The ART of India’s HIV/AIDS response

Subject: Science and tech

Section: Health

Context:

April 1 commemorates the 20th anniversary of the launch of Free Anti-retroviral Therapy (ART) for Persons living with HIV (PLHIV) by the Indian government, a pivotal step in the nation’s HIV/AIDS response.

Details:

Initially, HIV/AIDS was seen as a death sentence following its emergence in the early 1980s, surrounded by significant fear, stigma, and discrimination.
The first antiretroviral drug, AZT (zidovudine), was approved in March 1987 by the US FDA, followed by the approval of three more drugs in 1988 and the introduction of protease inhibitors in 1995.
Despite these advancements, access to these life-saving treatments was mostly restricted to high-income countries.

The evolution of free ART:

Antiretroviral therapy (ART) is the treatment of people infected with human immunodeficiency virus (HIV) using anti-HIV drugs. The standard treatment consists of a combination of drugs (often called “highly active antiretroviral therapy” or HAART) that suppress HIV replication.
The commitment to combat HIV was solidified in 2000 at the UN General Assembly’s Millennium Summit, leading to the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002, which advocated for universal access to HIV services.
In 2004, India had an estimated 5.1 million People Living with HIV (PLHIV), with a population prevalence of 0.4%, and very few were receiving antiretroviral therapy (ART).
The introduction of free ART for adults in India was a crucial step, expanded to include children from November 2006.
By 2023, HIV prevalence in India dropped to 0.20%, with the number of PLHIV reduced to 2.4 million, decreasing India’s global share of PLHIV to 6.3%.
By the end of 2023, 82% of PLHIV in India knew their status, 72% were on ART, and 68% had achieved viral suppression.
The annual new HIV infections declined by 48%, and AIDS-related deaths decreased by 82%, surpassing global averages and marking significant public health achievements.

Patient-centric approach to services:

The success in combating HIV in India is not solely due to free ART; it also involves comprehensive initiatives including free diagnostic services, prevention of mother-to-child transmission (PMTCT), and managing opportunistic infections and co-infections like TB.
The ART program has evolved to be more inclusive and patient-centric, moving from strict CD4 count eligibility criteria to a “Treat All” policy in 2017, allowing anyone diagnosed with HIV to start treatment regardless of CD4 count.
Rapid ART initiation policies were adopted in 2021, enabling treatment to start within seven days of diagnosis, sometimes on the same day.

95-95-95 target of UNAIDS:

The fifth phase of India’s National AIDS Control Programme (NACP) aims by 2025 to significantly reduce new HIV infections and AIDS-related deaths, eliminate vertical transmission of HIV and syphilis, and achieve the 95-95-95 targets set by UNAIDS: 95% of PLHIV knowing their status, 95% of those diagnosed on ART, and 95% of those on ART achieving viral suppression.