Written By: Shraddha Rupavate | Updated : May 19, 2014 12:06 PM IST
For years, the public health policy makers have been pretty clear about HIV prevention - wear a condom, prevent HIV. Now we might finally might have a different solution, with the US Centers for Disease Control and Prevention (CDC) releasing new guidelines which suggest taking an HIV prevention pill called Truvada. We further ask experts whether such an approach would work in India...
On May 14, the first detailed clinical practice guidelines on pre-exposure prophylaxis (PrEP) for HIV prevention were released by a working group led by the US Centers for Disease Control and Prevention (CDC).
According to the PrEP guidelines, people who are at an increased risk of developing HIV should take anti-HIV medicines to prevent HIV infection and progression to AIDS. This approach has been shown to effectively reduce HIV infection rates in individuals by 90%. The guidelines recommend the use of the U.S. Food and Drug Administration (FDA) approved combination drug called Truvada. Here are details about the news: Now, prevent HIV if you think you've been exposed to the virus.
As per the guidelines, the high risk individuals who are recommended to take PrEP include:
Will it work in India?
While the PrEP approach looks efficient, whether it will be suitable for Indians and whether India should also come up with such guidelines for HIV prevention is still questionable. Dr Ratan Vaish, senior consultant, department of medicine, Rockland Group of Hospitals, and Dr Anita Arora, HOD of Quality and Principal Consultant Microbiology at FMRI, throw some light on the possibility of PrEP in India.
Is an approach like PrEP being used anywhere in India?
No. Currently India does not have any pre-exposure prophylaxis or a similar approach for HIV prevention, experts say.
How relevant is PrEP in India? Should it be made available for everyone?
Both the experts believe that PrEP would be relevant to Indians but making it available for everyone would be challenging. 'An additional approach to prevention of this nature is definitely welcome. However, a well thought out approach would be needed before it is made available to everyone in view of certain challenges,' says Dr Arora.
PrEP cannot be made available for everyone without identifying high risk groups. 'If guidelines for PrEP in India are to be made, then identification of high risk group individuals definitely needs extra efforts,' says Dr Vaish.
So then what do you think would be the challenges in implementation of such guidelines for Indians?
Social stigma: Both experts agree that the biggest challenge would be to overcome social stigma surrounding HIV. 'In India, a sizeable population suffering from HIV belongs to the low socio-economic strata, where social stigma is highly prevalent' says Dr Arora. 'Because of the social stigma and lack of support from family members and society, it is very difficult to ensure anti-HIV medicines are taken by every individual at high risk,' adds Dr Vaish.
Lack of education and awareness: Making peopleaware about the existence of PrEP once it is made available would be challenging. Even if a few people are aware, it will still not be sufficient. 'Because of lack of education and awareness, most individuals at high risk would be reluctant to express their problem and take medicines,' says Dr Vaish.
Cost of the medicines: Due to the poor economic status of high risk individuals in India, affordability of anti-HIV medicines will be a big challenge. 'The government should work towards setting up free of cost or low cost services for ensuring that every individual at high risk can afford them,' says Dr Vaish.
Dr Arora also believes that additional cost of diagnosis and compliance to the course of medicines as well as follow testing would be challenging.
Additional cost of diagnosis: To identify high risk individuals previously infected with sexually transmitted diseases, diagnosis is necessary. This again will be challenge because of lack of awareness among people.
Ensuring compliance: Adherence to the course of any therapy and follow up testing is already a big problem in India. If PrEP for HIV is to be introduced then additional thought for ensuring compliance is also required. 'Also, making the approach available for everyone would be risky because if the medicine is taken blindly by an HIV negative person then there are high chances of development of resistance to antiretroviral therapy. And it may happen that in future the medicines may not work if the person gets exposed to HIV. This will further increase the cost of medicines and chances of side-effects,' says Dr Vaish.
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