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Identifying the challenges and the critical areas for mounting a better response against the HIV epidemic in low- and middle-income nations


1 Vice-Principal Curriculum, Member of the Medical Education Unit and Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpattu, Kancheepuram, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpattu, Kancheepuram, Tamil Nadu, India

Date of Submission11-Jun-2019
Date of Decision22-Aug-2019
Date of Acceptance15-Oct-2019

Correspondence Address:
Saurabh RamBihariLal Shrivastava,
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpattu, Kancheepuram, Tamil Nadu - 603 108
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_166_19

  Abstract 


HIV continues to remain one of the major public health concerns for more than 3 decades and has accounted for the deaths of 35 million people till date. Despite making considerable progress in the response against the disease, it continues to pose major threats across all the regions. This is mainly because the reach of services is inadequate and that the scale up plan is also slow. Another major challenge is the rise in the incidence of a number of conflicts and other humanitarian emergencies, which not only jeopardize the health delivery system, but also forces the people to migrate to other regions, which might again pose a major pressure on the health system of the recipient nations. This is a high time to focus on the critical areas and further strengthen the existing momentum of the HIV response by the nations. In conclusion, HIV infection is a major public health concern and all the involved sectors and stakeholders have to work together to keep the infection under check and improve the quality of life of the infected people.

Keywords: HIV, stigma, vulnerable population



How to cite this URL:
Shrivastava SR, Saurabh PS. Identifying the challenges and the critical areas for mounting a better response against the HIV epidemic in low- and middle-income nations. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Mar 5]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=308713




  Introduction Top


HIV continues to remain one of the major public health concerns for more than three decades and has accounted for the deaths of 35 million people till date.[1] In fact, in the year 2017 alone, 1.8 million and 0.94 million people were infected and died because of the disease, respectively, across the globe.[1] Since the start of the century, the incidence of infections and deaths has reduced by 36% and 38%, respectively, and this is predominantly because of the concerted efforts of policymakers and involved stakeholders.[1] Further, threefourths of the HIVinfected people were of their status, whereas close to 22 million people have been started on antiretroviral therapy worldwide.[1]

Understanding the ground reality

Despite making considerable progress in the response against the disease, it continues to pose major threats across all the regions, especially in low and middleincome nations.[2],[3] This is mainly because the reach of services is inadequate and that the scaleup plan is also slow. [2,[3],[4] Analysis revealed that a large proportion of vulnerable population is not covered equitably, and these disparities exist in access to diagnostic, treatment, and care services.[2],[4]

Existing challenges

The problem of stigma and discrimination has complicated the issue of access to the muchneeded services.[1] Further, the services should be more intensified in low and middleincome nations, which together hosts more than twothird of the HIVinfected people, but then, these nations have their own challenges of multiple other public health priorities, weak public healthcare delivery system, and minimal support from the welfare/donor agencies.[1],[4]

Another major challenge is the rise in the incidence of a number of conflicts and other humanitarian emergencies, which not only jeopardize the health delivery system, but also forces the people to migrate to other regions, which might again pose a major pressure on the health system of the recipient nations.[2],[3] Simultaneously, it is quite essential to sustain the quality of the delivered services, as any gaps in that regard are bound to affect the effectiveness of the program.[4] Further, policymakers have to deal with the rising trends of coinfections and other comorbidities, as they essentially determine the outcome of the infection.[1],[4] Finally, it is important to note that the implementation of earlier strategies won't deliver encouraging results in future as the infection is constantly evolving, with definite evidence of the emergence of drug resistance.[1],[2]

Need of the hour

This is a high time to focus on the critical areas and further strengthen the existing momentum of the HIV response by the nations.[3],[4],[5] The prevention package of services has to be further strengthened through the addition of new tools, and our target should be to ensure that all people living with the infection should be aware of their status.[5] Further, the available treatment should be expanded to all the infected people and all measures should be taken to offer holistic care for them.[3] Finally, measures have to be taken to reach the vulnerable population group, and the aim should be to minimize the involved cost (in both diagnostic and treatment areas).[1],[2]


  Conclusion Top


In conclusion, HIV infection is a major public health concern in low and middleincome nations, and all the involved sectors and stakeholders have to work together to keep the infection under check and improve the quality of life of the infected people.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. HIV/AIDS – Key Facts; 2018. Available from: https://www.who.int/en/news-room/fact-sheets/detail/hiv-aids. [Last accessed on 2018 Jan 15].  Back to cited text no. 1
    
2.
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;10:509-10.  Back to cited text no. 2
  [Full text]  
3.
Shrivastava 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 Pioneer Med Sci 2016;6:77.  Back to cited text no. 3
    
4.
World Health Organization. Global Health Sector Strategy on HIV, 2016-2021. Geneva: WHO Press; 2016. p. 1-18.  Back to cited text no. 4
    
5.
Barber TJ, Saunders JM, Barnett N. Person-centred care and HIV: Challenges and solutions. Sex Transm Infect 2018;94:582-4.  Back to cited text no. 5
    




 

 
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