Containing HIV/AIDS in India: the unfinished agenda

CARE, Merrifield, Virginia, United States
The Lancet Infectious Diseases (Impact Factor: 22.43). 09/2006; 6(8):508-21. DOI: 10.1016/S1473-3099(06)70551-5
Source: PubMed


India's HIV epidemic is not yet contained and prevention in populations most at risk (high-risk groups) needs to be enhanced and expanded. HIV prevalence as measured through surveillance of antenatal and sexually transmitted disease clinics is the chief source of information on HIV in India, but these data cannot provide real insight into where transmission is occurring or guide programme strategy. The factors that influence the Indian epidemic are the size, behaviours, and disease burdens of high-risk groups, their interaction with bridge populations and general population sexual networks, and migration and mobility of both bridge populations and high-risk groups. The interplay of these forces has resulted in substantial epidemics in several pockets of many Indian states that could potentially ignite subepidemics in other, currently low prevalence, parts of the country. The growth of HIV, unless contained, could have serious consequences for India's development. India's national response to HIV began in 1992 and has shown early success in some states. The priority is to build on those successes by increasing prevention coverage of high-risk groups to saturation level, enhancing access and uptake of care and treatment services, ensuring systems and capacity for evidence-based programming, and building in-country technical and managerial capacity.

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    • "In this context, HIV prevention programs in India have focused on about 5 million long-distance truckers plying on the 3.3 million kilometers of road networks across the country. Although truckers constitute a smaller share than migrants of the bridge population, they are considered to be the most crucial HIV carriers in the country and hence targeted in the national HIV/AIDS prevention program [4] [9] [17]. While many studies in India and globally have explored the risk taking behaviors of trucker drivers and helpers , a comparative analysis of truckers and other clients who visit sex workers is somewhat limited. "
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    ABSTRACT: This paper examines whether truckers have been over-stigmatized as HIV carriers in the country. Data were taken from cross-sectional surveys of clients of female sex workers conducted in 2006- 2007 in 12 districts of the country. A total 4822 clients of female sex workers were covered in the survey. Low-income skilled/semi-skilled men, including non-agricultural/casual labor, and petty businessmen/small shop owners, have the largest share in the clients’ population. There was no significant difference between truckers and other sub-group of clients’ population in terms of consistent condom use with female sex workers and prevalence of HIV or STI. These evidences suggest that the contribution of truckers in HIV epidemic in India might to similar to other sub-groups of clients’ population. Thus, truckers might have been over-stigmatized as HIV carriers in the country. However, there is no doubt that truckers constitute an extremely important target group for the HIV prevention programs and these efforts must be continued to prevent new HIV infections in the country.
    Full-text · Article · Mar 2015 · Open Journal of Preventive Medicine
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    • "In the early phase of India's national AIDS control programme, the focus was on preventing HIV transmission within heterosexual relationships, particularly between female sex workers and their male clients (Dandona, Sisodia, et al., 2005; Halli, Ramesh, O'Neil, Moses, & Blanchard, 2006; Steinbrook, 2007; Thilakavathi et al., 2011). However, there is increasing recognition today of the much greater degree of heterogeneity in HIV transmission dynamics in India (Chandrasekaran et al., 2006). "
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    ABSTRACT: Sexual partner mixing among men who have sex with men (MSM), based on both gender and partnership status, is an understudied theme in India. Using data from Round 2 of the Integrated Bio-behavioral Survey, this paper reports on gender and partnership status-based sexual mixing and levels of consistent condom use (CCU) among MSM in Maharashtra. A total of 689 MSM were sampled using probability-based sampling. Bivariate and regression analyses were carried out on condom use and partnership mixing. Over half (52%) of all MSM reported having only male partners while about one-third (34.5%) reported having partners of both gender. Over 70% of MSM engaged in sex with a mix of casual, regular, commercial and non-commercial partners. MSM with only male partners reported lower CCU as compared to MSM with partners of both genders (47.3% and 62%, respectively, p = 0.11). CCU levels differed significantly by status of sex partner. Overall, MSM having 'men only' as partners and those with partners of mixed status have greater risk behaviour in terms of low CCU. HIV prevention interventions need to focus attention on men in 'exclusively male' sex partnerships as well as MSM with a mix of casual, regular and commercial partners.
    Full-text · Article · Nov 2014 · Global Public Health
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    • "India has approximately 3.5 million truckers. They are more likely than other men to be clients of sex workers and sex work venues are common along major truck routes (Chandrasekaran et al., 2006; O'Neil et al., 2004). Truckers may become infected with HIV while away from home and then infect their wives when they return home. "
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    ABSTRACT: It is important to know about patterns of sexual behaviors among married couples in order to develop effective HIV prevention strategies for them. Herein we describe the sexual behaviors, estimate prevalence of anal intercourse (AI) among truck drivers ("truckers") and their wives, and determine partner-specific demographic and behavioral correlates of AI. We carried out a cluster-sampled cross-sectional survey among 18-49 year-old wives and their trucker husbands in a south Indian district. Data were collected by same-gender research team members with color-coded computer-assisted interviews. We used random intercept logistic regression to identify the independent correlates of AI. Thirteen percent of 475 wives and 467 truckers reported ever having AI with their spouse. Of those who responded, 55 % of 40 wives and 47 % of 36 truckers never used condoms during AI. Of those who responded, 22 of 32 wives and 24 of 32 husbands felt that condoms were unnecessary during AI. Reporting ever having AI was associated with younger age and higher education of both husband and wife. AI reported by wives was associated with having sexual partner(s) other than husband (adjusted OR 8.8 [95 % CI 3.2-24.0]), correctly answering all HIV knowledge items (adjusted OR 4.9 [95 % CI 1.9-12.5]), husband's sexual debut occurring before marriage (adjusted OR 1.9 [95 % CI 1.0-3.5]), and husband's high HIV risk perception (adjusted OR 2.5 [95 % CI 1.2-5.4]). AI reported by truckers was associated with having sex with a male or transgender (adjusted OR 4.0 [95 % CI 1.2-13.3]). Reported prevalence of AI was high considering that in India anal sex is non-normative, heavily stigmatized and, criminal. Indian heterosexual mobile populations need to be informed about the greater risk of HIV infection consequent to unprotected AI.
    Full-text · Article · Sep 2014 · Archives of Sexual Behavior
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