Global response to the AIDS epidemic will reach a critical landmark in 2025 — namely achieving some of the intermediate targets as part of meeting the sustainable development goal of ending the AIDS epidemic by 2030.
It is an appropriate time to evaluate the performance of countries in preventing the spread of the HIV virus, in saving the lives of the infected, and ending the transmission of HIV from mothers to babies, besides reflecting on the pivotal role played by the Indian pharma sector. New infections must reduce by 90 per cent of the number in 2010 and treatment access provided on a 95-95-95 formula — 95 per cent of people living with HIV should have a diagnosis, 95 per cent of whom should be taking lifesaving antiretroviral (ARV) treatment, and 95 per cent of people living with HIV on treatment should achieve a suppressed HIV viral load.
The recent report of UNAIDS released by The Lancet has highlighted the significant progress made in the global fight against the virus. New HIV infections have fallen by 22 per cent between 2010 and 2021, and HIV-related deaths by 40 per cent globally. The global decline in HIV incidence is largely driven by sub-Saharan Africa, where the likelihood of getting the virus over a lifetime has fallen by 60 per cent since its peak in 1995. However, worryingly, in central and eastern Europe, central Asia, north Africa and West Asia new infections are on the rise.
The legal systems governing the key populations such as sex workers, people who inject drugs, transgender individuals, and homosexuals remain oppressive in many parts of the world, particularly in regions like Africa. In several countries, homosexuality is criminalised, creating significant barriers to healthcare access.
Drug laws remain inconsistent, with access to both traditional and newer synthetic drugs loosely controlled. This weak regulatory framework exacerbates public health challenges, underscoring the need for a balanced approach that combines legal reform, public health measures, and harm-reduction strategies.
India’s stance
In this challenging scenario, India’s response to the pandemic presents a mixed picture. Impressive gains have been recorded by the Indian programme as it extended anti-retroviral therapies (ART) to 1.5 million people living with HIV. It has led in the production of generic ARV drugs, with the active involvement of the pharma sector and supported by a robust legal framework, with the Indian Patent Act 1970 playing a pivotal role in prioritising public health over commercial interest.
On prevention, there were impressive gains, but the incidence rates have fallen only by 44 per cent since 2010, and not the desired level of 90 per cent, en route to achieving the 2025 targets. The target of elimination of mother-to-child transmission of HIV has also not been achieved. The programme needs focused attention on these two aspects for the country to achieve the desired 2025 targets, paving the way to end the AIDS epidemic by 2030.
(The writer is former UN Secretary-General’s Special Envoy on AIDS in the Asia Pacific and former Health Secretary, Government of India. Views are personal)