This year’s World AIDS Day theme, “Let communities lead" palpitates as a powerful call to action, urging communities living with, at risk of, or affected by HIV to actively engage in shaping and supporting initiatives to combat the virus. India, with the third-highest burden of HIV globally, is facing a critical situation. The 2022 HIV estimates indicate that around 2.47 million people are living with HIV in the country, making this approach especially crucial. To effectively reduce the disease burden and transmission, a targeted focus on high-risk groups is essential, which include sex workers, men who have sex with men, IV drug users, prisoners and other risk groups. Testing and treating HIV emerge as pivotal tools in the arsenal against the virus.

Importance of treatment
In recent years, good evidence has emerged to support the assertion that when HIV is undetectable, it is untransmittable (U=U). "Undetectable" refers to individuals undergoing treatment who maintain an undetectable viral load in their blood, rendering them unable to sexually transmit the virus to others (untransmissible). It is crucial to raise awareness among the public about the significance of "Undetectable = Untransmittable'' (U=U). This awareness is crucial for overcoming taboos, fostering consistency in HIV treatment, and reducing the transmission of HIV. This, in turn, will contribute to a decline in new cases and alleviate the overall disease burden over time.

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PrEP and PEP
In addition to treatment, two other crucial modes of preventing HIV transmission are pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Individuals engaging in high-risk behaviours should be aware of these options and should consult with a doctor. It's important to note that these measures are not a substitute for safe sex through condom use. Condoms remain effective in preventing various other sexually transmitted infections, including syphilis and gonorrhoea, which are not addressed by HIV PrEP and PEP.

HIV treatment simplified
Current HIV treatment options are remarkably simple, often limited to a single pill. Anticipated advancements include long-acting injection medications for both prevention (PrEP) and treatment, administered once every few months. These innovations promise to enhance treatment adherence, optimize HIV infection management, and decrease transmission rates. The future of HIV control revolves around a comprehensive strategy: testing, with a focus on high-risk groups; treating those diagnosed; implementing PrEP for prevention; and offering PEP as needed.

HIV cure?
While a lot of research is happening in the field, cases of HIV cure without treatment are extremely rare. Only a handful of cases have been reported following stem cell transplants, which were performed for other reasons such as leukemia. Until we have a cure for HIV, let us focus on testing, treatment, PrEP, and PEP to protect ourselves and the population at large.
(Dr A Rajalakshmi, Senior Consultant, Department of Infectious Diseases, KIMSHEALTH) 

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