KOCHI: Two decades have passed since the global human immunodeficiency virus (HIV) epidemic peaked in 2004. Significant progress has been made in curbing its spread and reducing AIDS fatalities.
“Ending AIDS as a public health threat by 2030 is within reach,” said UN Secretary-General António Guterres on World AIDS Day (1 December).
However, he cautioned against complacency, urging global leaders to “commit to dismantling barriers to healthcare and upholding human rights”.
“Every 25 seconds, someone in the world is infected with HIV,” Guterres noted. “One-quarter of people living with HIV – more than nine million people – lack access to lifesaving treatment.”
This prompted us to take a look at the situation in Kerala.
First, a flashback
The world first identified HIV in humans in 1959. Within a few decades, this virus became one of the deadliest threats the human race has ever faced.
In 1981, the epidemic gained attention when a few men in the US were diagnosed with pneumocystis pneumonia, a condition common in patients with low immunity or those undergoing organ transplantation. This was the first detected manifestation of AIDS, the final stage of HIV infection.
Fear grew as the virus spread worldwide, infecting thousands. The epidemic peaked in 2004, with over 31 lakh deaths due to AIDS that year alone.
In India, HIV cases surged during the 1990s and early 2000s, sparking panic and stigma. HIV-positive individuals, including children infected through parent-to-child transmission, faced alienation. Relatives, friends, and even some medical practitioners avoided them.
The first HIV case in Kerala was detected in 1987, a year after the first Indian case where two doctors found HIV among female sex workers in Chennai. Panic and stigma existed here as well.
Care homes were established across Kerala, especially for children ostracised because of their HIV status. “The 2000s were terrifying for people with HIV,” recalls Fr Jose Kizhakedath, who oversaw activities at one such care home under St John’s Health Services in Thiruvananthapuram.
“They had to endure not only a predicted, disease-ridden short life but also complete societal alienation. Only government medical colleges treated HIV-positive patients, as many private hospitals refused to do so.”
St John’s Health Services, originally established to treat leprosy patients, stepped in to provide care for HIV-positive individuals. “A life with dignity had been denied to these people,” Fr Jose adds. “Children from across Kerala lived here and studied at our residential school. All had been HIV-positive and rejected by society.”
Positive strides
Today, the situation has improved significantly. The centre no longer operates as a residential school. “The 15 children currently living here attend regular schools in the district,” Fr Jose explains.
“They are all over the age of 10. We have not received new cases. The infection rate is now low, and there have been advancements in treatment,”
The widespread panic surrounding HIV/AIDS has largely dissipated, with discussions mostly limited to World AIDS Day.
“With greater awareness, the infection rate has dropped below 1 per cent,” says Anson P D, managing director of Kanal, an NGO that coordinates the Project X sex education programme. “Screening is now quicker and easier. Every hospital routinely tests for HIV during surgeries or pregnancies.”
Between April 2022 and March 2023, Kerala reported only 1,183 positive cases out of 14,10,679 tests. From April to October 2023, just 724 cases were detected — far lower than the 50,000 cases reported annually during peak years.
According to sexuality educator Dinta Suresh, improved treatment has been transformative. “Testing is free in government hospitals, as is antiretroviral therapy (ART). Now, even those who test positive show negligible viral loads,” she says.
Anson agrees. “Mother-to-child transmission during pregnancy has been almost eliminated. In some cases, patients now show negative viral loads,” he notes.
However, Dinta highlights that antiretroviral medicines, which need to be taken regularly, remain expensive.
National data reflects optimism. Between 2010 and 2022, India’s infection rate fell by 44.23 per cent, outpacing the global decline of 39 per cent. However, certain groups have higher prevalence rates, including people who inject drugs (9.03 per cent), transgender individuals (3.78 per cent), and men who have sex with men (3.26 per cent).
Cautious optimism
On World AIDS Day, Chief Minister Pinarayi Vijayan expressed cautious optimism as he outlined Kerala’s “95:95:95 target” for 2025. “The first goal is to ensure 95 per cent of affected individuals are aware of their condition. The second is to provide ART to 95 per cent of those infected. The third is to control the virus’ spread [by 95 per cent],” he explained on Facebook.
Density of HIV affected people was low in Kerala, he added. “However, the chances of spread among the population is also high here. In this scenario, the need for disease prevention programmes and spread of awareness is vital,” Vijayan noted.
Dr Edwin Peter, founder of Sexual Education Kerala, echoes similar views. “Intravenous drug use is rising again. Unhygienic needle-sharing could lead to a resurgence of HIV among youth,” he says.
He also points to the “increasing sexual liberation” among younger generations. “Without proper sex education, rising drug use, and unprotected sexual activity, we may see higher infection rates in the future,” Edwin cautions.
Where’s the vax?
The research for HIV prevention vaccine began about 30 years ago. There has been no breakthrough so far. However, what’s being described as “closest to a vaccine” was found against the virus recently - a shot that needs to be administered twice a year.
As of now, the leading preventative measure globally has been pre-exposure prophylaxis (PrEP) therapies. People, including those whose partners are HIV+, can take medications to prevent infections.