Tamil Nadu’s HIV success story is far from over

Almost 33 years ago, Tamil Nadu rang the HIV/AIDS alarm bells for the country, with the diagnosis of the disease among six sex workers in Chennai by Dr Suniti Solomon, founder of YRG Care, who played a pivotal role in its treatment. Having been at the heart of the discovery, the state began pioneering work in terms of testing, counselling and treatment, besides creating awareness.

From a prevalence rate of 0.83% in Tamil Nadu in 2003, it has come down to 0.27%, with 1.42 lakh people living with the disease in the state.

The average number of fresh cases reported every year was hovering around 15,000 till six years ago, and there has been a steady dip recently. The latest data from the Tamil Nadu State Aids Control Society shows that 10,321 new cases were reported from across the state in 2019.

However, with a growing segment of the vulnerable population taking to dating sites and apps, to sustain the decline in infection rates, the programme in the state now has to look beyond conventional approaches and usual target groups like sex workers, men having sex with men, truck drivers, transgenders, etc, say experts.

Relook approach towards traditional target groups

Kallana Gowda, chief impact officer, Swasti, an organisation working towards HIV/AIDS treatment for several years, says that strategies in the past may not continue to work as the HIV rate in the state is now under control, and it is now the question of sustenance.

He says that while the conventional target groups cannot be overlooked, the approach towards them should change.

“Sex work for some is a question of livelihood, and they can be pushed to the extent that they are ready to take risk because they want the money. In such cases, risk reduction approach by providing condoms and awareness is not going to work. We have to look at vulnerability reduction. There are a number of social security schemes in the state that they should be linked with — like pensions and public distribution systems. They need to be empowered through social protection schemes,” he stresses.

Fighting in virtual space

Gowda also observes that with the advent of technology and virtual hotspots, many are becoming unreachable.

“There are categories like MSM (men having sex with men), injecting drug users (IDU) and female sex workers (FSW). Not all of them are in the virtual space, but it has become difficult to access them, unlike before, when they were reachable in physical hotspots like at transit points,” he says.

“With Grindr, Tinder and other such dating and hook-up apps penetrating the Indian market, online and virtual populations who seek partners through these apps are definitely a population that we need to keep a close eye on. However, they are not easy to reach,” Dr Sunil Suhas Solomon, chairman, YRG Care, notes.

On the drug-induced epidemics, he points to the influx of drugs, especially drugs by injection, in north and central India.

“The penetration of club drugs such as ecstasy and stamp as well as cocaine and MDMA can also see an increase in sexually transmitted infections (STIs) and HIV in the party-going populations. In several countries around the world, we are starting to see an increase in drug resistant STIs,” he says.

Studies in recent years like the one published in 2015 in China has shown correlation between HIV/AIDS and club drug use, revealing the prevalence of HIV, syphilis, and herpes simplex virus-2 were higher among drug users at 18.6 per cent when compared to 10.6 per cent among non-drug users. Another UK-based study published in Lancet HIV in 2016 linked polydrug use among HIV infected MSM and condomless sex.

Yet, the intervention in the state has not gone beyond the traditional target groups.

A source from TNSACS says while there is enough awareness on HIV, the younger age group which is turning out to be adventurous and becoming sexually active in the teens, has to be individually targeted. “We have taken this up with the Centre and are asking them to come up with modules to target the group so that we can adopt them here,” the source says.

Drop in drop-in centres

Jaya, general manager at Sahodaran, an NGO working with the LGBTIQ, says that a few years ago, those living with HIV could access drop-in centres.

“These are clinical spaces with large operating costs,” she says, observing that it looks like the government has assumed that since the population that needs it is small, they don’t have to incur such large costs,” adds Jaya.

Sources from TNSACS admits that engaging HIV-positive people at these centres to take care of the new cases has been effective. “However, these were discontinued because they were isolated centres and heightened the stigma. We have taken up this with the state government.”

For the last couple of years, the intensity of the programmes have died down, says a source working with vulnerable groups through an NGO, on the condition of anonymity. “We keep hearing from the TANSACS that there is a fund-crunch and that the National Aids Control Organisation (NACO) at the Centre is not disbursing enough funds. However, the state should be stepping up with their own contribution without expecting the Centre to do it,” the source said. “If the state has been able to bring down the rates to 0.27 from 0.83 in 2003, it is because of the efforts it put in for over a decade. The ramifications of the current complacency will be seen five years from now.”

The government is supported by over 80 NGOs looking at various aspects of advocacy and implementation, the source from TNSACS says, adding that projects are being carried out in sync with ground reality, denying charges of lack of funds.

Stigma remains

Patricia (name changed), a 42-year-old woman and mother of an HIV positive daughter, prays every day that her status is never revealed to society.

“I contracted the disease from my husband who passed away a few years ago. I have been running around in search of a stable home since my disease was confirmed a decade ago. Some landlords asked me to vacate after they realised I was struggling to pay their rent. If the current landlord knows I am HIV-positive he will chase me out of the flat. Even in my daughter’s school, I have told only the principal about her condition. I pray that when she learns about her condition, she accepts it and gets the strength to live with it,” she says, tears welling in her eyes.

Since the first diagnosis was made among sex workers, the stigma associated with it has remained a challenge, say health experts.

Rama Pandian, project director, Tamil Nadu Network of Positive People, says, “Maybe, families have extended support to people with HIV. But the society still considers them outcasts. There is still a lot of talk about moral values. I don’t know when the society will look beyond it and accept that people with the disease are an entity, just like they are.”

Profiles have changed but women are still at risk.

In Chennai, like every year, in 2019 too, 992 new cases were diagnosed without much change in the rates over the last five years.

“With more testing centres added this year, we tested more people. However, the rates of infection is equal. While earlier we saw more men carrying the disease, now the ratio is almost equal at 55:45 between men and women. Women are still a higher risk group,” he says, stressing on the need for preventive strategies targeting women.

TNSACS sees the higher rates among women as a sign of the success of their approach that has made women the starting point of diagnosis. “We have made it mandatory for every pregnant woman to be tested for the disease in the state. Through them, we move to their spouses, ensuring that they are diagnosed early,” says the TNSACS source.

Community has to come forward

The World Health Organisation’s theme this year is ‘Ending the HIV/AIDS Epidemic: Community by Community’.

The community should come forward, including transgenders, injecting drug users, along with the team of outreach workers, counsellors and civil society, points out Gowda.

In Coimbatore, the Native Medicare Charitable Trust has launched Sandippom, an organisation focusing on the upliftment of those living with the disease through opportunities to run their own businesses, skill development programmes, etc.