India to get PrEP(ed) soon

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People susceptible to the virus have been demanding a PrEP policy for a long time.

Pre-exposure prophylaxis (PrEP) is in the pipeline and is likely to be available at government-run antiretroviral therapy (ART) centres soon, said Dr. Mahesh Kumar, the District AIDS Control Officer. He added that this plan could not be executed earlier due to the pandemic.

Aman (name changed), 24, Noida was infected by the virus on Sept. 4, 2021. He said, “In the LGBTQIA+ community, PrEP should be mandatory. When ART is free at government centres then why not PrEP?”

Until now there is no PrEP policy for acquired immunodeficiency syndrome (AIDS) susceptible people in India even when World Health Organisation (WHO) had mandated it in Sept. 2015.

PrEP should definitely be implemented for AIDS prevention in India, Dr. G. S. Srinivas, District Health and Family Welfare Officer, Bengaluru Urban said at the AIDS day facilitation programme organised by Karnataka State AIDS Prevention Society (KSAPS) and Lions Club in Samata Bhavan. An amendment in Lok Sabha would be needed for that, he added.

Dr. Kala Yada Chief Medical Officer Integrated Counselling and Testing Centres (ICTC), Bowring and Lady Curzon Hospital disagreed with implementation of a PrEP policy. She said, “Why should we go with drugs, why not with preventive measures?” There are barrier methods which can help prevent AIDS. Medications like these can be very harmful for the body. People find it hard to administer even two doses of post-exposure prophylaxis (PEP) which is necessary after a sexual exposure, she added.

However, doctors or quacks have been prescribing PrEP over the counter. These drugs should be very strictly administered and prescribed only after following a due process, she said.

‘Mandate achievable’

The WHO mandate for eradicating AIDS by 2030 is definitely achievable, said Dr Srinivas. He said that, “There are no human immunodeficiency virus (HIV) related deaths. The positivity rate has come down from 1.5 percent to 0.22 percent. In another five to six years, by giving health education and spreading awareness we can achieve it.”

AIDS eradication by 2030 is possible, agreed Dr. Kumar. He added that PrEP could not be implemented due to the pandemic but soon it would be administered at the ART centres. “Many more activities are going to take place like education, supply of contraceptive measures and regular supply of ART treatment,” he added.

Dr. Srinivas said, “Awareness about sex education is also necessary. Without awareness students go for unusual sex without using condoms which may increase the number of cases.”

Virus can’t be controlled by a single thing or a single person, it has to be a group activity.  Dr. Kala said that for the initial tenure, mother to child transmission did decrease but numbers for men to men infection and trans people kept on increasing. Trans People felt neglected and disrespected by the government and the society as a whole. It was only after the Supreme Court’s decisions that vested them with certain rights that they came forward  and helped in the eradication of the disease.

ICTC centres are government run centres where HIV testing and counselling is conducted. If someone is tested positive they are referred to an ART centre. Syed Raqeeb Ahmed, a technician at ICTC centre, Bowring and Lady Curzon Hospital, had been working in ICTC project for 20 years. He said that testing has increased in the centres. “Patients used to panic a lot earlier but now when they visit for counselling — since they have already started ART, they don’t seem that tensed,” he added.

Dr. Kala added that transmission rates have definitely come down and early recognition, even in babies has increased. “There are some pockets in the country where people are still unaware. Poverty is such a thing where they just think of earning and eating,” she said.

Concerns still prevail

India predominantly had HIV-1 subtype C virus but now we also have HIV-2, said Dr. Kala. Earlier this strain was prevalent only in Africa and some other Western countries. The important thing is that this virus is immune to whatever medications are prevalent in the market right now.

She further added that neither is HIV-2 highly transferable nor is it that severe. But, it still has the basic properties of HIV with slight variations which can be very harmful.

Additionally, AIDS patients still face stigma. Surendra Rao, Delhi NCR, talked about the rude and unprofessional behaviour of staff at the government run ART centres. “Their is no secrecy in such centres. A person who is HIV positive has already pulled himself/herself enough to stand in that queue for medicine. What is the reason for calling their name out loud in front of 100 other people?”

A person suffering from HIV/AIDS has the right to keep his/her HIV/AIDS status confidential. The Section 8 of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (Prevention and Control) Act, 2017 states that no person shall be compelled to disclose his/her HIV status.

Aman too felt uncomfortable when his name was shouted for the first time at the ART centre. “Every one looked at me,” he said. During his last visit to the centre he advised them to implement a token system. “Lets see what happens,” he said.