Comments on World AIDS Day by Fight AIDS Coalition – Barry Leslie Kharmalki, President North East Regional Network of People Living With HIV
FAC- Yes you have pronounced it right! FAC stands for Fight AIDS Coalition-The North East Chapter. The FAC is not an organization or an institution, but a group of AIDS treatment activists around the world, who are here to remind everyone that people living with HIV are still dying from AIDS!!!
Dec 1st 2021 (World AIDS Day), political leaders, decision makers, the state government, institutions and people will rally to confront the inequalities that drive AIDS and to reach people who are currently not receiving essential HIV services. Concerned stake holders would like to highlight that India loses nearly 60,000 people living with HIV on an annual basis. Over 3 percent of people who test HIV+ and are linked to antiretroviral therapy have low CD4 counts (below 200) and are at risk of dying from life threatening infections (cryptococcal meningitis, pneumonia, TB and other severe bacterial infections)
“We demand that NACO immediately implement the WHO recommendations on testing and treatment for advanced HIV disease (a technical term for AIDS). The technical Resource Group has recommended for their implementation but we see no action at the local level in Meghalaya.”
The ambitious 90-90-90 strategy was announced by UNAIDS in 2014, aiming to end the AIDS epidemic by 2030 by achieving 90% diagnosed among all people living with HIV (PLHIV), 90% on antiretroviral therapy (ART) among diagnosed and 90% virally suppressed (VS) among treated.
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The number of people with advanced HIV remains high in India. The mortality rate among people with advanced HIV disease is very high even with access to ART. PLHIV with AHD have low CD4 count and are at high risk from life threatening infections, and death. The risk of death is higher with low CD4 cell count, especially with CD4 cell count <100 cells/mm3. In short, IT IS IMPOSSIBLE TO REACH THE THIRD 90 % IF AHD AMONG PLHIV IS NOT ADDRESSED!!!
No one will addressed this but the truth is that 58.96 thousand AIDS-related deaths were estimated in the year 2019 in India (See OI GLs 2021) and all these deaths could have been preventable if access to WHO’s AHD package which includes testing and treatment for life threatening infections is implemented by NACO.
WHO Definition for AHD
For adults and adolescents, and children older than five years, advanced HIV disease is defined as CD4 cell count <200cells/mm3 or WHO stage 3 or 4 event (Includes both ART naïve individuals and those who interrupt treatment and return to care) All children younger than five years old with HIV are considered as having advanced HIV disease.
Major causes of death among People Living with HIV include co-infections such as TB, severe bacterial infections, cryptococcal meningitis. WHO guidelines include recommendations for an enhanced package of interventions (diagnosis, prophylaxis and treatment) to reduce mortality/morbidity but we don’t have accessed to these life savings treatment.
Here what’s missing from the National and State Policy (Even when WHO has recommended)!!!
- ART centres do not have the tools and training to manage patients in need of hospitalization and regular monitoring e.g. in treatment of cryptococcal meningitis, DR TB etc.
- No referral for Hospital level facilities to provide critical care to PLHIVs with AHD;
- NACO’s lacks centres of excellence which have clinical expertise in management of critically unwell AHD patients
- Lack of access to screening tests such as TB-LAM and CrAg that help diagnose life-threatening diseases like TB and cryptococcal meningitis in PLHIVs with low CD4 counts.
- NO Appropriate Laboratory capacity (timely access to culture, lumbar punctures and laboratory monitoring )
- Lack of reliable and sustainable supply of paediatric anti retro virals for children with HIV at high risk of AHD.
Health is a state subject, so this World AIDS Day, my message as a person Living with HIV to those working in the HIV response, policymakers, programmers, governments and community-based organisations in Meghalaya is “I do not want your CONDITIONAL SOLIDARITY”.
