Community empowerment
Even though India has prioritised interventions among key sub-populations (like sex workers, men who have sex with men, injecting drug users, migrants), one of the larger goals that still remains is to ensure that community itself leads the targeted interventions, with NGOs acting as only gatekeepers, feels Gangakhedkar. "Community-led structural interventions should have complete control on all kinds of prevention and control services. Community-based HIV testing should improve and even ART centres for these sub-populations should be hosted in community-based organisations with some technical support (by a doctor or pharmacist) from outside. Once community starts managing their own programmes they will also manage their other day-to-day non-health-related problems as well.
"The marginalized and disempowered communities have to be empowered in a more holistic manner so that they do not remain vulnerable to just HIV/AIDS, but to other diseases too. Community voices have to become stronger and inequity between main-stream and key sub-populations reduced substantially. We must be advocates to provide the right kind of support to the community organizations so that they lead by themselves; but we should not be part of these organizations. This is the kind of advocacy I foresee myself doing in the coming years," he said.
#endAIDS by 2030
As of today, only 14 lakh (1.4 million) of the estimated 21 lakhs (2.1 million) PLHIV in India have been diagnosed. This leaves an estimated 7 lakh (700,000) PLHIV who are not even aware of their HIV-positive status. Gangakhedkar called for prioritizing and intensifying community-based testing all over the country. "But rapid scale up of services should not be at the cost of quality of services. Only by improving quality of services and intensifying our strategies will we be able to achieve the last 90 of the UNAIDS goal of maintaining virological load suppression for elimination of HIV/AIDS."
There is also a dire need for implementation research in HIV/AIDS, to not only identify the gaps but also the solutions at each level of implementation. A completely decentralised approach for decoding of evidences and modification of policies is vital. There is no one size that fits all. We have to build the capacity of those involved with the interventions so as to be able to interpret the evidences and have strategies that are locally adapted, he said.
Some proud achievements
When Dr Gangakhedkar started his career in HIV there was no treatment available. At times he would feel frustrated that as a doctor he could do nothing beyond counselling his patients. But he persevered and, in his own modest way, brought about many changes in the HIV/AIDS-control scenario. His landmark study, done in India at a time when stigma around HIV was very high, found a very high prevalence of HIV amongst married monogamous women. This was contrary to the existing perceptions, as till then HIV was presumed to be prevalent in only high-risk populations like sex workers, MSMs, and injecting drug users. "But my study proved that a very high percentage of married monogamous women acquired HIV infection--not because of their behaviour but because of the risk behaviour of their husbands. The study results were extensively used for HIV-related advocacy work all over SE Asia region. It also led the policy makers to have women-centric prevention approaches. The focus was suddenly shifted to women in mainstream population, resulting in interventions like PPTCT."
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