2020 — a year of reckoning for response to AIDS

This year’s World AIDS Day comes with a message “Ending AIDS Epidemic – Community by Community”. While the emphasis on communities is a timely one, the goal of ending AIDS epidemic looks more aspirational than achievable at this stage.

The Sustainable Development Goal (SDG) 3.3 optimistically declares that AIDS should end as a public health threat by 2030. To achieve this, certain intermediate goals were set for 2020, a year of review and stocktaking for countries around the world to sit back and evaluate their performance in the last 10 years. And the scenario does not look all that promising. In fact, it looks pretty depressing.

In Asia and the Pacific, a region with 60 per cent of world population, the data indicates that most of the countries will be missing on all the intermediate targets.

We can look at three important outcomes of AIDS response, the number of people who are covered under Anti-Retroviral Treatment (ART), reduction in the number of new infections generally known as incidence and elimination of Mother to Child Transmission (EMTCT) of HIV to assess their performance.

The number of people on ART should be scaled up to 4.2 million and above to achieve the 2020 goal. In 2018, only 3.2 million were actually covered under the programme. Bulk of this number comes from India and Thailand. In elimination of MTCT, the performance is much below par. Only three countries in the region, Thailand, Maldives and Malaysia, could declare elimination as certified by WHO. Large countries like China, India and Indonesia are still not near to achieving the elimination levels.

Low priority

But the biggest setback is in reduction of new infections, the key to ending AIDS as a public health threat. Between 2010 and 2018, the annual incidence level has come down by only 30,000. To reach the goal of 2020 the new infections should be fewer than 90,000 but the actual number stands at little more than 3,00,000! India alone recorded 88,000 new infections in 2017 and that number will not reduce significantly by 2020.

The National AIDS Control Organisation (NACO), in its estimation report of 2017, agreed that “between 2010 and 2017, new HIV infections have declined by only 27 per cent. The target is to achieve 75 per cent reduction in new infections by 2020, from the baseline value of 2010”. This overall disappointing performance points out to only one fact. Control of HIV epidemic has been relegated to a low priority in this region. Commitment of political leadership, provision of resources and, above all the community activism, which was the main driving force behind these efforts until 2010, have all just dissipated.

On the positive side, there is good news on the resource front with the Global Fund for AIDS TB and Malaria (GFATM) getting a commitment for $14 billion in their resource mobilisation exercise. A significant part of this resource should flow into this region for prevention of new infections among key populations who account for more than half of that number. And new technologies like Pre Exposure Prophylaxis (PrEP,) effective in cutting down new infections in countries like Australia, should be introduced in scale as a part of prevention package. Funding for key population interventions should be revived, which are core to the prevention package.

Countries should try to bring convergence of PMTCT and ART programmes with general health systems under the Universal Health Coverage agenda to maximise the coverage and reach of the programmes. Domestic health budgets should progressively earmark funds for ART and PMTCT implementation. This will release much needed funding from external sources for prevention programmes. The joint UN programme on AIDS (UNAIDS) should play a leading advocacy role under its new leader, a woman who can reinvigorate the organisation and make it a fighting fit unit once again. The World AIDS Day 2019 should serve as a wake-up call to leadership at all levels not just in Asia Pacific, but globally, that the fight against the pandemic will be lost if the present trend is not reversed soon.

The writer is a former Health Secretary, Government of India. Views expressed are personal