutions. This year's World AIDS Day theme is 'End Inequalities. End AIDS. End Pandemics.' Post-Covid, we seem to have forgotten the 2.1 million people living with HIV in India. This World AIDS Day, UNAIDS has highlighted the urgent need to end inequalities that drive AIDS and other pandemics around the world. Despite free antiretroviral treatment being available, the uptake remains low, as many people face difficulties in accessing clinics; post-COVID lockdowns also have taken their toll. Without bold action against disparities, the world risks missing the target to end AIDS by 2030. I have heard from my People Living with HIV (PLHIV) friends that post-Covid, people living with HIV are pushed back. The disruption to antiretroviral treatment (ART), the loss of jobs and the absence of access to health insurance are real fears that engulf people living with HIV and their caretakers. Although the priority at present is to fight against Covid-19, we cannot forget the AIDS epidemic that India, along with the rest of the world, has been fighting for more than 30 years. This need and approach should be that the gains made in fighting AIDS are not lost. We must address the issues being faced by people living with HIV in this health emergency. In recent years, however, we have seen a deterioration in funding for HIV causes. Resources in low- and middle-income countries have been decreasing. To get the global AIDS response back on course, UNAIDS is calling for yearly HIV investments in low- and middle-income countries to rise to a peak of $29 billion by 2025. There is now more awareness and options than ever before to reduce the risk of acquiring or transmitting HIV. Important questions, however, continue to linger: 1. Will people living with HIV continue to receive their ART? 2. Will people living with HIV show up with Covid-19 symptoms in a health-care setting get the same treatment as others? 3. Will people living with HIV who lose their jobs and livelihoods because of Covid-19 be taken care of? 4. Will they be able to resume their work when the situation normalises and have access to adequate social protection? We should show our support for the red ribbon, the global symbol for solidarity with HIV-positive people, not just on World AIDS Day. HIV still threatens the world, not due to a lack of knowledge or tools, but because of structural inequalities that obstruct proven solutions to HIV prevention and treatment. The pledge of the UN Sustainable Development Goals to leave no one behind has been built around the principle of protecting the human rights of all, including the rights of PLHIV to work, to earn a livelihood and to medicines. They must not be forgotten during this pandemic. Debates and discussions on HIV estimates don't mean much. Social protection schemes and policies for people living with HIV make a real difference. HIV infection is preventable and prevention is the cure. The response, however, cannot be led solely by the Ministry of Health and Family Welfare. It has to be a multi-sectoral effort, for HIV impacts everyone. The global lesson is that stigma and discrimination have to be fought if prevention programmes are to succeed. So, if one has to commit to the World AIDS Day message of 'End Inequalities. End AIDS. End Pandemics', one has to adopt a multi-pronged approach. (Dr Manorama Bakshi heads the public health advocacy group, Consocia Advisory, and Dr Praveen Aggarwal is its Director and Co-Founder.)