Dr. Sunil Solomon, An associate professor at Johns Hopkins University School of Medicine explains Vivek Roychaudhura importance SafeZindagi.com’s “virtual” information initiative to survey, diagnose and treat segments with a higher severity of HIV infection. He also predicts that with the advent of long-acting drugs, the future of HIV prevention and treatment may be as simple as one or two injections every 4-6 months, similar to getting a booster from COVID

Dr. Sunil Solomon, your mother Dr. Suniti Solomon’s diagnosis of India’s first AIDS cases among sex workers in Chennai in 1986 was the first difficult step that forced the country to abandon denial of AIDS levels. Has the country managed to put the stigma of HIV in the future, given that we see the same opposite in varying degrees to many diseases ranging from cancer, tuberculosis and even SARS-CoV2 infection in the early stages of a pandemic?

Stigma is something that does not change overnight. Generations are needed to change and accept. But the stigma to HIV has diminished over the years. I still remember my mother desperately trying to find a hospital that would be willing to give birth to an HIV-infected woman in the 90s. Today I have a choice based on patient preferences.

But stigma against HIV alone is not enough. There are several vulnerable groups, such as men who have sex with men, people who inject drugs, trans women and sex workers – we condemn them without trying to understand them. As long as we don’t really recognize that we are all human and we all make choices for a reason and can’t accept the cause, HIV will continue.

But the only thing HIV has taught us is the power of communities and propaganda, which is not enough for other diseases. Stigma exists for some conditions due to ignorance – literacy in the treatment of these other diseases can help alleviate stigma.

The only thing missing from the list is mental health – in my opinion, we all have some mental health problems and in some special sense “crazy”, but mental health is something that is rarely talked about, and COVID really discovered this. I would almost put mental health above all these other conditions and would plan campaigns to make it normative rather than a taboo subject.

What have been the initiatives to increase the number of examinations and diagnoses in recent decades?
The Government of India and the National AIDS Organization (NACO) have done an excellent job of expanding access to HIV diagnosis – there are more than 5,000 centers across India where people can get tested for HIV. In addition, the community conducts surveys of key populations as well as through community organizations. The challenge is to shape the demand and literacy of treatment with respect to the benefits of early diagnosis and treatment.

So I would say it’s more a question of demand than a question of supply. Ways of communication have changed, and much of the information about health today comes through social media rather than the press, and NACO is now expanding to include social media in dissemination, which I think will further improve screening.

What is the difference between the Safezindagi.in initiative launched on the last World AIDS Day, and what gaps is it trying to close?
SafeZindagi is something we are experimenting with in cooperation with national AIDS programs and funded by PEPFAR / USAID. What has happened in the last decade is the penetration of the internet and mobile dating / connection sites across India. This has led to the fact that the population searches for sexual partners online or buys drugs online, and physical objects do not reach these populations.

SafeZindagi’s goal is to reach these populations and provide them with education, testing, and a connection to online help through “virtual” outreach workers. The vision is to make it a completely virtual clinic to meet the health needs of the “Swiggy” generation.

What reactions and developments have been made so far from this initiative?
I have to say that I am surprised by what we have seen over the last year and a half. We have provided HIV testing services to more than 3,000, and HIV self-testing services to more than 2,500 clients from these virtual locations. Surprisingly, most have a very low risk of HIV infection, although approximately every 20 HIV tests were positive.

But more surprisingly, the vast majority of them have never been tested for HIV before. Given the overall prevalence of HIV in India in the population is about 0.2 percent, the customers we can test through these highways have almost 25 times the severity of HIV.

HIV infection comes along with concomitant TB infections, etc. How does this complicate the treatment of the disease?
As I mentioned earlier, the key is early diagnosis and treatment. If we are able to detect and treat them early, they lead a normal life by simply taking one pill a day, with almost no side effects, and we don’t need to worry about co-infections.

In fact, tuberculosis is more complicated and drugs are more toxic than HIV drugs. This complicates treatment due to drug interactions, but there are now enough drugs available in both the public and private sectors to manage both conditions. But, as I said before, the easiest way to treat TB with HIV is to prevent it through early diagnosis and treatment.

What is the cost of HIV severity at the individual, community, and national levels?
At the individual and community level, if you seek help in the public sector, the costs essentially consist of your transportation to the place and the loss of wages per day – so minimal. The recent introduction of dolutegravir (a very potent and safe drug) in the public sector puts the public sector program in India on a par with any other country, including the US and Europe.

At the national level, most people with HIV are in the economically productive age group of 20-50 years, and therefore, in my opinion, their performance offsets the cost of drugs. The number of new infections each year has also declined, and the key to making it even more cost-effective is to reduce the number of new infections and the most effective way to do so is to attract as many people as possible to treatment. People who receive effective HIV treatment do not transmit HIV to others because the amount of virus in their blood is too low for effective transmission.

What have been the latest innovations in the fight against HIV in India? Are these innovations available to vulnerable populations in India and around the world?
As I mentioned earlier, the introduction of dolutegravir in the public sector, in my opinion, will change the game. And it’s free for everyone through the public sector. The introduction of remote medical care and multi-month dispensation (dispensing several months of medication at a time) are also excellent means of maintaining treatment and accessible to all.
The biggest change in the game of HIV in the world is the introduction of long-acting drugs for the treatment and prevention of HIV. They have recently been approved by the US FDA and we are only seeing the first generation of these drugs. Given the conveyor belt, I believe that the future of HIV prevention and treatment may be as simple as one or two injections every 4-6 months. That’s where the field goes. This will be similar to getting a COVID amp.

You received a $ 35 million grant from USAID to implement and evaluate innovative service delivery models to improve the HIV care cascade in India with a focus on vulnerable populations. Can you give us information about your work to improve HIV care in India?

The COVID-19 pandemic has hampered our progress and plans in many ways. But still, despite the pandemic, we have been able to implement new models and strategies that are now being evaluated. As I mentioned, the online platform safezindagi.in has opened my eyes to the risk that exists in the private sector. With this platform, we were also able to conduct HIV self-testing in India for the first time, as well as gain access to Risk Prevention (PrEP) for these vulnerable virtual populations.

We are also experimenting with a stand-alone model of HIV care led by the TAAL + HIV community in Pune. We have established in Hyderabad one of the first clinics of integrated health care for transgender communities under the leadership of the trans community – “Mitr Clinic”. Since then we have also set up two more in Maharashtra. The goal is to provide society with a space where they have access to their health needs.

We have also set up teen-friendly wellness centers for children and adolescents living with HIV and their siblings with the aim of not only improving their HIV outcomes but their lives in general.

[email protected]

[email protected]

Source by [author_name]