The war on HIV/AIDS in India is surely not over, but the results to date are very encouraging. The number of new HIV infections in India has decreased by more than 50 percent in the last ten years. India’s success at reducing new HIV/AIDS infections in its own country, and its contribution to stemming a large portion of global infections, has led to the world seeing a decline in HIV infections as well.
So what has India done right?
The answer is simple—it chose to invest most of its resources selectively in prevention programs that 1) have been proven to work, and 2) stop transmission of the virus at the very source where the largest numbers of infections are occurring.
For India, this means working with high-risk individuals such as sex workers, men who have sex with men, or injecting drug users—even though expending resources on sexual education programs among youth or large mass media campaigns for the general population would have been more socially appealing in the early years.
Here’s a window into India’s prevention landscape—the successes, the challenges, and the lessons learned—so we may continue to reduce the number of people infected by HIV and AIDS.
A snapshot from the field
In Bangalore city, the information technology (IT) capital of India, with a population of more than 8 million people, I visit Swathi Mahila Sangha, to experience a microcosm of India’s prevention landscape.
A community-based organization of female sex workers (FSWs); Swathi Mahila Sangha reaches out to more than 10,000 FSWs with prevention services. When I walk into their drop-in center, a safe space for the community, I am amazed at the bustling energy.
I am immediately greeted by a community member, who welcomes me with pride and a big smile to her “second home.”
As I look around, I see women engaged and busy. A group sitting on the floor in an almost perfect circle holds a meeting on their micro-finance initiative. Others wait for their turn to visit the doctor, to get their scheduled clinical visit, or for the counselor to get referred for HIV testing.
Vibrant discussions are being held all around me on various issues ranging from community outreach activities to their violence response system. I am struck by the levels of strength and capability, and the organizational skills of this vulnerable community of women.
It is no surprise that HIV prevalence in this community declined from 12.7 percent in 2006 to 9.3 percent in 2010.
In fact, there are thousands of Swathi Mahila Sanghas and other non-governmental organizations across India doing similar work, funded either by the Government of India, or by the Gates Foundation through its Avahan program.
What do the experts say?
In a study in India, undertaken by Dr. Rajesh Kumar and his colleagues, researchers found that condom use between sex workers and their clients increased significantly as a result of these programs. The results also show that the increase in condom use led to a reduction of HIV among young women in the population.
They estimate that 2.6 million HIV infections will be averted by 2015 as a result of these programs.
In a follow-up study, the team also concluded that these interventions are indeed cost-effective. The cost of preventing each HIV infection? The relatively small sum of US$106. Another team raised a question about what the impact of the Avahan program has been. They subsequently estimated that this program alone has averted almost 100,000 HIV infections in its first five years.
The Lessons
India is a big country and the experience it offers is rich. As India works to reduce the prevalence of HIV and AIDS throughout the country, the lessons we’ve learned thus far are essential to continued success.
- Use data to prioritize. When it comes to tackling new HIV/AIDS infections, throughout the country, it’s important to determine exactly what’s driving the epidemic. Is it a particular population of people? A geographic region? A behaviour or set of behaviours? Using this information has helped those working on the issue to strategize about how best to bring down the HIV/AIDS rate.
- Bet on a few proven game-changing interventions. What we’ve seen in India is the willingness of programs—whether via the government or non-governmental organizations—to bet on a few proven “game-changing” interventions like prevention programs with female sex workers, men who have sex with men, and injection drug users.
- Quickly “scale up.” It’s important to quickly scale up a few game-changing interventions to cover more than 80 percent of the target population.
The road ahead
As we celebrate India’s success, it is important not to be complacent. Unfortunately, HIV does not disappear and there is still much more to be done, more infections to be prevented. Continuing and strengthening what has worked, innovating and strategizing as needed, and assigning the requisite resources will be crucial to gain and sustain an edge in the war on India’s HIV/AIDS epidemic.