As COVID Delays HIV Targets, Experts Emphasize Implementing Effective Prevention Strategies in India

As a follow up to the World AIDS Day and to commemorate the Human Rights Day 2020, on December 10, Centre for Sexuality and Health Research and Policy (C-SHaRP) and The Humsafar Trust (HST) hosted a virtual event to understand how far India has come in terms of adopting HIV pre-exposure prophylaxis or PrEP recommended by World Health Organisation (WHO).

The discussion comes at a time when COVID-19 is having a devastating impact on all 17 Sustainable Development Goals (SDGs) and threatening the achievements already made for HIV prevention in the country.

The event focused on Pre-Exposure Prophylaxis (PrEP), a highly effective medicine for preventing HIV and emphasised on the relevance of human health rights – having the right and access to affordable medicines to protect one’s health.

Speakers and panellists discussed the current status and way forward on scaling up PrEP programmes in India.

Nearly all speakers agreed that there is an urgent need to generate awareness with accurate information and to understand the demand for PrEP – a step to ending global and national goal of ending HIV by 2030. Further, it was highlighted that ending stigma related to HIV and prevention of the virus must be high prioritised. 

Dr. Kenneth H Mayer, Professor, Harvard Medical School said, “PrEP has been shown to be highly effective in protecting against HIV when taken consistently in multiple studies and real-world settings. The keys to optimal PrEP implementation are having clinicians who are knowledgeable about the medications, who can provide culturally competent counseling, and informed consumers, who understand that adherence is the cornerstone of PrEP’s benefit. Providers and consumers also need to have a broader understanding of sexual health, since PrEP does not protect against other sexually transmitted infections.”

WHO and Centers for Disease Control and Prevention, U.S.A have released guidelines on PrEP; however, India is yet to formally release a national PrEP guideline. Commenting on the status, Dr. Ishwar Gilada, President, AIDS Society of India said, “PrEP is an important integrated tool for larger prevention of HIV. I don’t know why there should be any reservation to PrEP; which is a medicine-based prevention, if there is no reservation to use of condoms; which is a barrier-based prevention? Private sector is usually quick and innovative in implementing science-based practices as compared the government; which has to consider a lot more issues and sometimes act in knee-jerkism!”.

Expressing the Indian research outlook, Dr. Seema Sahay of Indian Council of Medical Research – National AIDS Research Institute (ICMR-NARI) said, “There are gaps in implementing PrEP which we need to address. We need to look at delivery models; social-behavioral research needs to be done to understand acceptability, adherence and sustainability; community awareness strategies need to be developed, community voices need to be included and demand generation has to be there.” Further, she added that it is essential to be prepared for interruptions such as COVID to ensure delivery is not affected.        

Most importantly, voicing the community’s needs, Abhishek Desai said, “I think as the conversation around PrEP is opening up in India, my suggestions to policymakers would be to increase accurate information, accessibility and affordability. I would push policymakers to view this from the lens of how do we make this (PrEP) a public conversation whether it is about normalising PrEP just as condoms are today normalised or how do we move this conversation to a broader spectrum who may or may not come under high risk and how to we move this conversation beyond privileged gay men”.

In line with other speakers, Dr. N. Kumarasamy, Chief & Director of Infectious Diseases Medical Centre VHS added, “India needs Biomedical HIV prevention in the form of PrEP. Science shows this works. Implementing PrEP will facilitate ending HIV in India.”

The event was titled ‘PrEP-ing India – Update on HIV Pre-exposure Prophylaxis and Way Forward’ and was an interactive virtual session for 1.5 hours, with Dr. Venkatesan Chakrapani from C-SHaRP and Ms. Shruta Rawat from the Humsafar Trust moderating a vibrant discussion on how PrEP should be accorded more seriousness in the research community as well as in government initiatives in the coming years. A key consensus from the event was that PrEP be introduced in the national programmes quickly as an option to reduce one’s HIV risk and be made accessible to at-risk marginalized communities.