We can #endAIDS now if undetectable equals untransmittable becomes a reality for all persons living with HIV

Shobha Shukla *

13th National Conference of AIDS Society of India (13th ASICON) in Hyderabad

If every person living with HIV is aware of the positive status, is receiving lifesaving antiretroviral therapy, and remains virally suppressed, then not only virus is undetectable but also untransmittable (U Equals U). Not only this will ensure optimal quality of life for every person living with HIV but also will help translate the promise of our governments to end AIDS by 2030. We can end AIDS now, said Dr Jyoti Dhar, senior HIV expert from UK, who was speaking at the opening of 13th National Conference of AIDS Society of India (13th ASICON) in Hyderabad.

The promise to #endAIDS by 2030 is enshrined in the Government of India's National Health Policy 2017 as well as United Nations Sustainable Development Goals. Ending AIDS is also a human rights imperative. We have the tools to diagnose everyone living with HIV, we have the tools to provide lifesaving antiretroviral therapy, as well as we can monitor viral load and help ensure viral load suppression to make "undetectable equals untransmittable" a reality for everyone. No excuse not to do that, said Dr Ishwar Gilada, President of 13th ASICON, and national President of ASI who is also on the Governing Council of International AIDS Society (IAS).

The 13th ASICON is being held on the theme of “Confronting Pandemics with Proficiency, Precision and Persistence”, in academic partnership with India’s National AIDS Control Organization (NACO), National TB Elimination Programme (NTEP), World Health Organisation (WHO), United Nations joint programme on HIV/AIDS (UNAIDS), International Union Against Tuberculosis and Lung Disease (The Union), Centre for the AIDS Programme of Research in South Africa (CAPRISA) and Society for Health, Allied Research and Education (SHARE), said Dr Naval Chandra, Scientific Co-Chair of the conference, and senior HIV expert from Nizam Institute of Medical Sciences in Hyderabad.

As per NACO Sankalak Report 2020 there are an estimated 2.35 million (23.49 lakh) people living with HIV (PLHIV) in India and nearly three in four (around 76%) of them know their HIV status, and among these 84% (1.49 million or 14.86 lakh) are on anti retroviral treatment (ART). This includes around 1.4 million (13.8 lakh) PLHIV availing free lifelong ARTs from 553 ART centres under the national AIDS control programme. Also, among those on treatment whose viral load is measured, 84% were virally suppressed.

Annual new HIV infections in India have declined by 37% between 2010 and 2019 in comparison to the global average of 23%. Similarly, during the same period, AIDS-related deaths have declined in the country by almost 66% in comparison to the global average of 39% decline, said ASICON expert while speaking to CNS (Citizen News Service). The decline is even higher than this national average in the states of Andhra Pradesh, Maharashtra, Karnataka, Telangana, Tamil Nadu, and West Bengal and very noticeable among women and children with 73.7% and 65.3% respectively.

However, despite progress, challenges continue to confront us to realise the goal of ending AIDS by 2030. While overall overall HIV prevalence rate in adults is 0.22, three Indian states showed very high HIV prevalence in adult population in 2019: Mizoram (2.32%), Nagaland (1.45%), and Manipur (1.18%).

HIV prevalence among most- at- risk populations is also very high: almost 28 times higher in people who use drugs; 6 to 13 times higher among Hijra/Transgender people, men who have sex with men and female sex workers; and 9 times higher among inmates in central jails (where the population with high-risk behaviour is over-represented) as compared to the national adult prevalence rate. More than 69,000 people were newly infected with HIV in 2019 - more than twice the envisaged 2020 milestone.

This AIDS congress is featuring national and global leaders to deliberate on issues confronting us in the fight against AIDS and HIV-associated co-morbidities and co-infections, including Hepatitis B and hepatitis C, tuberculosis, COVID-19 and other emerging infectious diseases as well.

Conference highlights include scientific sessions with latest research updates on HIV (and HIV-COVID-19) epidemiology, virology, immunology, pathogenesis, strategy for early HIV diagnosis and progress update on 2020 goal of 90:90:90 and future goal of 95:95:95, test and treat strategy, Pre-Exposure Prophylaxis (PrEP), Post Exposure Prophylaxis (PEP), HIV in women, new-born, children and adolescents, HIV and HIV-TB drug resistance, combination prevention, research updates on HIV prevention technologies such as vaccines, HIV treatment science, non-AIDS defining diseases, HIV-TB, HIV-hepatitis, HIV and sexually transmitted diseases (STDs), HIV and cancers, HIV and COVID-19 including post-COVID/ long COVID, TB and COVID-19, COVID-19 vaccines and other emerging infectious diseases, among others.

COVID-19 pandemic has exposed not only the fault-lines of inequitable health responses but also the fragility of health systems in the wake of humanitarian crises or emergency situations.

The conference organisers have called for stronger and well-coordinated integrated health responses to end AIDS, TB, COVID-19 and other infectious and non-communicable diseases, and social determinants of health, said Dr Dilip Mathai, Co-Chair of 13th ASICON and Dean of Apollo Institute of Medical Sciences and Research.

"ASICON is the annual national AIDS conference of the AIDS Society of India. Since the pandemic this is the first in-person ASICON conference. 13th ASICON is a three-days meeting where various aspects of HIV and related opportunistic infections and various therapies for the management of HIV infections and COVID-19, and COVID-19 related complications, newer therapies for COVID-19 will be discussed by various experts from India and abroad" said Dr N Kumarasamy, Scientific Co-Chair 13th ASICON and Director, Infectious Diseases Medical Centre, Voluntary Health Services, Chennai.

"The conference will focus on many thematic areas including the impact of the COVID-19 pandemic on the HIV pandemic and lessons learnt from that for future reference" said Dr Glory Alexander, co-Chair of 13th ASICON.

Dr Vijay Yeldandi, scientific co-chair of 13th ASICON and head of SHARE India, said "Once again AIDS Society of India has put together a stellar program of particular relevance in the time of the COVID-19 pandemic to address all significant developments in HIV policy as well as newer scientific advances to improve the practice of clinical care for people living with HIV we are making steady progress towards eliminating HIV as a public health threat."

13th ASICON presents an important opportunity to learn lessons on what went well and what could have gone better in the past two years of controlling COVID-19, HIV and TB during the pandemic year, and also better understand the similarities of epidemic and endemic diseases and their geographic predisposition. With less than 106 months left to end AIDS (and 46 months left to end TB) in India, it is high time to join forces to accelerate progress towards honouring these public health promises as envisaged in the sustainable development goals.