Acquired Immune Deficiency
syndrome (AIDS), caused by the
Human Immunodeficiency Virus
(HIV), is a disease that
affects the human immune system. In due course of the infection, the virus interferes more and
more with the immune system, making the person much more susceptible to common diseases like tuberculosis, as well as opportunistic infections and
tumors which could result in
death of the patient.
HIV is transmitted primarily through unprotected sexual intercourse, contaminated, blood transfusions, hypodermic needles and from mother to child during
pregnancy, delivery or breastfeeding.
HIV/AIDS is a global pandemic. In India, the prevalence of AIDS has reduced down
to 0.3 percent, which means an estimated 2.1 million people are infected. Less
than 25% of HIV positive individuals receive
Anti-Retroviral Therapy (ART) due to frequent
drug shortage. There is little access to HIV testing and often a scarcity of
testing kits at counseling and testing centers. However, one of the most significant
challenges India faces is the stigma attached to HIV/AIDS patients, where they
are ostracized from the society.
AIDS Healthcare Foundation (AHF) is a Los
Angeles based nonprofit organization, which provides cutting-edge medicine and
advocacy to over 350,000 HIV patients in 36 countries. They are the largest
provider of HIV/AIDS medical care in the U.S.A with the mission to rid the
world of HIV/AIDS. They began their work in India in 2004 and have since become
a pre-eminent AIDS organization. In 2006, AHF India Cares became the first to
offer free ART for those who had developed resistance to certain medications,
by establishing the Centre of Excellence ART clinic in New Delhi. Dr. Nochiketa
Mohanty is the Country Program Manager for AHF India Cares. Dr. Mohanty holds a
degree in MBBS from Sambalpur University and MPH as well as an MBA degree from
the University of Alabama, Birmingham, USA. He has been a key asset to AHF
India through his academic experience and understanding of public health,
business administration and community medicine and represents the organization
internationally.
Medindia interviewed Dr. Mohanty, who shared a
few insights from the workings of AHF India, the pertinent issues the
organization faces and the extent of success of the many ambitious AHF
programs.
Excerpts from the interview:
- Was there a hype and
creation of a 'fear factor' about HIV/AIDS in the early
years?
There
was no hype. Before treatment became available, people were dying of AIDS
because of the
stigma and fear of the then-unknown deadly
disease that was untreatable. AIDS is no longer a death sentence, but millions
of people still die every year because of AIDS-related causes. The epidemic and
the global crises that it represents are certainly not over, though there is
still a pervasive and dangerous sense of complacency as if it’s
behind us.
- Which country currently
has the maximum burden of HIV/AIDS?
South
Africa has 6 million people living with HIV/AIDS, the most in any country.
- What are the challenges
your NGO faces in the field - especially in the lesser-developed countries?
Bureaucracy,
corruption, outdated policies, lack of political and
financial commitment by governments, discriminatory laws towards people living
with HIV/AIDS and high risk groups also homophobia, stigma,
poorly developed infrastructure and the lack of healthcare
workers.
- Please tell us more
about the 20X20 initiative.
20×20 is a global campaign to
up-scale access to Anti-Retroviral Therapy (ART) for at least 20 million
people by the year
2020. Currently only 12 million people out of 35 million are on ART, which is
far too low. Millions of people still die of AIDS-related causes every year
because they cannot get the medicine they need.
Investing in up scaling of
treatment will yield humanitarian and economic benefits that far outweigh the initial
costs. This is the chief aim of 20×20, which would spark a renewed vision. The
present global mindset and interpretation that the AIDS response is a burden
should be changed, as it is a smart long-term investment that will pave the way
to ending AIDS, boosting economic growth and saving millions of lives, which is
possible with the campaign.
- Would you want to
comment on the role of Indian Pharma companies in supplying cheaper ART to the
world?
India
has been called the pharmacy of the world for its vital role in supplying
affordable medicines to the developing world. The country’s generic
pharmaceutical industry was responsible for a 10-fold decrease in the price of
antiretroviral therapy in the 1990s, which made life-saving treatment
accessible to millions of people living with HIV/AIDS across the developing
world.But, now this progressive position is increasingly under attack as a
result of continued pressure on intellectual property enforcement from the US
and the EU. A stronger stand needs to be taken by the government keeping the
interest of the public in view so that flexibilities existing in the current
Intellectual Property Laws are not affected.
- It was a great
initiative by AHF to take up the issue of cancellation of government price caps
on expensive medicines for HIV. Can you please tell us how far it has
succeeded?
Our first goal was to start the
conversation and get public attention — judging by the overwhelming
response, we’ve succeeded to a certain extent, but the issue is far from
being resolved and we’ll keep pressurizing the government until the caps are
restored.
The update on this issue is that
NPPA (National Pharmaceutical
Pricing Authority) has drafted a new list including those non-listed
medicines in the NLEM
(National List of Essential Medicines). The acceptance of this
draft will definitely bring relief to many who are unable to afford these
medicines and will definitely be an accomplishment for the NPPA and dawn a new
day in the drug pricing standards of essential medicines.
- What kind of policy
changes do you think should be brought in to address the pertinent issues
involving AIDS?
Testing policies must be
streamlined and brought in line with the modern best practices, such as the use
of two rapid tests to establish a diagnosis instead of using blood draw and
slow lab tests that take up to a week for results. Testing must be scaled
up across India in a major way. The treatment initiation threshold should
be brought in line with the WHO recommendations, so that people can start
treatment sooner when their CD4
count is 500, instead of the current 350. India must maintain a strong
stance on prioritizing access to essential medicines over granting patents to
pharmaceutical companies. Condoms should be widely promoted and
freely distributed as the most cost effective way to prevent new
infections.
- It is a known fact that
not all people have access to the HIV medicines especially the LGBT community,
commercial sex workers and injected drug users. How has AHF helped in such
cases?
While technically, the Government
ART centres provide free access to all including the LGBT, Commercial sex
worker and IDU communities, it needs to be understood that there is a stigma
associated with these communities. Sometimes, the community members face
discrimination in the hospitals from the OCTC/ART personnel due to the stigma
associated with their gender/ profession/ risk behavior and sometimes from the ambience even if it may not
actually exist. Also, there is a felt loss of confidentiality in the Government
centres due to crowded attendance. This factor affects the LGBT and Commercial
Sex workers more as their livelihood is dependent on confidentiality, i.e., if
a community member is aware of their HIV status, they may lose their livelihood
as the word may go out and they may be ostracized.
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While the AHF Testing vans and partner sites provide
an alternate avenue for
HIV
testing for these
communities, AHF clinics in New Delhi and Mumbai provide the ambience and
confidentiality sought by these communities. As a part of our MOONLIGHT project
(Mainstreaming Out of Network Lesbian Intersex Gay Hijra and Transgender), the AHF New Delhi clinic
and Testing facilities are also accessible in the late evening hours till 10 PM
from Monday to Saturday, which enhances the accessibility of testing and
treatment services for these communities who tend to be more available during
after-hours slots.
