‘Testing policies must be streamlined and brought in line with the modern best practices’
AIDS Healthcare Foundation (AHF) is a non-profit HIV/AIDS healthcare provider that provides medical care and services in 36 countries worldwide. AHF India functions under the AHF Global to tackle the huge AIDS burden in the country. Dr Nochiketa Mohanty, Country Programme Manager – AHF India talks about dealing with the huge AIDS burden, treatment strategies, need for rapid testing and prevention programme, policy changes needed and AHF India’s role in fighting AIDS, in an interaction with Lakshmipriya Nair
India, with a huge AIDS burden, has been waging a war against it for decades now. So, what have been our major achievements?
Some of our major achievements have been access to affordable generic medications for India’s citizens and people in the developing world, and a position on intellectual policy rights that has prioritised public health over corporate interests. But, now this progressive position is increasingly under attack as a result of continued pressure on intellectual property enforcement from the US and the EU. A stronger stand needs to be taken by the government keeping the interest of the public in view so that flexibilities existing in the current Intellectual Property (IP) laws are not affected.
Tell us more about AHF’s 20X20 campaign to provide AIDS care to 20 million individuals by 2020.
20×20 is a global campaign to scale up access to antiretroviral therapy (ART) for at least 20 million people by the year 2020. Currently, only 12 million people out of 35 million are on ART, which is far too low. Millions of people still die of AIDS-related causes every year because they cannot get the medicine they need.
The chief aim of 20×20 is to spark a renewed vision—that investing in treatment scale up will yield humanitarian and economic benefits that far outweigh the initial costs. This campaign seeks to change the global mindset and reinterpret the AIDS response not as a burden, but as a smart long-term investment that will pave the way to ending AIDS, boosting economic growth and saving millions of lives.
AHF has been against PM Narendra Modi’s decision to lift the restrictions on pricing of 108 drugs in India. Can you explain your stand?
In a press statement issued on October 13, we respectfully asked Prime Minister Modi to reinstate these potentially life-saving drug price caps for the benefit of Indians as well as the entire world. Our stand on the move by the government is:
“Now that drug pricing restrictions have been lifted, prices will likely increase, making medicines unaffordable, especially for the estimated 30 per cent of India’s population that lives below the poverty line.”
The setback is doubly disappointing, because United Progressive Alliance (UPA) —the ruling coalition prior to Modi’s election—had to overcome substantial pressure from the pharma lobby in order to implement these price caps in the first place.
A UNAIDS report informs that a huge number of HIV-positive people are unaware of this fact and this is accelerating the spread of AIDS. How can the situation be reversed?
HIV testing must be scaled up in a big way around the world. Governments from across the world need to embrace community-based streamlined testing models that use rapid testing technologies and make testing-free, convenient, hassle-free and easily accessible, particularly for the most affected populations. Testing results should be available the same day and there needs to be strong linkage to care and services for those who test HIV-positive.
What are the major challenges in the fight against AIDS? How to mitigate them?
Low level of testing is a major problem — many HIV positive are unaware of their medical status, rendering them incapable of taking the necessary steps to protect their partners and loved ones. Government policies and bureaucracy make the testing process long and cumbersome, so many people are lost along the way before they ever get to see a doctor and receive treatment.
Prevention programmes are being scaled down, especially, with many centres facing stock-outs for condoms and HIV test kits. This decreases the faith of those accessing prevention programmes in the existing facilities and risk behaviours go unprotected thereby, increasing the risk of transmission.
Treatment as prevention is an accepted international standard and is recommended in all international guidelines. Therefore, early treatment initiation irrespective of CD4 counts or at least below CD4 count of 500 has been recommended by WHO. India is still lagging behind in the implementation of these recommendations. A political and bureaucratic will to attain these international standards is lacking.
Stigma towards people living with HIV and sexual violence towards women is also among the major problems. People are afraid to receive treatment or reveal their status out of fear of being shunned by their family and community. Each of these issues require a specific strategy to mitigate it, but if the government makes a commitment to prioritise HIV/AIDS in India and take concerted steps to address the epidemic, as has happened in South Africa, this would go a long way in helping India get AIDS under control.
What are the policy changes needed to fight AIDS more effectively?
Testing policies must be streamlined and brought in line with the modern best practices, such as the use of two rapid tests to establish a diagnosis instead of using blood draw and slow lab tests that take up to a week for results.
Testing must be scaled up across India in a major way. The treatment initiation threshold should be brought in line with the WHO recommendations, so that people can start treatment sooner, when their CD4 count is 500, instead of the current 350. India must maintain a strong stance on prioritising access to essential medicines over granting patents to pharma companies. Condoms should be widely promoted and freely distributed as the most cost effective way to prevent new infections.