'Prevention is better than cure'

Broadening HIV prevention for India's most at-risk populations

Earlier this month, health professionals in India gathered with experts from the Johns Hopkins University School of Medicine, The Fenway Institute, and USAID to learn about the latest evidence-based practices for HIV prevention.

India is home to the second-largest population of people living with HIV in the world and about 62,000 new cases emerge each year. As India broadens its prevention strategies, the seminars covered two HIV prevention medications: PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis).

PEP is a medication taken after HIV exposure to reduce the chances of infection and PrEP is taken before exposure to help prevent infection. 

While there has not yet been a public sector rollout of PrEP or PEP in the country, there is demand. Through the support of PEPFAR and USAID, ACCELERATE develops novel models for HIV prevention strategies for at-risk populations that can help inform the local, state, and national HIV response.

“PrEP really works to prevent HIV, and with high adherence the efficacy can definitely be improved,” said Jalpa Thakker, program director for ACCELERATE at the Johns Hopkins University School of Medicine. “We need to make sure that PrEP is a choice, and providing different choices for PrEP can also improve the uptake and adherence.”

Sukhvinder Kaur, Project Management Specialist, USAID, highlights the importance of Thakker's statement, emphasizing that educating healthcare providers and communities on PrEP and other innovative testing and prevention strategies is crucial in implementing effective programs towards ending HIV in India.

For instance, the program has delivered PrEP to more than 1,200 people through the web-based platform Safe Zindagi since 2020. Meanwhile, the program’s Mitr clinics—the first comprehensive health clinic model for and by the transgender community—have created access to PrEP for key populations with the support of the John C. Martin Foundation.

Kanchan Pawar, a Mitr clinic medical officer, emphasized the demand for PrEP in communities, along with some of the challenges.

“PrEP is really needed in India, particularly in the young and sexually active, transgender, and gay populations,” Pawar said. “But there is a need to address persistent structural and social barriers for PrEP uptake.”

Increasing the acceptance, accessibility, and affordability will be important factors as policymakers, health professionals, and other stakeholders pave the way for PrEP in India. 

During the discussion, Kevin Ard, Medical Director, LGBTQIA+ Health Education Center, The Fenway Institute, Assistant Professor of Medicine, Harvard Medical School, highlighted the time-sensitive nature of nPEP and emphasized the importance of following the 48-72 hour timeline. In addition, he suggested that barriers to PrEP uptake, such as limited availability and awareness about timelines, should be addressed through a 24/7 hour hotline for nPEP.

Building on this, Kenneth Mayer, Professor of Medicine at Harvard Medical School and Research Director at The Fenway Institute, stressed the significance of judiciously utilizing both existing and new technologies to extend PrEP and PEP in India and other parts of the world. He suggested that regarding PrEP as primary care could lead to better overall health outcomes. Meanwhile, Trena Mukherjee, Biomedical Prevention Advisor Division of Prevention, Care & Treatment, Office of HIV//AIDS, USAID, suggested implementing differential service delivery approaches, such as telemedicine, providing starter kits, and integrating other service delivery entry points such as non-communicable diseases, mental health and a tuberculosis screening, to enhance the accessibility of PrEP and generate greater demand and uptake.

Ishwar Gilada, CMD at Unison Medicare and Research Center, IAS, emphasized the need to expand HIV education among the younger generation by coupling it with information about other sexually transmitted infections. Megan Coleman, Senior Technical Advisor for Key Populations at the USAID Bureau for Global Health, pointed out that some of the first steps to reducing stigma around HIV require an understanding of one’s rights and continued awareness of how to access available resources. Ground-level advocacy has played a crucial role in increasing awareness and driving demand for PrEP. 

During the seminar, Deepika Srivastava, Chief HIV & AIDS Division, USAID, discussed the importance of PEP in preventing HIV infection. "In addition to PrEP, PEP for HIV is an equally important tool for minimizing the risk of infection following potential exposure to HIV," she said.

"So PEP is not just an additional HIV prevention tool but a key component of a comprehensive HIV prevention package. It's also an essential component of the minimum package of post-violence, clinical care services."

The seminars highlighted the significance of prevention in tackling the HIV epidemic. While there are challenges to overcome, ACCELERATE and its partners are committed to developing novel models for HIV prevention strategies and expanding the reach of PrEP and PEP in India. 

The full seminars are available on the ACCELERATE YouTube channel: PEP and PrEP. Are you interested in attending future seminars on HIV prevention and care in India? E-mail us: accelerate.2030@gmail.com 

ACCELERATE, a five-year #USAID and #PEPFAR-supported HIV program, under the leadership of the National AIDS Control Organisation & State AIDS Control Societies provides assistance to the national, state, and district HIV/AIDS programs to deliver comprehensive HIV prevention and treatment services to vulnerable populations including people living with HIV, key populations and their partners, as well as orphans and vulnerable children. The effort is led by The Johns Hopkins University School of Medicine and partners YR Gaitonde Centre for AIDS Research and Education (YRGCARE), The Fenway Institute, and Blue Lotus Advisory.