Prevention is better than cure, and is cheaper too!

Shobha Shukla *

This is an old adage that signifies the importance of taking precautionary steps to prevent a problem from happening rather than fixing it after it occurs. It is a fundamental principle of healthcare to avoid/reduce occurrence of any disease.

Prevention is especially crucial to control the spread of infectious diseases, be they COVID-19, TB or HIV/AIDS. Unless we break the chain of transmission we will not be able to prevent new infections from occurring and we will not be able to #endTB or #endAIDS by 2030. This message was clearly brought out during the recently concluded 13th National Conference of AIDS Society of India (ASICON) under the theme of "Confronting pandemics with Proficiency, Precision and Persistence."

According to Dr Dilip Mathai, Dean and Professor of Medicine at Apollo Institute of Medical Sciences and Research, Hyderabad, “We have preventive measures, including vaccines, and yet we are failing on primary prevention to break the chain of transmission of many infectious diseases. We are even failing to roll out the existing 19 vaccines against a host of diseases in the elderly. Unless we increase the healthcare spend, we will not be able to improve the health of our people”.

In the case of HIV/AIDS, 1.5 million people globally, became newly infected with the human immunodeficiency virus (HIV) in 2020. 100,000 of these infections occurred in South East Asia, out of which 69220 (69%) were in India alone. With an estimated 2.35 million of its people infected with this virus, India bears the second-highest burden of people living with HIV in the world (after South Africa) and the highest burden of the disease in South East Asia.

Although India’s National AIDS Control Programme has made tremendous progress in bringing about a reduction of 66% in AIDS-related deaths and 37% reduction in yearly new infections as compared to 2010, we are still lagging behind in achieving the global UNAIDS 90-90-90 targets for 2020. With 190 new HIV infections occurring every day (or 8 new infections occurring every hour) in India, we do not seem to be doing very well in preventing the spread of the virus.

Preventive healthcare is a neglected aspect of our health systems, as compared to tertiary healthcare. There is more emphasis and more budget for tertiary care, but very less budget for primary care, lamented Dr Ishwar Gilada, President of AIDS Society of India (ASI) and member of the Governing Council of International AIDS Society (IAS), while interacting with the media at 13th ASICON.

He explained that the first phase of Indian government's national AIDS control programme, which was launched in 1992 for prevention and control of HIV/AIDS in India, focussed on awareness and education. In its second phase the programme broadened its scope and added blood safety and targeted interventions to its strategy. The third phase focused on treatment with the introduction of free anti-retroviral treatment (ART) in 2004. Next came the test and treat policy and introduction of viral load testing, as well as reducing stigma through the HIV/AIDS Act 2017 that prohibits discrimination or unfair treatment of HIV-infected people.

However, during the last decade or so, the tempo of the awareness campaigns has dwindled and prevention activities have taken a back seat. “Children who were around 10 years old in 2005-2010 have become adults now, but unlike their predecessors, they have not seen or heard of any major primary HIV prevention campaigns. These young adults are the risk takers which is evident from the fact that currently most of the new infections are in the age group of 18-30 years.

Our prevention campaigns are poor, targeted interventions have almost nullified, and HIV control programmes for sex workers programmes are not working well, more so due to the changing face of sex work and the arrival of dating Apps. Some of the youth are using pre-exposure prophylaxis (PrEP), but they do not know that it can prevent only HIV and not other sexually transmitted infections. So we are also seeing an emergence of herpes, venereal warts and syphilis”, said Dr Gilada.

Dr Gilada rightly points out that when a disease has a high death rate, it attracts more attention. As soon as we start overcoming the problem, people’s efforts to sustain its control diminish. This has happened with HIV/AIDS also. When HIV/AIDS was akin to a death sentence, people were ready to take all precautions and make all out efforts to prevent it.

However, thanks to the untiring efforts of our scientists and researchers, today people living with HIV on treatment can lead a near normal life, reduce their viral load to undetectable levels within 3 months of treatment and become non-infectious, and they can give birth to HIV negative kids. As it is no longer a dreaded disease, it seems to have resulted in a "could not care-less" attitude, with the focus shifting from prevention to treatment.

And as Dr Marjolein Jacobs of UNAIDS said, while we have worked a lot on diagnosis, treatment and care of people living with HIV, and made good progress in these areas, we need to give much more importance to prevention if we have to deliver on the goal of ending HIV/AIDS by 2030.

While scientists charter newer territories for improved diagnostics and treatments of diseases, we cannot slacken our efforts to roll out primary prevention interventions, including safe sex practices and immunisations against vaccine preventable diseases, to safeguard human health.