03rd December 2019 : The Hindu Editorials Notes : Mains Sure Shot
Question – Analyse the SDG target related to AIDS and show where does India stand in this. Also highlight the additional steps that should be taken.(25o words)
Context – UNAIDS target 2020.
What is AIDS?
- HIV is a virus that damages the immune system. The immune system helps the body fight off infections. Untreated HIV infects and kills CD4 cells, which are a type of immune cell called T cells. Over time, as HIV kills more CD4 cells, the body is more likely to get various types of infections and cancers.
- HIV is transmitted through bodily fluids that include: blood, semen, vaginal fluids or rectal fluids and breast milk.
- The virus doesn’t spread in air or water, or through casual contact.
- The Sustainable Development Goals (SDG), adopted by member countries of the United Nations in 2015, set a target of ending the epidemics of AIDS, Tuberculosis and Malaria by 2030 (SDG 3.3).
- Risk of acquiring HIV infection is 22 times higher in homosexual men and intravenous drug users, 21 times higher in in sex workers and 12 times more in transgender persons.
Since AIDS is a pandemic disease, how do the organisations trace the progress made?
- The key indicator chosen to track progress in achieving the target for HIV-AIDS is “the number of new HIV infections per 1,000 uninfected population, by sex, age and key populations”.
- The key requirements in achieving the SDG target are high-level political commitment, financial support, health system thrust, public education, civil society engagement and advocacy by affected groups.
- UNAIDS, the lead UN agency that coordinates the battle against HIV, has set an ambitious “90-90-90” target. The target stated that by 2020, 90% of those living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained anti-retroviral therapy and 90% of all people on such therapy will have viral suppression.
- Guided by the goals of this target, UNAIDS will take steps to bridge the gaps in each process i.e. the gaps in detection, initiation of drug therapy and effective viral control were to be bridged to reduce infectivity, severe morbidity and deaths from undetected and inadequately treated persons already infected with HIV, even as prevention of new infections was targeted by SDG 3.3.
Where does India stand?
- The Indian experience has been more positive but still calls for continued vigilance and committed action. HIV-related deaths declined by 71% between 2005 and 2017. HIV infection now affects 22 out of 10,000 Indians, compared to 38 out of 10,000 in 2001-03. India has an estimated 2.14 million persons living with HIV and records 87,000 estimated new infections and 69,000 AIDS-related deaths annually.
- Nine States have rates higher than the national prevalence figure. Mizoram leads with 204 out of 10,000 persons affected. The total number of persons affected in India is estimated to be 21.40 lakh, with females accounting for 8.79 lakh. Assam, Mizoram, Meghalaya and Uttarakhand showed an increase in numbers of annual new infections.
- The strength of India’s well established National AIDS Control Programme, with a cogent combination of prevention and case management strategies, must be preserved.
- At the end of 2019, on the road to the 2020 and 2030 targets, while much success has been achieved in the past 20 years in the global battle against AIDS, there has been a slowdown in progress which seems to place the targets out of reach.
- Between 2000 and 2018 new HIV infections have reduced by 37%, HIV-related deaths have fallen by 45%, and 13.6 million lives saved due to Anti-Retroviral Therapy (ART).
- Most of this has been possible due to effective drugs developed to combat a disease earlier viewed as an inescapable agent of death, generic versions generously made available by Indian generic manufacturers, led by the intrepid Yusuf Hamied which made the drug widely affordable for the poor, public and private financing and actions by both the government, NGOs, civil society and other international organisations.
- Ignorance and stigma were vigorously combated everyday by coalitions of HIV-affected persons who were energetically supported by enlightened sections of civil society and the media.
- According to a recent report by UNAIDS, of the 38 million persons now living with HIV, 24 million are receiving ART, as compared to only 7 million nine years ago.
How far have we come to achieve the “90-90-90” target?
- At the end of 2018, while 79% of all persons identified as being infected by HIV were aware of the fact, 62% were on treatment and only 53% had achieved viral suppression — falling short of the 90-90-90 target set for 2020.
- Due to gaps in service provision, 770,000 HIV-affected persons died in 2018 and 1.7 million persons were newly affected.
- There are worryingly high rates of new infection in several parts of the world, especially among young persons. Only 19 countries are on track to reach the 2030 target.
- While improvements have been noted in eastern and southern Africa, central Asia and eastern Europe have had a setback, with more than 95% of the new infections in those regions occurring among the ‘key populations’.
- In the terminology of HIV prevention and control, the phrase “key populations” refers to: men who have sex with men; people who use injected drugs; people in prisons and other closed settings; sex workers and their clients, and transgender persons.
Why did we slowdown?
- The remarkable success achieved in the early part of this century, led to a dominating sense of victory among the agents i.e. the governments, NGOs, civil society and other international organisations which subsequently slowed further efforts.
- The global funding streams started identifying other priorities.
- Improved survival rates reduced the fear of what was seen earlier as dreaded death and pushed the disease out of the headlines.
- Hence, the information dissemination blitz that successfully elevated public awareness on HIV prevention did not continue to pass on the risk-related knowledge and strong messaging on prevention-oriented behaviours to a new generation of young persons.
- Vulnerability of adolescent girls to sexual exploitation by older men and domineering male behaviours inflicting HIV infection on unprotected women have been seen as factors contributing to new infections in Africa.
What can be done?
- Awareness needs to be spread that even the improved survival rates in persons with HIV bring forth other health problems that demand attention. Risk factors for cardiovascular disease are high among survivors as they age, with anti-retroviral drugs increasing the risk of atherosclerosis. Other infectious diseases, such as tuberculosis can co-exist and cannot be addressed by a siloed programme. Mental health disorders are a challenge in persons who are on lifelong therapy for a serious disease that requires constant monitoring and often carries stigma.
- Drug treatment of HIV is now well founded with an array of established and new anti-viral drugs. The success of drug treatment to prevent mother-to-child transmission, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and male circumcision, especially among MSM population, is well-documented. Given the wide diversity of the HIV virus strains, development of a vaccine has been highly challenging but a couple of candidates are in early stage trials. However, mere technical innovations will not win the battle against HIV-AIDS.
- Success in our efforts to reach the 2030 target calls for resurrecting the combination of political will, professional skill and wide ranging pan-society partnerships that characterised the high tide of the global response in the early part of this century.
- The theme of the World AIDS day this year (“Ending the HIV/AIDS Epidemic: Community by Community), which is communities make the difference, is a timely reminder that community wide coalitions are needed even as highly vulnerable sections of the community are targeted for protection in the next phase of the global response.
Note: There is an article on NRC, we have already discussed it earlier (27th November) very elaborately. The following are the additional points:
Question – Is National registry of citizenship compulsory or what is the legal sanction behind this?
- Section 14A in the Citizenship Act of 1955 provides in sub-section (1) that “The Central Government may compulsorily register every citizen of India and issue national identity card to him”. The word may implies a discretion contingent on other factor. Hence whether it is compulsory or not is debatable.
- Under the Foreigners Act of 1946, the burden of proving whether an individual is a citizen or not, lies upon the individual applicant and not on the state (Section 9).
- The procedure to prepare and maintain NRIC is specified in The Citizenship (Registration of Citizens and Issue of National Identity Cards) Rules, 2003.
- Rule 11 states that the “Registrar General of Citizen Registration shall cause to maintain the National Register of Indian Citizen in electronic or some other form which shall entail its continuous updating on the basis of extracts from various registers specified under the Registration of Births and Deaths Act, 1969 and the [Citizenship] Act . No action or duty is enjoined upon the citizens to apply for (or prove) their citizenship afresh.
- Rule 4 provides that “Preparation of the National Register of Indian Citizens” which provides that the Central Government shall carry out a “house-to-house enumeration for collection for particulars related to each family and Individual including the citizenship status”.
- Rule 6 provides that every individual must get himself/herself registered with the Local Registrar of Citizen Registrations during the period of initialisation (the period specified as the start date of the NRIC).