On the eve of World AIDS Day, the AIDS Healthcare Foundation (AHF), the largest US non-profit healthcare provider for HIV/AIDS in the US, questioned the efficacy and the claims of the National HIV policy and India’s celebrated AIDS model . A conference they held on the eve of World AIDS Day looked to provide a reality check on the progress in India towards the UNAIDS slogan – Getting to zero – zero discrimination, zero AIDS related death and zero new infections.
This comes in a time when the national body, NACO, claimed to have decreased HIV prevalence from 2.4 million at 0.31% to 2.1 million at 0.27% in the International Conference for AIDS in the Asia Pacific (ICAAP) held in November. The years of 2012 and 2013 saw many incidents of test kit stock out complaints from various community members and District officials in various forums. ‘Are the lower numbers due to lower access of testing facilities due to a decreased faith in the testing centres as a result of the continuous lack of test kits?’ asked AHF India. (HIV and AIDS in India)
Outdated treatment protocols?
According to Dr Nochiketa Mohanty, Country Program Manager, AIDS Healthcare Foundation, India, ’In India, outdated treatment guidelines are followed for people living with HIV on treatment as compared to the latest recommendations by WHO on CD4 count, which could help them fight the disease at a much earlier stage of disease. Not only this, outdated policies and methods of testing are implemented i.e. Serum based testing, which is less accessible, lengthy, requires venipuncture, trained technician & is cumbersome as compared to the implementation of Whole blood finger stick rapid tests, which is recommended by WHO, is more faster, & easy to perform at any place. Many lesser economies like Sierra Leone in Africa have started following these guidelines and have shared their success stories in various international forums. If they can, India definitely can implement these strategies. Is there an effort to decrease testing to find lesser people living with HIV so that a success story of a decreased HIV burden can be shared to the world?’ (WHO’s new guidelines to treat AIDS)
Move to a two-test process
‘Developed countries like Australia and many other countries like Vietnam, China and Uganda have changed their national policies from a 3 HIV test policy to a 2 test policy in order to make testing more accessible, less cumbersome, faster as well as economical and also since the specificity and sensitivity of the results were shown to be comparable. Even in India, the Revised National TB Control Program (RNTCP) has moved from a 3 test to 2 test policy for sputum smears on similar grounds. The Department of AIDS Control in India needs to learn from these strategies to make testing more accessible especially since more than 40%, based on the earlier estimates of 2.4 Million provided by NACO, are still unidentified’, said Dr Chhim Sarath, Asia Bureau Chief, AIDS Healthcare Foundation.
‘The treatment guidelines for HIV in India are archaic and follow older versions of international guidelines of WHO and CDC recommended prior to 2009 and do not follow the current international recommendations. While WHO recommends early initiation of treatment irrespective of CD4 count and many countries have initiated treatment provision for those with CD4 count below 500, India still recommends waiting till a CD4 count of 350 and lesser to initiate treatment. For pregnant women, it is recommended that treatment be started irrespective of the CD4 count to decrease transmission but there are many instances of pregnant women who are not initiated on treatment since there CD4 count is above 350. There seems to be a greater focus on the economics of putting more people living with HIV on treatment over the larger public health perspective in India’, said Ms Terri Ford, Chief of Global Advocacy, AIDS Healthcare Foundation.
‘Department of AIDS Control, India needs to step up to the modern world instead of holding on to antiquated recommendations for testing and treatment in order to help the world curb the epidemic’, said Mr Michael Weinstein, President, AIDS Healthcare Foundation.
AIDS Healthcare Foundation (AHF) is the largest non-profit HIV/AIDS healthcare provider in the USA. AHF currently provides medical care and/or services to over 250,000 individuals in 32 countries worldwide in the US, Africa, Latin America/Caribbean, Eastern Europe, and Asia. For more information, visit www.aidshealth.org.’India Cares‘ under the aegis of AHF was established as a trust in New Delhi. The Trust called AHF India Cares carries forward the vision and mission of AHF Global in India. Apart from providing free ART to more than 550 clients our preventions programs include Free Community based Rapid HIV testing through our mobile testing vans and partners as well as condom distribution.