Drug offers 99.9% HIV shield, but Indians will have to wait
The main concern stems from the new injectable drug lenacapavir's substantial cost of Rs 24 lakh ($28,218) per person for two injections taken six months apart. Also, NACO (National AIDS Control Organisation) has not fully embraced PrEP (pre-exposure prophylaxis) medications, the category to which lenacapavir belongs.
"Our govt distributes condoms to break HIV transmission, it provides antiretroviral therapy drugs to prevent parent-to-child transmission of HIV, but it hasn't ever given PrEP to youngsters who are likely to indulge in high-risk behaviour," said health activist Ganesh Acharya.
A couple of years ago, NACO made it mandatory for its counselling centres to disburse information on PrEP. He is alarmed because 75% of the 88% diagnosed with HIV in Mumbai between 2023-24 were in the 15-49 age group that is classified as young.
PrEP is available for those seeking treatment in the private sector.
PrEP, as a method to prevent HIV transmission before a risky exposure, has been around for almost 12 years. It was widely accepted in developed countries, but India's public health machinery never mentioned it until a few years ago.
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"They set up a committee, then a white paper was brought out that served as a backgrounder for guidelines that were drawn up last year. However, there has been no development since," said a doctor with a public hospital.
Dr Ishwar Gilada of the People's Health Organisation (India) said PrEP is the lesser evil compared to HIV transmission. "The govt should distribute PrEP to check the spread of the disease, which has only been increasing in recent years.
The total number of HIV-positive people in India increased from 2.2 million to 2.5 million in a few years," he added.
The problem is more pronounced in Mumbai, he said, where the number of people with sexually transmitted diseases has been rising. "A recent survey in Mumbai among men who have sex with men found that 60% of them were positive for the human papilloma virus. While gonorrhoea and chlamydia vanished 25 years ago, their numbers are shooting up," said Dr Gilada.
PrEP would be the solution, according to him. The govt could adopt a three-tier payment system for PrEP: Charge full cost from those who can afford it, subsidy for some, and free for those who cannot afford medications. Despite efforts, NACO officials were not available for comment.
PrEP is not the only HIV-related policy that the govt hasn't acted on. Self-testing HIV kits, for instance, are not allowed in India. "We have self-testing kits for pregnancy, diabetes, and Covid, but policymakers fear about the mental health of people after a positive result in self-testing HIV kits," said Dr Gilada.
The same logic is possibly behind the delay with introducing PrEP in the public health system, said a senior doctor, as a section of public health officials fear that giving PrEP would seem like a licence for risky behaviour.
However, there is hope that lenacapavir would be available in India sooner rather than later. Bala of Bombay Gay said lenacapavir is a "monumental milestone forward in HIV treatment and prevention," but its pricing makes it inaccessible to Indian patients.
"So, we have to wait and see if prices will come down over time," he added.
Dr Gilada is positive Indian generic pharma companies licensed by Gilead Sciences can bring lenacapavir injections at below $100 per annum cost and may be rolled out soon. "India can do it," he said.
In a statement released a couple of days ago, UNAIDS urged Gilead Lifesciences to drop the price of the new HIV prevention shot.
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