India needs more awareness generation and removal of stigma around HIV/AIDS

Health Care Comments Off

Mother-to-child transmission of the disease can only be prevented through targeted efforts

New Delhi, 30 January 2019: About 80 adolescents will be dying of AIDS every day globally by 2030 if progress in preventing transmission is not accelerated, according to a report by the UNICEF. The report mentions that the current trends indicate that AIDS-related deaths and new infections are slowing, but the downward trajectory is not happening fast enough. Programmes to treat the virus and prevent it from spreading among older children are nowhere near where they should be.

Currently, three million persons 19 years and younger, are infected with HIV worldwide. Two million new infections could be averted by 2030, if global targets are met — this means providing adequate access to HIV prevention, care and treatment services, and testing and diagnosis. Many infected children and adolescents are unaware of their illness, and even when tested HIV-positive, rarely adhere to proper treatment.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “The HIV virus remains concealed in the reservoir cells; for this reason, the HIV infection, which is in remission with antiretroviral drugs (ART), becomes active again as soon as ART is discontinued. Killing these latent reservoirs is therefore essential to achieving cure. Scientists are better equipped today, both with knowledge and technology, which raises hopes of finding a cure. HIV/AIDS also continues to affect the Indian population despite various mass awareness campaigns, availability of various state-of-the-art medical interventions, and evolving technology. A large part of this is also due to the social stigma that our society has associated with the disease. This is also one reason why people avoid routine checkups. There is an urgent need to educate the masses about the various disease prevention measures along with the fact that people with HIV can live a normal life.”

The UNICEF report cites a global target reduction in the number of HIV-infected children by 2030 to 1.4 million. However, the projected number of 1.9 million, shows that the world is off-track by around 500,000.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “HIV can spread from an infected woman to her child during pregnancy and childbirth. It can also be passed from a mother to her child through breastfeeding. All pregnant mothers should get HIV test done. Antiretroviral therapy (ART) should be started at the earliest to prevent HIV transmission to sexual or drug using partner/s or from the mother to the infant during pregnancy or breastfeeding.”

Some other facts

  • ABC for safe sex: Abstain, Be faithful to your partner and if you cannot, use Condoms.
  • Drinking alcohol or taking drugs interferes with judgment. Even those who understand the risks of AIDS and the importance of safer sex may become careless after drinking or using drugs.
  • People with STIs should seek prompt treatment and avoid sexual intercourse or practice safe sex.
  • Used infected razor blades, knives or tools that cut or pierce the skin also carry some risk of spreading HIV.

·         HIV-positive people may remain asymptomatic but can still pass on the virus to others.

Government should introduce limit of 8 lakh for EWS for insurance cover

Health Care Comments Off

Not just medical care, social factors too play an important role in determining one’s health status. These factors are also responsible for the gaps in health among the various strata. Lack of availability and accessibility to resources that improve health among the socially disadvantaged groups are major factors contributing to this health inequity.

These social factors have been termed as social determinants of health and have been defined by the WHO’s Commission on SDH (CSDH) as “the conditions in which people are born, grow, live, work, and age including the health system.” According to the Commission, this means that health cannot be achieved by medical care alone; it is also a social phenomenon.

Among the 10 social determinants of health, social gradient has been deemed to be the strongest predictor of health and wellbeing. It is measured by variables such as income, education, occupation or housing. The lower the socioeconomic position, the higher the risk of poor health.

The extreme poor or the poorest of the poor are the worst off. The World Bank has defined “extreme poverty” as living on less than $1.90 per person per day. This amounts to Rs. 135 per person per day and around Rs 4000 per person per month.

Much progress has been made to make health care accessible to the poor; but, inequities still persist.

The high out of pocket expenditure further add to the financial burden. Many people are pushed below poverty line on account of the high medical expenses in what has been termed as “the medical poverty trap”.

About 55 million Indians were pushed into poverty in a single year because of having to fund their own healthcare and 38 million of them fell below the poverty line due to spending on medicines alone, as per a study published in the British Medical Journal. Health expenditure is considered to be catastrophic if it constitutes more than 10% of overall household consumption or income (TOI, Jun 13, 2018).

Evidently, there is a need to reduce the health inequity.

This has been addressed in the National Health Policy 2017 as a key policy principle, which states “Reducing inequity would mean affirmative action to reach the poorest. It would mean minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers. It would imply greater investments and financial protection for the poor who suffer the largest burden of disease”.

Right to health and access to healthcare is a fundamental right under Article 21 of the Constitution. Article 41 also provides for ensuring assistance during old age, sickness, and disablement.

The Ayushman Bharat scheme, which provides up to Rs 5 lakh cover, is one step towards this end. This year, constitutional amendment bill providing for 10% reservation to the economically weaker sections of the General Category was notified. These are in a bracket of less than 8 lakh annual income.

Only by reducing the health inequity, can the goal of universal health coverage be realized.

In the coming budget, the government needs to bring this 8 lakh limit to the definition of EWS for the purpose of ESI, health subsidy and Ayushman Bharat subsidy. Those above this bracket should be able to buy their insurance on their own.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA