First detected in the latter half of the 20th century, nearly 4 crore people are living with HIV and AIDS in the world today. Even as we make significant progress in reducing mortality among patients and understanding the molecular virology of the infection, concerted efforts to prevent and manage the condition continue to be undertaken by infectious disease experts like Dr Ishwar Gilada.
Leading the 20th edition of Practo Connect – a webinar meant exclusively for doctors and healthcare professionals – he shares his experience on opening India’s first AIDS clinic in 1986 at the government-run JJ hospital in Mumbai, and the progress made since then.
“Back then, I did not realize that a lifetime can be spent learning about a single disease,” says Dr Gilada, who is also the President of AIDS Society of India. “There is still plenty left to be explored, from prevention strategies to new innovations in treatment and management,” he adds.
Prevention of HIV and AIDS
According to Dr Gilada, there are three levels of prevention strategies across phases, starting from onset of the disease to clinical diagnosis of the condition.
Primary -> Avoid development of the disease and remove risk factors
Secondary -> Detect treatment early and prevent its progression
Tertiary -> Reduce complications of established disease
All three encompass effective management of HIV infection, enabled by the launch of test and treat strategy (2017), the HIV/AIDS Act (2017), and launch of viral load (VL) testing (2018). Although private firms have been running VLs since 1995, public sector intervention has been a long-pending demand.
“With these developments, the narrative on the management of HIV shifted from ‘prevention being the only treatment’ to ‘treatment as prevention’,” he says, adding, “However, we must not forget that for us to get to this stage, it took a substantial commitment of time and effort. From building awareness on sexually transmitted diseases, to scaling up efforts to distribute condoms, especially among sex workers through government and NGO interventions, has been a great learning experience for me too.”
Challenges in the treatment and management of HIV and AIDS
As per the latest HIV estimates report (2019) of the government, nearly 24 lakh Indians are living with HIV/AIDS (PLHIV). Over two decades before this report was published, Dr Gilada started the first private sector comprehensive HIV care center in India that led the way for patient-focused treatment in the country.
“By protecting the privacy of patients and their families, we were able to build the foundation on which people who sought treatment developed the confidence to approach us,” he says, adding, “Over the years, our focus remained on exploring newer trends in treatment, administering antiretroviral therapy (ART) early, examining new drugs, keenly monitoring patient response, and in the process, aiming to achieve patients’ normal life expectancy.”
However, several challenges remain. Procurement of critical drugs, upscaling of viral load facilities, high costs involved, lack of home testing, operational issues, and shortage of experts continue to hinder progress. In fact, as per Dr Gilada, India does not even have 100 full-time trained or qualified HIV physicians.
Another pressing issue is the stigma and discrimination against people living with HIV.
“Over 80% of people living with HIV surveyed had experienced some form of discrimination related to their condition over the last one year,” says Dr Gilada, adding, “They are often denied health insurance, jobs and even admission in hospitals. This should be countered with greater awareness campaigns and public education.”
Moreover, implementing the HIV/AIDs ACT 2017, outlining penal provisions for discriminators, and putting vicarious responsibility on management will also help change this scenario. According to the Act, retro antiviral therapy is a legal right of HIV/AIDS patients, and states that ‘every person in the care and custody of the state shall have right to HIV prevention, testing, treatment and counselling services.’ It also asks the central and state governments to provide such treatment along with infection management.
HIV and AIDS in India: The way forward
AIDS is the cause of death in only half the patients receiving treatment for HIV, and many succumb to serious non-AIDS-related comorbidities like cardiovascular or liver diseases.
“Vaccinations are not just for children. Adult vaccinations that are available today provide protection against 14 deadly diseases, including hepatitis-B, typhoid, whooping cough, mumps, influenza, measles, chickenpox and now COVID-19,” says Dr Gilada, adding “However, only 20% of HIV positive people have taken the COVID-19 vaccine. Thus, the first step is to encourage people to get fully vaccinated against these diseases.”
Today, HIV has become a chronic manageable infection, which demands a holistic and multi-pronged approach for prevention, management and treatment of the condition.
Join us every month as we partner with leading industry and doctor associations for our educational webinar series, Practo Connect. Watch this, as well as previous webinars, here.