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HIV/AIDS: The pandemic we are missing

top view of red aids ribbon, isolated on dark red. Image credit: lightfieldstudios / 123rf
Progress has been made against HIV/AIDS. COVID-19 threatens to undo that progress. Image credit: lightfieldstudios / 123rf

Today marks World AIDS Day. As of the end of 2019, HIV/AIDS has claimed 32.7 million lives. In India, 2017 alone saw 69,000 deaths due to HIV/AIDS. 

The organisation dedicated to combating HIV/AIDS is UNAIDS or, to give it its full title, the Joint United Nations Programme on HIV and AIDS. UNAIDS’s mission assumes heightened importance during the COVID-19 pandemic, given the constrictions of the pandemic upon public health programmes that tackle all diseases and the diversion of attention to the novel coronavirus outbreak.

Earlier this year, UNAIDS warned that the world is falling behind on combating HIV/AIDS. It did add, however, that the COVID-19 pandemic was not the sole reason for this.

“All global targets for 2020 will be missed,” the report warned at the time. That report came four years after a large-scale consensus was achieved at the United Nations of the need to scale up “HIV services alongside rights-affirming and enabling environments for those services.”

As Health Issues India reported contemporaneously, “this is not to take away from the progress we’ve made. Increased access to antiretroviral therapy (ART), for example, is estimated to have averted 12.1 million AIDS-related deaths since 2010. Yet, on the downside, the report observes that the 39 percent reduction in AIDS-related mortality since 2010 still translates to “far too many people dying unnecessarily.”

Nonetheless, we are missing the mark. As such, last week, UNAIDS unveiled a report which “[called] on countries to make far greater investments in global pandemic responses and adopt a new set of bold, ambitious but achievable HIV targets. If those targets are met, the world will be back on track to ending AIDS as a public health threat by 2030.

UNAIDS goes on to note that “modelling of the pandemic’s long-term impact on the HIV response shows that there could be an estimated 123,000 to 293,000 additional new HIV infections and 69,000 to 148,000 additional AIDS-related deaths between 2020 and 2022.” 

College students taking part in a HIV/AIDS awareness campaign in Chandigarh.

In 2019, according to UNAIDS, the world witnessed 1.7 new infections with HIV, or the human immunodeficiency virus (HIV). In 2019, 38 million people were living with HIV. Tragically, 2019 saw 690,000 people die due to AIDS-related illness.

In India, the HIV/AIDS crisis is a pronounced one. The country’s HIV/AIDS epidemic is the world’s third-largest. Countering it is a public health priority. Indeed, the Union Ministry of Health and Family Welfare has unveiled ambitious targets to rid the country of the scourge of HIV/AIDS in recent years. To this end, advances have been made.

“Three major policy changes have been achieved,” Dr Bilali Camara, UNAIDS Country Director for India, told me in a phone interview earlier this year. “The first was changing to provide ART [antiretroviral therapy] e.g. every three months instead of every month (Multi-months dispensing of drugs (MMD). 

“The second was mobilising communities (Community-Based Dispensing of drugs (CBD) to provide antiretroviral drugs so, instead of going to health facilities, people could get the drugs they need from those who came together – in Gujarat, Delhi, Karnataka, Tamil Nadu, Uttar Pradesh Maharashtra etc.. 

“The third was to adapt so people continue their Opioid Substitution Therapy by introducing a policy to allow take home doses of OST. “Another key point has been engaging with key populations – using targeted interventions to provide testing, contraceptives, addressing comorbidities, which have remained open despite the lockdown. Using these mitigating factors has been a success. 

“These are important strategies and they are working.” 

An AIDS clinic located in Himachal Pradesh. Concerns over access to HIV treatment are abundant during the COVID-19 crisis. Image credit: John Hill / CC BY-SA (

Building on such progress is essential, especially during COVID-19. UNAIDS warns “insufficient investment and action on HIV and other pandemics left the world exposed to COVID-19. Had health systems and social safety nets been even stronger, the world would have been better positioned to slow the spread of COVID-19 and withstand its impact. COVID-19 has shown that investments in health save lives but also provide a foundation for strong economies. Health and HIV programmes must be fully funded, both in times of plenty and in times of economic crisis.”

This sentiment is apposite. More than twelve million people lack access to HIV treatment globally. This must be rectified – in India and everywhere. The strides the country has made do not allow for complacency. It ought to serve as a call to action. This World AIDS Day – a time when so many suffer so much – we must work towards countering the dual pandemic of COVID-19 and HIV/AIDS. Expanding treatment for HIV/AIDS and access to a COVID-19 vaccine once proven safe are dual needs of the hour. 

Patients, UNAIDS emphasise, must be at the centre of the dialogue. “Ending AIDS means closing gaps and ensuring that no one is left behind,” Winnie Byanyima, UNAIDS’s executive director writes in the foreword of her report. “The HIV response is fundamentally about inequality—to end AIDS, we must end inequality. If over the next five years we meet these new targets, end inequalities in HIV treatment and HIV prevention and reduce the stigma and discrimination that holds back the HIV response, the world will be well on its way to ending AIDS by 2030.” 

Similarly, “we are making sure that the needs of people with HIV/AIDS and key populations continue to be met,” said Dr Camara in our interview earlier this year, referencing the COVID-19 pandemic. “The work is ongoing and the process has changed, but we are continually working and it is working very, very well. We have not reduced the intensity of our efforts or the intensity of our programmes. We have just come up with new ways to address HIV/AIDS in India.”

“Prevailing against pandemics by putting people at the centre” can be accessed here.

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