The AIDS Society of India advocates for HIV self-testing and pre-exposure prophylaxis inclusion in national policies to address diagnosis gaps and achieve 95-95-95 targets.
Swapnil R Mishra
A path-breaking publication-“Leveraging HIV self-testing to achieve the UNAIDS 2025 targets in the South and Southeast Asia region’ by Ishwarprasad S. Gilada, et al published in the Journal of International AIDS Society (JIAS), Volume27, Issue 10 October 2024 https://doi.org/10.1002/jia2.26357 should serve as another urgent reminder for the Indian Government to include HIV self-testing (HIVST) in its HIV-
testing policies, if we are keen to achieve 95-95-95 targets in letter and spirit.
The AIDS Society of India (ASI) calls upon the government of India, to include HIVST
and Pre-Exposure Prophylaxis (PrEP) in its policies and programs without any further
delay – as the clock is ticking!
The World Health Organization (WHO) recommended HIV self-testing as part of the HIV care cascade as it is an important approach to address gaps in HIV diagnoses, especially among key populations in 2019.
As HIV testing is the key entry point to the HIV care cascade, it is worrisome that in India one in five people living with HIV do not know their HIV status. India can no longer keep sheltering under the COVID-19 pandemic for negatively impacting the pace of HIV testing and the control program. We need to ensure that 100% of people living with HIV know their status so that they can receive a full cascade of HIV care services and stay virally suppressed (undetectable viral load) – which is essential for them to live full and healthy lives – as well as to end AIDS as “Undetectable equals Untransmittable equals Zero”.
Almost half of the countries (98) have included HIVST policies, and one-fourth of nations globally (52) are routinely implementing it. Self-tests for COVID-19, pregnancy, diabetes, etc have not only proven successful in increasing the uptake of tests but also in how they link to care services. There is no reason at all to delay the full-scale rollout of HIVST in India and other countries that are missing leveraging upon this evidence-based intervention.
The Gap:
Since most nations could not meet 90-90-90 by 2020 AIDS targets, now the eyes are set on the 2025 goalpost of 95-95-95 targets (95% of people living with HIV to know their status, 95% of them should be on ART, and 95% of these be virally suppressed). HIV self-test is one of the key cog-in-the-wheel to “reaching out to the last mile” for the first-95 target.
According to the Government of India’s Fifth edition of NACO’s Sankalak Report 2023, 79% of people living with HIV (PLHIV) knew their status, 86% of them were on antiretroviral therapy, and 93% of them had viral suppression. This translates into 63% of total PLHIV in India being virally suppressed in 2023 against the target of getting 86% of them virally suppressed by 2025. The weakness in the first 95 has a cascading effect on the other two 95s!
Key populations most left behind:
While the overall adult prevalence remains low, HIV prevalence among high-risk groups
And the bridge population remains very high. HIV prevalence among migrants is 4 times, among truckers is 5 times, among inmates in central jails and female sex workers, is 9 times, among men who have sex with men (MSM) is 16 times, among hijra/transgender people is 18 times and among people who use drugs is 43 times of the overall adult HIV prevalence.
It is important to remember that HIV self-testing is not a standalone initiative but
integrated into the HIV care cascade where HIV testing services include: counselling (pre-test information and post-test counselling); linkage to appropriate HIV prevention, treatment and care services, and other clinical and support services; and coordination with laboratory services to support quality assurance and the delivery of correct results, among others.
India’s role in the global prevention of HIV-related deaths is unmatched and laudable.
However, we see a ‘darkness below the lamp’ kind of situation in India. Almost 92% of people living with HIV (PLHIV) and persons at risk of contracting HIV globally are consuming ‘made-in-India’ antiretrovirals (ARVs).
The recent success story of twice-yearly
shots of Lenacapavir preventing HIV in over 96% of at-risk people and the Gilead granting Royalty-free Voluntary Licenses to six generic pharma globally including four Indian, hit headlines. How India benefits from it remains in the doldrums, as PrEP is not part of its National AIDS Control Program (NACP). India is way behind many LMICs in both – offering HIVST as well as PrEP. Although HIV infections in India were declining with the wide-scale implementation of ART through 750 government-run ART centres, HIV cases started rising in 2020, with a high burden on young people, especially MSM, bisexuals, Trans community, Injection Drug users and jail inmates.
