The prognosis for people living with HIV/AIDS has been transformed through anti-retroviral therapy (ART), which is the use of medicines to treat HIV infection, and it is recommended for everyone who has HIV. ART helps people with HIV live longer, healthier lives and reduces the risk of transmission to others.
Now, new analysis has established that further investment in preventing the spread of HIV/AIDS through ART is one of the 12 best investments that India can make to speed up its achievement of the Sustainable Development Goals. This finding is an early result from a study that looks at India’s attempts to implement SDGs.
There are 169 targets in total aiming to do everything from improving nutrition and cutting communicable disease to expanding green spaces and improving the jobs worked by everyone. All of these are great things to do, but not a single nation can afford to achieve every single goal fully before 2030.
Now, India is the first country in the world to have 100 of its government programmes studied to establish which will do the most to advance the Goals. This work was undertaken by India Consensus, a partnership between Tata Trusts and Copenhagen Consensus.
This could make a huge difference: for example, if India were to spend Rs 50,000 crore more to achieve the SDGs, focusing on the most phenomenal programmes identified by India Consensus to date would create extra benefits for India worth Rs 20 lakh crore — more than the entire Indian public consumption.
The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. Over time, its focus has shifted from raising awareness to behaviour change, and from a national response to a more decentralised response that increases involvement of NGOs and networks of people living with HIV/AIDS.
The programme is now in its fourth phase and aims to reduce new infections by 50% from 2007, and provide comprehensive care to all persons living with HIV/AIDS. Importantly, prevention is a priority of the government under the National Strategic Plan with almost two-thirds of the NACP budget allocated towards prevention strategies, and nearly 20% going toward high-risk groups.
And a very significant part of prevention is treating people who become HIV positive, as soon as possible. The aim is to extend HIV treatment for all infected persons regardless of how advanced their HIV is. This speaks to the importance of intervening early.
There are several studies that have estimated the benefits of early adoption of ART in India.They suggest that every rupee spent on ART for someone living with HIV achieves benefits to society (from the reduction in transmission and a better, healthier life for the person living with HIV) worth about Rs 8-9. A study that focused on a concentrated epidemic setting found even higher benefits.
A recent review showed that the cost effectiveness of prevention varies substantially depending on the exact strategy, target group, and country. Condom promotion to men who have sex with men and female sex workers in Vietnam created benefits to society worth 60-times and 20-times the investment, respectively. Prevention of mother to child transmission (achieved through medicine) also had a very good return on investment in different settings.
Three studies in India show that focusing on prevention in high-risk groups have yielded very high returns to society in India. One study looked at the Avahan programme of community mobilisation and empowerment, and another studied peer-led counselling for behaviour change towards safer sexual practices, condom promotion and quarterly referral for health check-ups yields. All studies showed returns to society in the hundreds for every rupee spent.
A study by India Consensus found that HIV prevention under NACO is assessed as a phenomenal investment. Obviously, the cost-effectiveness of HIV prevention will vary substantially from one population to another, and will be affected by what other interventions are being made. However, the evidence suggests very high returns. Preventing a case of HIV/AIDS, whether through condom provision, community mobilisation, counselling, or treating those living with HIV/AIDS at the earliest opportunity, can transform lives and save untold heartache.
(The writer is President of the Copenhagen Consensus Centre and Visiting Professor at Copenhagen Business School)