Fighting AIDS during pandemic

The India HIV Estimation, 2019 report has much to cheer about the decline in new infection in the country, but for the northeast region, the devil is in the details. The report published in July this year shows that there were an estimated 69,220 thousand new infections in 2019 in the country even though it has declined by 37% since 2010 and by 86% since attaining the peak in 1997. The prevailing COVID-19 pandemic situation coupled with rise in incidents of injectable drug abuse have brought new challenges for North-eastern states to fight the global epidemic and the Acquired Immunodeficiency Syndrome (AIDS) Control programme in the region. If left untreated, HIV infection can lead to the AIDS-related illness. In 2019, there were an estimated 23.49 lakh People Living with HIV (PLHIV) in the country. They include 79,000 Children Living with HIV(CLHIV). About 9.94 lakh women living with HIV constitute 44% of the PLHIV aged 15 years and above. An estimated 58,960 people died from AIDS -related illnesses last year.

Globally, 38 million are living with HIV, 1.7 million became newly infected while 6,90,000 died in AID-related illnesses in 2019. Observance of the World AIDS Day has become more significant in the region to express solidarity with people living with HIV and fight the epidemic as COVID-19 pandemic has disrupted various intervention programmes including access to treatment. The 2019 estimation shows that three States of the region- Mizoram, Manipur, and Nagaland are among the states with the highest adult HIV prevalence. What is alarming for the region is these three states are also the three top states in the country with the highest AIDS-related mortality per one lakh population. Manipur tops the list with 36.86 mortality per one lakh population, followed by Mizoram (28.34), Nagaland (26.20), Andhra Pradesh (21.76), Puducherry (15.33), Meghalaya (11.08), and Telangana (10.79) against the national average of 4.43. This calls for backing the awareness drive with better access to Anti-retroviral treatment (ART) centres and ensuring availability of ART medicines in sufficient quantities in these states in particular and in the region as a whole.

The report states that "Tripura, Arunachal Pradesh, Chhattisgarh, West Bengal, Mizoram and Nagaland face a major challenge of preventing new HIV infections, where it has continued to rise/remain stable between 2010 and 2019." The States in the region must take note of these estimation seriously to evolve effective strategy to prevent new infection. The report describes the status of HIV/AIDS epidemic in the region to be "indeed alarming" and reveals that except for Manipur, the HIV prevalence in these States has shown a stable to rising trend due to a relatively higher number of annual new HIV infections. Annual new HIV infections have, in fact, increased in Arunachal Pradesh and Tripura while being almost stable in Mizoram and Nagaland during 2010–2019. It is hoped that the states in the region will start working on the timely recommendation made in the report for community-driven integrated AIDS response "on an urgent basis" to respond to the "growing HIV problem in the region". Growing number of seizures of illicit injectable drug in the region corroborates the findings of the National Survey on Extent and Pattern of Substance Use in India mentioned in the report titled "Magnitude of Substance Use in India, 2019".

Manipur has the highest population of 33,344 People who inject drugs (PWID) followed byNagaland with 33,888 PWID. In the region, Mizoram figures third in the list with 28,288 PWID followed by Assam with 17466 injecting drug users. Apart from unprotected heterosexual behaviour and unprotected homosexual behaviour, unsafe injecting drug use behaviour is considered to be a high-risk behaviour causing HIV infection. About 27 per cent of PWID share needles and syringes with their peers, the survey revealed. A concerted effort by all stakeholders is needed to address the twin challenges of fighting HIV epidemic and illicit drug use in the region to achieve the desired result. Making the state police forces and other agencies, which have been relentlessly fighting against illicit drug trafficking, important stakeholders in the AIDS control programme is critical to curbing new HIV infection, more particularly among the growing number of PWID in the region. Restoring the access to HIV testing and treatment disrupted by COVID-19 pandemic situation should be the top priority for the states in the region to ensure that gains of past decades in the fight against HIV epidemic are not lost. The guidelines of the National AIDS Control Organisation (NACO) require all core high risk groups to be tested for HIV once in every six months. The states need to overcome the challenges of disruptions posed by COVID-19 pandemic situation to implement these guidelines in toto.This global day is an appropriate occasion to test the pandemic resilience of AIDS control programmes in the region.