Annals of Tropical Medicine and Public Health

EDITORIAL COMMENTARY
Year
: 2017  |  Volume : 10  |  Issue : 3  |  Page : 509--510

Challenges in HIV care: Accelerating the pace of HIV-related services to accomplish the set global targets


Saurabh RamBihariLal Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy 
 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kancheepuram, Tamil Nadu, India

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India




How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Challenges in HIV care: Accelerating the pace of HIV-related services to accomplish the set global targets.Ann Trop Med Public Health 2017;10:509-510


How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Challenges in HIV care: Accelerating the pace of HIV-related services to accomplish the set global targets. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Dec 9 ];10:509-510
Available from: http://www.atmph.org/text.asp?2017/10/3/509/213162


Full Text

HIV-related estimates for the year 2015 have been released, with 2.1 million and 1.1 million people being diagnosed and dying because of the disease-related complications worldwide, respectively.[1] However, the cumulative estimates suggest that in excess of 35 million people have lost their lives to the deadly disease, while close to 37 million people are living with HIV at the end of 2015.[1] As the disease continues to remain a major global public health concern, there is an immense need to address the four key areas of challenges, namely prevention of acquisition of infection, expanding the reach to treatment, responding to the concern of emergence of drug resistance, and maintaining constant finance to strengthen and broaden the ongoing activities.[2],[3]

Even though, a slight reduction has been observed in the global incidence of the infection, the incidence in some of the regions or among some high-risk groups (such as men who have sex with men) is still on the rise.[1] In other words, prevention programs should be targeted to the most vulnerable population groups, in such a way that all the existing social or legal barriers are addressed, so that they can readily access HIV-related services.[1],[2] At the same time, there is a need to integrate HIV prevention into sexual and reproductive health services, encourage condom promotion, facilitate voluntary medical male circumcision, initiate antiretroviral therapy (ART) among all infected people, and expand the reach of preexposure prophylaxis (for HIV-negative partner) and postexposure prophylaxis activities, all with an ultimate aim to ensure that these services are delivered to people at affordable cost.[1],[2],[3]

Despite no cure being available for the infection, the infected people still can lead a healthy and productive life, provided they have an easy access to the effective ART, which not only limits the virus amplification, but even its transmission.[1],[2] Acknowledging this, the World Health Organization (WHO) has recommended that all HIV-positive people should be started on ART at the earliest.[1],[4] However, currently only 46% of the people are receiving the therapy, which presents a major challenge for the program managers.[1] Also, four of every 10 people living with HIV are still not aware about their HIV status, and thus there is again a need for ensuring ready access to simple and affordable testing services, including self-testing. In short, there is a need to reach people who are reluctant to come forward and support them through a full range of community-based services, which can be achieved through strengthening of the health systems.[2],[5]

Furthermore, evidences of drug resistance have been observed and it has become a more significant threat in some nations and populations, with more than 5% of people on ART being resistant to at least one antiretroviral drug.[2] In fact, WHO has released a report comprising a set of program-related factors (such as treatment adherence and retention, interruptions in the supply of drugs, poor quality of treatment services, and others), which are contributing toward the emergence of drug resistance.[2],[3] Amidst the anticipated expansion of treatment even in the coming years, there is an immense need to be vigilant and strengthen surveillance, to ensure that the problem of drug resistance can be minimized.[1],[2]

Another, big challenge is to keep up the pace of the ongoing activities and even adopt innovative strategies, and this can happen only if sustainable financial support is extended toward different activities (such as diagnosis, treatment, strategic information, human resources, and the like) of the program.[2],[3] Most of the low-income and middle-income nations are already struggling to implement routine interventions due to the shortage of financial support.[3] The aim is to shift from external to predominantly domestic funding to not only strengthen HIV-related activities but also reduce the cost of drugs, and hence move toward universal health coverage.[1],[2]

To conclude, there is no room for complacency, if the global stakeholders aim to accomplish the set targets by the year 2030. The need of the hour is to deal with the existing challenges, and ensure that all the services are delivered in a targeted manner for the welfare of the people living with HIV.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1World Health Organization. HIV/AIDS—Fact Sheet; 2016. Available from: http://who.int/mediacentre/factsheets/fs360/en/. [Last accessed on 2016 July 13].
2World Health Organization. WHO Flags Key Challenges to global HIV Response at International AIDS Conference; 2016. Available from: http://who.int/mediacentre/news/notes/2016/international-aids-conference/en/. [Last accessed on 2016 July 17].
3Pandve HT, Giri PA. HIV/AIDS prevention and control in India: Achievements and future challenges. N Am J Med Sci 2015;7:575-6.
4Shrivastava SR, Shrivastava PS, Ramasamy J. Eligibility criteria for antiretroviral therapy expanded: World Health Organization aims for a better future for people living with HIV. J Pioneering Med Sci 2016;6:77.
5Shrivastava SR, Shrivastava PS, Ramasamy J. How can we improve the universal uptake of HIV testing services? World Health Organization. Int J Prev Med 2016;7:13.