December 1 marked the 30th anniversary of World AIDS Day. On the occasion, Director of NARI, Dr Samiran Panda, underscores the importance of HIV testing. This year’s theme is ‘Know your status’. Panda tells Anuradha Mascarenhas that there is a need for active participation by both youth and ‘at risk’ population groups
Is HIV still a threat?
India has many success stories to share with rest of the world pertaining to HIV containment, including generation of estimated numbers of people living with HIV in the country at regular intervals, establishment of a countrywide sentinel surveillance system as well as ensuring HIV treatment for over 1.2 million people. However, HIV still remains a concern as we are yet to reach a stage where the HIV transmission can be declared as non-issue in the country.
Anti-retroviral therapy has played a huge role in bringing down HIV prevalence. What’s your take on this?
The impact of anti-retroviral therapy over the last decade is obvious as there has been a sharp decline in the estimated number of people living with HIV in the country. Combination treatment used against HIV (using three or more anti-HIV medicines from different classes) and the ‘test and treat’ strategy of the National AIDS Control Organisation, Government of India, have played a major role in this regard. This treatment, by bringing down the viral load in individuals living with HIV, not only prolongs life and improves its quality, but also serves as a prevention tool because the chance of further transmission either through unsafe sex or through unsafe injection practices gets reduced due to adequately suppressed viral load.
What has been NARI’s role in fight against HIV infection?
The National AIDS Research Institute (NARI), one of the premier organisations under Indian Council of Medical Research (ICMR), was established in 1992. Since inception, its vision has been to build a research capacity of distinction, which is capable of facing the growing challenges of HIV/AIDS in the country. We are painstakingly following our dreams in this direction and have also contributed to the national AIDS control programme by generating evidence for action. For example, NARI, at the national level, plays a crucial role in quality control of HIV diagnosis, CD4 count and viral load estimation.
Currently, we are working on development of a protocol to examine the accuracy of an indigenously produced HIV oral self test.
Despite progress, stigma and discrimination persists, preventing people from undergoing HIV screening. How can this be combated?
Yes, stigma around HIV, although reduced, does exist and negatively impinges upon various programmatic aspects starting from HIV test uptake at individual level. HIV self screening test, if made available in the country, has the potential of being a major game changer. Scientists attached with NARI are currently involved in designing a study that would examine the promises that HIV self tests come with and would also look into the acceptability of such tests.
HIV estimations report shows there is a decline in incidence of HIV but the pace has slackened in last few years. What do you think needs to be done?
‘Reaching out’ is the answer. Reaching out to people yet unreached and reaching out to difficult geographical pockets yet uncovered are the keys. In order to be able to do so, the national programme needs to rely upon innovation. Active participation of ‘at risk population groups’ and also of the youth are quintessential in this regard.
Is there a need for an HIV vaccine? If yes, what efforts are underway?
Yes, there is a need for HIV vaccine as it has the potential to address issues around residual risk behaviour among ‘at risk’ population groups and resulting HIV transmission. However, the challenges related to HIV vaccines are many. There are ongoing efforts globally to develop HIV vaccines, which are stable and safe, which would have good efficacy and considerable protection durability. Cost of such vaccines and acceptability in the community will also have to be considered while making a programme decision for use of an HIV vaccine at large scale. Till that time, behavioural modifications and combination anti-HIV treatment will remain as two major components in the intervention package where an HIV vaccine could be an important add on element.