World AIDS Day is a day treated like an opportunity for people worldwide to unite in their fight against HIV, show their support for people living with HIV and to commemorate people who have died out of HIV. This year’s theme – “Ending the HIV/AIDS Epidemic: Resilience and Impact” prime’s focus is to create global solidarity and provide resilient services. With every effort put forward to raise awareness and to unite people worldwide in the fight against the global health issue of acquired immune deficiency syndrome, it has become significant to also fight the stigma around it and focus on providing care and support for those who are already living with the disease.
The global HIV epidemic is not over and maybe accelerating during the COVID-19 pandemic, with a devastating impact on communities and countries (Hindustan Times, 2020). In 2019, there were still 38 million people living with HIV infection. One in five people living with HIV were not aware of their infection and one in 3 people receiving HIV treatment-experienced disruption to the supply of HIV treatments, testing and prevention services, especially children and adolescents. In 2019, 690 000 people died from HIV-related causes and 1.7 million people were newly infected, with nearly two in three (62 per cent) of these new infections occurring among key populations and their partners (World Health Organisation, 2020).
Back home in our North Eastern (NE) states, even though the population is less in comparison to other Indian states, however, there are some 100,000 people, who live with HIV and AIDS in all the eight States. In September this year, a joint New Delhi-based UN team travelled to NE, India, for a programme where the United Nations has engaged with the National Aids Control Organization (NACO) in an HIV and AIDS prevention and care programme, and found that Adult HIV and AIDS prevalence rates in Manipur and Nagaland are 1.57 and 1.2 per cent respectively and well above the national average of 0.34 per cent according to the Department of AIDS Control, Ministry of Health and Family Welfare, Government of India (Albertin, 2020).
For the so-called high-risk groups, numbers are alarming: in Manipur 19.8 per cent of injecting drug users are HIV positive as well as 10.4 per cent of men having sex with men. In Nagaland, 16.4 per cent of female sex workers are living with HIV and AIDS, all numbers well above the national average. Although HIV prevalence has been decreasing since 2002 at the national level, this has not translated into a similar decrease in the northeast. Whereas interventions for injecting drug users have shown impact, prevalence rates remain high above the national average of 6.9 per cent, meaning that much more needs to be done (United Nations Office on Drugs and Crime).
One of the causes for the rise in the epidemic is drugs and this is rampant among both men and women. Mizoram for instance witnessed sharing a common syringe by injecting drugs as one of the key reasons for the increasing rate. Such addictions occurred due to various personal reasons and not necessarily because of peer influence. In Meghalaya, the need to have a Policy on Drug Abuse Prevention in the State has become a necessity to ensure general public interest and also has become a compelling State Interest as drug-abuse is not only adversely affecting the general public but also the State and the lives of the future generation is at stake. The policy is elaborative and included key areas that need attention such as prevention, treatment, aftercare, capacity building and training and study and research.
The report by National AIDS Control Organisation (NACO) shows that the AIDS-related mortality per 1, 00,000 population in India was estimated to be the highest in Manipur (36.86), followed by Mizoram (28.34), Nagaland (26.20), Andhra Pradesh (21.76), Pondicherry (15.33), Meghalaya (11.08) and Telangana (10.79). The challenges have multiplied with the Covid-19 pandemic as evidence has emerged globally that HIV-infected people are more at Covid-19 death risk as compared to HIV-negative. This is as per the statement by Union Ministry of Health and Family Welfare`s Joint Secretary, Alok Saxena. The scenario has worsened with the trend of Intravenous Drug Users (IDU) picking up among the youth between 15 and 20 years in several north-eastern states, especially in Tripura, Mizoram, Manipur and Nagaland which is rising at an alarming rate.
The above data calls for multiple awareness programmes that need to cater to all sections of society. A finding by Avert – a UK-based charity listed the populations in India which require constant awareness and briefing on HIV/AIDS. These include commercial sex workers, men who have sex with men (MSM), People who inject drugs (PWID), hijras/transgender people, migrant workers and truck drivers. Since the infection is entirely preventable through awareness-raising, therefore, awareness-raising about its occurrence and spread is very significant in protecting the people from the epidemic. It is for this reason that the National AIDS Control Programme lays maximum emphasis on the widespread reach of information, education and communication on HIV/AIDS prevention. Changing knowledge, attitudes and behaviour as a prevention strategy of HIV/AIDS is doable and for this, the efforts need to roll to ensure maximum reach to all through mass media campaigns.
Increasing awareness among the general population and key affected populations about HIV prevention is a central focus of NACO. In the past, we have witnessed a lot of mass media campaigns initiated by NACO to reach the people in the villages and other interiors. They have used Doordarshan, cable and satellite channels, radio (FM), online and at cinema halls too. It has also broadcast phone-in and panel discussions on issues relating to HIV on regional radio networks and got folk troupes to perform in remote villages to reach people in places with no television or radio. When it comes to sex education in schools, Comprehensive Sexuality Education (CSE) through India’s Adolescent Education Programme initiated in 2018 – 2019, is available for students aged between 13 and 18. In line with this, the efforts of Red Ribbon Clubs operating in Indian schools and universities and doing their rounds of tightening similar awareness programmes has served to reduce HIV-related stigma.
Over the past decade, India has made significant progress in tackling its HIV epidemic, especially in comparison with other countries in the region. A major reason for this success is the sustained commitment of the Indian Government through its National AIDS Control Programme, which has been particularly effective at targeting high-risk groups. While ART is free and uptake, helped by the adoption of ‘test and treat’, is rising many people living with HIV still have difficulty accessing services, meaning the rapid pace at which coverage is being scaled up must continue. However, stigma and discrimination remain significant barriers preventing key affected populations and those at high risk of HIV transmission from accessing treatment and vital healthcare services.
There is also a need to strengthen the link between testing and treatments to ensure those with a diagnosis are able to access care. Equally important is a better understanding of the transmission dynamics between States caused by migration, which is increasingly being recognised as a key driver of new HIV infections in India. Improving data collection and analysis is crucial to identify these pockets of new infections and understanding patterns of vulnerability, making this field crucial to the success of India’s HIV response (Avert, 2020). Beyond and above what was mentioned, people living with HIV continue to experience high levels of discrimination. There is a high discriminatory attitude towards people living with HIV. This is a similar level recorded a decade earlier; suggesting current stigma-reduction activities are not working. Stigma and discrimination are very common within the healthcare sector.
A 2013 study of doctors, nurses and ward staff in government and non-government clinics in Mumbai and Bengaluru found discriminatory attitudes were common. This included a willingness to prohibit women living with HIV from having children, endorsement of mandatory testing for female sex workers and surgery patients, and stating that people who acquired HIV through sex or drugs ‘got what they deserved’. Several studies in India have shown that experiences or fear of being stigmatised are significantly associated with a delay in seeking care, with people particularly worried about having their positive status disclosed to others without their consent. (The writer can be reached at [email protected])