Prevention is the mainstay of the strategic response to HIV/AIDS in India as 99 percent population of the country is uninfected. The HIV prevalence pattern in the remaining one percent population largely determines the prevention and control strategy for the epidemic in the country.
Who is at Risk ?
The HIV prevalence trend in the country shows disproportionately higher incidence of the infection among certain population groups. An analysis of Annual Sentinel Surveillance data (2003-2005) shows that female sex workers (FSWs), men-who- have-sex-with-men (MSM) and injecting drug users (IDUs) have disproportionately higher incidence of HIV infection. Whereas HIV prevalence in the general population is 0.88 percent, its prevalence among FSWs is 8.44%, IDUs 10.16%, MSM 8.74% and among the attendees of STD clinics it is 5.66%( see the table below). To gain control over HIV/AIDS spread in the country therefore effective interventions are needed for HRGs.
HIV Prevalence among High Risk Groups
| Site Type | Number of Sites 2003-2005 | Percent +ve 2003 | Percent +ve 2004 | Percent +ve 2005 |
|---|---|---|---|---|
| Female Sex Workers | 32 - 83 | 10.30 | 9.43 | 8.44 |
| Injecting Drug Users | 18 - 30 | 13.30 | 11.20 | 10.16 |
| Men having Sex with Men | 9 - 18 | 12.10 | 7.50 | 8.74 |
| ANC population | 266 - 267 | 0.87 | 0.89 | 0.88 |
| STD population | 163 - 175 | 5.61 | 5.55 | 5.66 |
86 percent Transmission through Sexual Route
Evidence also suggests that India’s HIV/AIDS epidemic is largely due to unsafe sex worker-client interactions. About 86 percent HIV incidence in the country is from unprotected sex. Perinatal transmission of the infection is 2.72 percent, whereas 2.57 percent HIV infection is due to transfusion of infected blood or blood products. Though HIV transmission through injecting needles is only 1.97 percent of overall prevalence, it is the major route of the infection transmission in the north-east region.
Epidemic in General Population
Through MSM and sex worker-client interactions the infection spreads to general population. As a majority of men with MSM behaviour are married and a majority of sex worker clients are migrant labours and truck drivers, they pose the risk of infecting their spouses and unborn children.
Targeted Interventions for Prevention, Care and Treatment
For the overall reduction in the epidemic, targeted interventions (TIs) are aimed to effect behaviour change through awareness raising among the high risk groups and clients of sex workers or bridge populations. These interventions are aimed to saturate three high risk groups with information on prevention; address clients of sex workers with safe sex interventions, and build awareness among the spouses of truckers and migrant workers, women aged 15 to 49 and children affected by HIV or vulnerable population groups.
Apart from prevention of HIV infection, TIs facilitate prevention and treatment of sexually transmitted diseases as they increase the risk of HIV infection, and are linked to care, support and treatment services for HIV infected.
