Watch this video interview: http://bit.ly/2fLdcrJ
Listen or download the audio podcast: http://bit.ly/2gD21yT
(CNS): Success breeds complacency and complacency breeds failure. When the number of people affected by a disease decreases, there is a tendency to disregard it as a public-health problem.
Even as the HIV/AIDS epidemic is on the decline in India, we have to intensify, and not dilute, our efforts to have virtual elimination of the disease, emphasised Dr Raman R Gangakhedkar, director-in-charge at National AIDS Research Institute (NARI), Indian Council of Medical Research (ICMR).
He spoke with CNS (Citizen News Service) at the sidelines of the 9th National Conference of AIDS Society of India (ASICON 2016). This interview is part of CNS Inspire series -- featuring people who have decades of experience in health and development, and learning from them what went well and not-so-well and how can these learnings shape the responses for sustainable development over the next decade.
Dr Gangakhedkar, an eminent clinician and epidemiologist, has been intensely involved in devising guidelines for HIV management, as well as policy making for HIV/AIDS-control programmes at the national level. Initially trained as a paediatrician, he jumped headlong in the field of HIV/AIDS in 1989, at a time when even the mention of this dreaded disease was a big no-no. He later shifted from Mumbai to Pune when NARI was established in 1993.
Game changers for HIV/AIDS control in India
Mentioning major milestones in HIV/AIDS management in India, Gangakhedkar said, "It was community involvement in decision-making that proved to be the most important game changer. Going beyond just community mobilization, it involved sex-workers, MSMs and injecting drug users representatives sitting with the experts, and giving their opinions on policies and programmatic strategies to reach them."
Another bold step, according to him, was the national investment for prevention of parent-to-child transmission (PPTCT) programme for the mainstream population in 1999, when the Indian government started to invest its own money rather than depend on international donors. It also paved the way for free anti-retroviral therapy for people living with HIV--for the first time in the country's history, the government committed itself to give free treatment for a chronic disease that required life-long treatment.
Even though India has prioritised interventions among key sub-populations (like sex workers, men who have sex with men, injecting drug users, migrants), one of the larger goals that still remains is to ensure that community itself leads the targeted interventions, with NGOs acting as only gatekeepers, feels Gangakhedkar. "Community-led structural interventions should have complete control on all kinds of prevention and control services. Community-based HIV testing should improve and even ART centres for these sub-populations should be hosted in community-based organisations with some technical support (by a doctor or pharmacist) from outside. Once community starts managing their own programmes they will also manage their other day-to-day non-health-related problems as well.
"The marginalized and disempowered communities have to be empowered in a more holistic manner so that they do not remain vulnerable to just HIV/AIDS, but to other diseases too. Community voices have to become stronger and inequity between main-stream and key sub-populations reduced substantially. We must be advocates to provide the right kind of support to the community organizations so that they lead by themselves; but we should not be part of these organizations. This is the kind of advocacy I foresee myself doing in the coming years," he said.
#endAIDS by 2030
As of today, only 14 lakh (1.4 million) of the estimated 21 lakhs (2.1 million) PLHIV in India have been diagnosed. This leaves an estimated 7 lakh (700,000) PLHIV who are not even aware of their HIV-positive status. Gangakhedkar called for prioritizing and intensifying community-based testing all over the country. "But rapid scale up of services should not be at the cost of quality of services. Only by improving quality of services and intensifying our strategies will we be able to achieve the last 90 of the UNAIDS goal of maintaining virological load suppression for elimination of HIV/AIDS."
There is also a dire need for implementation research in HIV/AIDS, to not only identify the gaps but also the solutions at each level of implementation. A completely decentralised approach for decoding of evidences and modification of policies is vital. There is no one size that fits all. We have to build the capacity of those involved with the interventions so as to be able to interpret the evidences and have strategies that are locally adapted, he said.
Some proud achievements