The ‘ART’ of managing HIV

HIV is one of the greatest public health challenges the world is facing today. However, the response mankind mounted against this epidemic is historic. There is no other disease in the history which provoked such a comprehensive, prompt and effective response within a short span of time.

When HIV first struck in the world, the virtual absence of any hope regarding possible treatment or vaccine led to widespread scare, stigma and discrimination against the infected. The only measure we could take was spreading preventive messages.

But by 1996, we had an effective drug therapy which could bring back the lost immunity by suppressing the virus in the human body. From a death sentence, it changed to a chronic manageable disease. India started its Antiretroviral Programme with just eight ART centres in high prevalence States and the national capital in 2004 which grew to 224 full-fledged ART centres providing regular ART to more than 2,70,000 individuals today. It is worth mentioning that Kerala has achieved a unique distinction for starting its own ART programme in 2004 by providing free ART through all Government Medical Colleges which has been merged with the national programme now. Currently, the State has six ART centres and eight Link Art Centres. 4,018 People Living with HIV (PLHIV) are taking ART drugs from our centres, which are branded as Ushus Centres, for awareness purposes. 11,024 PLHIVs have registered themselves at the Ushus Centres for whom regular check-ups are provided. The availability of ART through the public healthcare system has changed the way world looked at HIV. It gradually became a chronic manageable disease. The mortality rate of HIV has suddenly reduced.

Earlier, the drug regime was complicated. Now it has been simplified, which helps the treatment adherence. Management of opportunistic infections for PLHIVs have helped them to gather confidence for a positive living. All these have increased the quality of living of PLHIVs. This led to large number of people who are at the risk of having this infection to come openly seeking HIV tests.

HIV is a developmental issue and several studies so far from various parts of the world have showed that HIV care has a role in the macro and micro economy of the society. For example, a study at the Thrissur Medical College showed that 74 percent of PLHIVs taking ART are employed at 10 months of ART and many of them got employed for the first time after the initiation of ART.

It is also possible that ART can reduce the transmission significantly, as the virus circulating in the blood reduces to undetectable level in few months of regular treatment. Also, ART can reduce the chance of a person - a healthcare provider getting infected during a surgery or a child getting infected from the mother. Proper care during pregnancy can reduce the transmission rate from mother to child to less than 2 percent from 30-40 percent without care. Even though we have many success stories, it is not the time to be complacent.

The recently published AIDS epidemic update by UNAIDS and WHO shows that even though there is a significant fall in new infections worldwide since 2006, the epidemic is still evolving and even the factors affecting the spread is not uniform.

Stigma and discrimination continue to be a big stumbling block in providing quality care and support services. Human rights violations in the name of HIV is also continuing. Hence, this World AIDS Day is the time for us to renew our pledge and promises we have made to the present and future generations.