HIV/AIDS in India

The government of India estimates that approximately 2.40 million Indians are living with HIV (1.93-3.04 million) with an adult prevalence of 0.31% (2009). Children (<15 years) represent 3.5% of all infections, while 83% are from 15 to 49 years old. Of all HIV infections, 39% (930,000) are women. The highly heterogeneous epidemic of India is concentrated mainly in a few states: in the industrialized south and west, and in the northeast. The four high-prevalence states of South India (Andhra Pradesh - 500,000, Maharashtra - 420,000, Karnataka - 250,000, Tamil Nadu - 150,000) account for 55% of all HIV infections in the country. It is estimated that West Bengal, Gujarat, Bihar and Uttar Pradesh have more than 100,000 PLWHA each and together account for another 22% of HIV infections in India.

India's epidemic focuses on vulnerable populations at high risk of contracting HIV. Concentrated worlds aids day epidemics are caused by unprotected sex between sex workers and their clients and the use of injectable drugs with contaminated injection equipment. Several of the groups at higher risk have high and still increasing HIV prevalence rates. According to the National AIDS Control Organization of India (NACO), the majority of HIV infections in India occur during unprotected heterosexual sex. As a result, and as the epidemic has matured, women represent an increasing proportion of people living with HIV, especially in rural areas. The low rate of concomitant sexual relations of multiple couples among the general community seems to have protected, so far, the broader body of people. However, although overall prevalence remains low, even relatively small increases in HIV infection rates in a country of more than one billion people result in a large number of infected people.

Risk factor's

Several factors put India in danger of experiencing a rapid spread of HIV if effective prevention and control measures are not extended across the country. These risk factors include:

Unsafe sex and low condom use: in India, sexual transmission is responsible for 87.4 percent of reported HIV cases and HIV prevalence is high among sex workers (men and women) and their clients. A large proportion of women with HIV seem to have acquired the virus from their regular partner who became infected during paid sex. Overall HIV prevention efforts targeting sex workers are increasing in India. However, the context of sex work is complex and the application of obsolete laws often acts as a barrier against effective HIV prevention and treatment efforts. Although recent data suggest an increase in condom use, in many places condom use is still limited, especially when commercial encounters take place in "risky" places with low tolerance of the police for this activity. In addition, the interventions tend mainly to sex workers based in brothels, who represent a minority of sex workers. Information and awareness about HIV among sex workers seems to be low, especially among those who work in the streets. Some prevention programs run by sex worker cooperatives, such as Sonagachi, Calcutta, for example, have promoted safe sexual practices and have been associated with lower HIV prevalence (Kumar, 1998, Jana et al., 1998). According to recent data from HSS 2010-11, Mizoram (27%), Maharashtra (7%) and Karnataka (5.35%) have the highest prevalence of HIV among FSW.

Men who have sex with men (MSM): Relatively little is known about the role of awareness by naco  sex between men in the HIV epidemic in India, but the few studies that have examined this topic have found that a significant proportion of men in India They have sex with other men.

According to recent data from HSS 2010-11, Chattisgarh (15%), Nagaland (13.58%) and Maharashtra (13%) have the highest prevalence of HIV among MSM. Limited knowledge of HIV has been found in groups of MSM. The extent and effectiveness of India's efforts to increase safe sex practices among MSM (and their other sexual partners) will play an important role in determining the scale and development of the HIV epidemic in India.

Injecting drug use (IDU): Injectable drugs with contaminated injection equipment are the main risk factor for HIV infection in the Northeast (especially in the states of Manipur, Mizoram and Nagaland), and appear increasingly in the epidemics of major cities elsewhere, including in Chennai, Mumbai and New Delhi (MAP, 2005; NACO, 2005) and in the state of Punjab. Injected products include legal pharmaceuticals (for example, buprenorphine, pentazocine and diazepam), in addition to heroin. Current interventions targeting IDUs tend to be inconsistent, and too small and infrequent to produce demonstrable results. Comprehensive harm reduction programs, which include the exchange of clean needles and syringes and opioid substitution therapy (OST), should be expanded and expanded urgently in parts of India with severe HIV epidemics related to drug injection. Recent data from HSS 2010 show that Delhi, Manipur and Mizoram have reported more than 10% HIV prevalence among IDUs.

Migration and mobility: migration for work distances people from the social environment of their families and their community. This can lead to a greater likelihood of engaging in risky behaviors. Concerted efforts are needed to address the vulnerabilities of the large migrant population. In addition, a high proportion of sex workers in India are mobile. The mobility of sex workers is probably an important factor contributing to the transmission of HIV aids in india through the connection of high-risk sexual networks.

National response to HIV / AIDS

Problems and challenges: priority areas

Institutional capacity: the national response still faces institutional limitations, both structural and management, to continue growing at the national and state levels. It is critical that these factors be addressed as the program expands its response to the epidemic. Performance at the state level varies significantly; an important factor is the high turnover of project managers at the state level, which results in limited continuity and variability in performance in all states. The ability to mount a solid program is weakest in some of the poorest and most populous states with significant vulnerability to the epidemic.

There is a need for tailored capacity-building activities and greater attention to performance-based financing approaches.

Use of data to adapt the response: although the national program generates a rich database for monitoring purposes, there is a need for greater use of data for decision making, including the use of program data and epidemiological data at the district and state level to adapt the response. The epidemiological profile of the districts that use the triangulation of data that began in 2009 is a step in the right direction. This will help ensure that much of the data that is generated is properly used to administer the program and inform policies and priorities. Greater emphasis is needed to evaluate the behavior change towards the end of NACP 3 and to plan for the future, since changes in the key performance indicators of the national program are critical to assess progress towards the achievement of the program's objectives .

Stigma and discrimination: stigma and discrimination against people living with HIV and AIDS and people considered high risk remain entrenched. Stigma and denial undermine efforts to increase the coverage of effective interventions among key populations, such as men who have sex with men, sex workers and their partners and injecting drug users. The harassment by the police and ostracism on the part of the family and the community drives the epidemic underground and diminishes the scope and effectiveness of prevention efforts. While there is a significant increase in awareness due to government efforts, there is much room for improvement, including scaling up to stigma reduction innovations, controlled by at-risk communities.

Targeted interventions for the most exposed populations: awareness by naco although India is increasing the coverage of interventions targeting the most exposed populations, it will be essential to maintain these efforts and expand more rapidly in those areas and among population groups that are lagging behind and hard to reach; most importantly, comprehensive harm reduction programs among injecting drug users and safe sex between men who have sex with men.