HIV/AIDS remains one of the most pressing health challenges worldwide, with India bearing a substantial burden of cases. According to the National AIDS Control Organization (NACO), approximately 2.4 million people live with HIV in India, making it the third-largest epidemic globally. While significant progress has been made in combating HIV/AIDS through prevention programmes and antiretroviral therapy (ART), accessibility and affordability of treatment continue to be formidable barriers for many individuals. This article explores the main challenges and opportunities in ensuring equitable HIV/AIDS treatment in India, offering insights relevant to healthcare professionals, policymakers, and organisations.
India’s Battle Against HIV/AIDS: Current Treatment Scenario
Access to Antiretroviral Therapy (ART) India has made significant strides in expanding ART coverage, with over 1.5 million people receiving
free treatment under the National AIDS Control Programme (NACP). Introducing fixed-dose combinations and efforts to decentralise treatment centres have improved accessibility in rural and semi-urban areas. However, an estimated 40 per cent of individuals with HIV remain untreated, primarily due to lack of awareness, stigma, and logistical barriers.
Affordability of medication
While ART is free of charge through government programs, out-of-pocket expenditures remain high for diagnostic tests, opportunistic infection management, and supplementary medications. Moreover, the private healthcare sector often charges exorbitant fees, placing life-saving treatment out of reach for marginalised populations.
Challenges in accessibility and affordability
Stigma and Discrimination
Social stigma remains a critical deterrent for individuals seeking diagnosis and treatment. Many patients fear discrimination in healthcare settings, employment, and communities, leading to delayed diagnosis and treatment initiation. Despite legal protections, societal attitudes often prevent individuals from accessing care confidently.
Geographical disparities
Healthcare infrastructure in India is highly concentrated in urban centres, leaving rural areas underserved. The lack of ART centres in remote regions forces patients to travel long distances, increasing financial and time burdens. Furthermore, interruptions in treatment due to geographical constraints can lead to drug resistance, complicating disease management.
Limited funding and resource allocation
While the government has committed significant resources to the NACP, funding gaps remain. India’s health expenditure, at 3.2% of GDP, is among the lowest globally, which limits the reach of programmes targeting HIV/AIDS. Insufficient allocation of funds also affects the quality of services,
including the availability of second- and third-line ART for patients with drug resistance.
Inadequate awareness and testing
Despite efforts to promote HIV testing, many individuals remain unaware of their status. The fear of being ostracized prevents many from accessing voluntary counselling and testing services (VCTS).
Additionally, misconceptions about HIV transmission and treatment perpetuate myths, further discouraging early diagnosis and intervention.
Opportunities for Improvement Leveraging Technology for Wider Reach
Telemedicine and digital platforms can play a transformative role in enhancing accessibility. Virtual consultations can bridge the gap between patients in remote areas and healthcare providers, reducing the need for physical travel. Mobile applications and SMS-based reminders can also
improve adherence to ART regimens.
Policy reforms for greater inclusivity
India’s HIV/AIDS (Prevention and Control) Act, 2017, is a critical step towards protecting the rights of people living with HIV (PLHIV). Strengthening the enforcement of this legislation and incorporating it
into public awareness campaigns can reduce stigma and discrimination. Additionally, policies incentivising private sector participation in affordable HIV treatment could increase overall access.
Community-based interventions
Grassroots-level interventions led by non-governmental organizations (NGOs) and community health workers have proven effective in reaching vulnerable populations. Training local health workers to provide basic counselling and distribute ART can decentralise care and make it more accessible.
Public-Private Partnerships
Collaboration between the government, private sector, and international organisations can boost resources and expertise for HIV/AIDS programmes. PPPs can support the development of cost-effective diagnostic tools, procurement of ART, and establishment of treatment facilities in underserved areas.
The role of innovative financing
Global funding support
International organisations such as the Global Fund to Fight AIDS, tuberculosis and malaria have been instrumental in funding HIV/AIDS programs in India. However, with shifting donor priorities, India must explore innovative financing mechanisms to sustain its initiatives.
Health insurance penetration
Expanding health insurance coverage to include comprehensive HIV treatment can reduce out-of-pocket expenditures for patients. Ayushman Bharat, India’s flagship health insurance scheme, could be leveraged to provide holistic care for PLHIV, including diagnostics, ART, and opportunistic infection management.
Subsidised drug manufacturing
India is a global leader in generic drug production, supplying affordable ART to low- and middle-income countries. Strengthening domestic manufacturing capabilities and streamlining regulatory processes can ensure the consistent availability of affordable HIV medications within the country.
Building awareness and advocacy
Educational campaigns
Targeted educational campaigns are crucial to dispel myths about HIV/AIDS and encourage early testing and treatment. Campaigns should focus on high-risk groups, including sex workers, injecting drug users, and transgender individuals, while also addressing the general population.
Workplace programmes
Collaborating with businesses to implement workplace HIV/AIDS programs can promote awareness, reduce stigma, and encourage testing. These programs can also ensure non-discriminatory practices for employees living with HIV.
Youth engagement
With young people comprising a significant portion of India’s population, engaging them through social media, workshops, and peer education initiatives can help normalize conversations about HIV prevention and treatment.
A call to action
Ensuring accessibility and affordability of HIV/AIDS treatment in India requires a multi-faceted approach involving collaboration between governments, businesses, and communities. Breaking down barriers such as stigma, geographical constraints, and financial hardships is critical to achieving universal healthcare for PLHIV. By investing in innovative solutions, strengthening policy frameworks, and fostering public-private partnerships, India can continue its progress towards an AIDS-free generation.
This effort is not just a moral imperative but a strategic necessity for building a healthier, more equitable society. As stakeholders in this mission, the responsibility lies with all of us healthcare providers, policymakers, and the business community to ensure that no one is left behind in the fight against HIV/AIDS.
Conclusion
India’s journey in combating HIV/AIDS has shown that progress is possible with sustained effort and commitment. However, achieving equitable treatment access and affordability demands continuous
innovation, resource mobilisation, and community engagement. Together, we can overcome these challenges and move closer to a world free of HIV/AIDS.