In Nagaland the battle on HIV/AIDS not over yet

Persistently high rate of HIV prevalence in antenatal clinics (ANC) in Nagaland indicates severity of what is now being seen as a generalized epidemic, with transmission most likely through unprotected sexual practices. It is no longer just ‘high-risk’ groups that urgently need intervention.

By Tushimenla Imlong — Naga Republic Feature

So where is Nagaland, Northeast region and India at present in the fight against HIV/AIDS?

People have recently been asking: “Is HIV over? We don’t hear much about it these days”. An optimistic response would be to agree that the epidemic in India is relatively under control and that HIV is now considered to be a chronic, manageable infection; but it would be naïve to assume that the battle is over.

India has been commended in international platforms on its progress towards achieving global targets, and is currently focusing on reaching the 90-90-90 goals; which aims that by 2020, 90% of all people living with HIV (PLHIV) will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained Anti-Retroviral Therapy (ART) and 90% of all people receiving ART will have viral suppression. India also launched the Test and Treat policy in April 2017 to provide ART to anyone who tests positive for HIV, irrespective of CD4 cell count.

Yet there is an apparent lag in momentum or visibility causing people to wonder if the epidemic is over. This could be ascribed to changes in funding mechanism, challenges with keeping up the impetus after years of intensive battle, fatigue, or perhaps a sense of complacency that has set in. But it is imperative to look at what the data is telling us about where we are heading.

To put it in context, here’s a quick look at the recent trends in the HIV sector: It is estimated that HIV prevalence among adults in India is at 0.26%, indicating an overall decline. Manipur has shown the highest estimated adult HIV prevalence of 1.15%, followed by Mizoram at 0.80%, Nagaland at 0.78%, Andhra Pradesh & Telangana, Karnataka, Gujarat and Goa.

Where are we on HIV?

Nagaland has an estimated 11,050 persons living with HIV

Adult HIV prevalence—Nagaland is the third highest at 0.78%,

HIV prevalence rates of 5.9 % among female sex workers in Nagaland

High rate of HIV prevalence in antenatal clinics (ANC) in Nagaland

Rising trends have been observed in some states that were earlier considered low-prevalence like Assam, Chandigarh, Delhi, Jharkhand, Punjab, Tripura and Uttarakhand. In terms of PLHIV population Andhra Pradesh and Telangana have the highest estimated number of PLHIV (3.95 lakhs) followed by Maharashtra (3.01 lakhs), Karnataka (1.99 lakhs), Gujarat (1.66 lakhs), Bihar (1.51 lakhs) and Uttar Pradesh (1.50 lakhs).

In comparison Nagaland has an estimated 11,050 persons living with HIV, as per the HIV Estimations 2015 Technical Report of National AIDS Control Organization (NACO).

HIV is considered as concentrated epidemic in India with disproportionately high proportion of ‘high risk’ population being infected.

The national Integrated Biological and Behavioral Surveillance (IBBS) 2014-15 data for Nagaland showed HIV prevalence rates of 5.9 % among female sex workers as compared to the national average of 2.2%; 3.2% among injecting drug users compared to 9.9% nationally and 1.8% among men who have sex with men compared to the national average of 4.3%.

However, what appears to be confounding experts even at the national level is the persistently high rate of HIV prevalence in antenatal clinics (ANC) in Nagaland which stands at 1.29%, followed by Mizoram (0.81%), Manipur (0.60%) against the national average of 0.29%. This is according to ANC HIV Sentinel Surveillance, India 2014-15.

HIV prevalence among pregnant women in ANCs is considered as proxy for prevalence in the general population. This indicates the severity of what is now being seen as a generalized epidemic, with transmission most likely through unprotected sexual practices. It is no longer just the ‘high-risk’ groups that urgently need intervention.

The community of PLHIV is more heterogeneous today – besides the ‘visible’ activists in the forefront of the movement, they could be grandfathers, grandmothers, children who are rapidly growing into their teens, young adults, professionals, public leaders, stay-at-home mothers, neighbors – let’s just say roughly one in every hundred persons, if we were to go by ANC data.

Perceiving the implications thereof need not cause alarm or panic – this has not happened overnight. But we can certainly gear our response as individuals and as a people to take a serious look as what we can do to deal with the epidemic from a more humane standpoint and ensure that no more precious lives are lost.

People feel most at ease to get tested for HIV in an environment that does not stigmatize or condemn; and for people who test positive we need to keep strengthening local support systems so that they can easily access treatment from the most convenient ART centers, take care of their overall health and also take up the responsibility of preventing further transmission of the virus. ART not only extends lives, but also has benefits in terms of HIV prevention as it reduces viral load, and as long as viral load is suppressed, HIV is not transmitted.

At the same time, one must admit that this vision can only become real when mechanism for testing and treatment are available and accessible; testing centers are well equipped, facilities to determine CD4 count and viral load are fully operational and that there are no constraints in the supply and availability of ART medication. Viral suppression can only be confirmed if a person is accessing regular treatment, monitoring and viral load testing.

As a caring community, we could be more proactive in what a friend once described as “making the comfortable uncomfortable, and making the uncomfortable comfortable”. There are certainly important roles for citizens to play in creating an environment where no one is afraid to step out and seize the opportunity to lead healthy, productive and meaningful lives.

Tushimenla Imlong is a freelance consultant in the public health sector, who works on issues related to HIV and Harm Reduction