Increased condom use among sex workers and their clients that have taken place as a result of preventive interventions, especially the targeted interventions seem to have contributed to the decline in HIV prevalence among young pregnant women in India

India has been able to avert three million HIV (human immunodeficiency virus) infections with World Bank support, along with the role of the government and NGOs (non-governmental organisations). The majority of the HIV infections are heterosexually transmitted, with unprotected paid sex being the major route of transmission. Besides being heterogeneous, the epidemic also has high prevalence in the high risk groups (HRGs): injection drug users (IDU) (7.2%), men who have sex with men (MSM) (7.4%), female sex workers (FSW) (5.1%) and people with sexually transmitted infections (STI) (3.6%). The epidemic seems to be stabilising as a decline in HIV has been observed in high HIV prevalence states of southern India (Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu). This conclusion is based on a news release from the World Bank on the eve of World Aids Day 2011—which falls on 1st December.

The HIV epidemic in India has remained more contained than was initially predicted. It appears that increased condom use among sex workers and their clients that took place as a result of preventive interventions; especially the targeted interventions (TIs) seem to have contributed to the decline in HIV prevalence among young pregnant women.

In the high HIV prevalence southern states, the number of TI projects for FSWs increased from five to 310 between 1995 and 2008. In high TI intensity quartile districts, 186 condoms per FSW/year were distributed through TIs. This is in comparison to the 45 condoms/FSW/year in the low TI intensity districts. Behavioural surveillance indicated significant rise in condom use from 2001 to 2009. Among FSWs consistent condom use with last paying clients increased from 58.6% to 83.7%, and among men of reproductive age, the condom use during sex with non-regular partner increased from 51.7% to 68.6%. A significant decline in HIV and syphilis prevalence has occurred in high prevalence southern states among FSWs and young antenatal women. The drop in prevalence is associated with a significant increase in consistent condom use. Among the women seeking antenatal care in districts with high intensity of targeted interventions, HIV prevalence declined by more than 50% from 1.9% in 2001 to 0.8% in 2008 compared with low-intensity districts where the infection rate remained constant at 0.9% in both 2001 and 2008.

Despite these advances in prevention in India, human and financial costs of HIV/AIDS continue to increase, requiring continued diligence and support from the government and the international community. “AIDS remains a critical development issue that is reversing decades of human progress. With 34 million people living with HIV, AIDS continues to decimate communities, stymie economic growth, and orphan children,” said David Wilson, World Bank’s Global HIV/AIDS program director. “As one of the early leaders in the global response to the epidemic, the Bank remains committed to doing our part to halt and reverse the spread of HIV and AIDS, particularly in helping countries invest in proven, cost-effective prevention efforts.”

The World Bank supports developing countries (like India) in their strategic planning for HIV/AIDS response in a number of ways, including helping countries develop well-prioritised, evidence-based AIDS strategies and action plans; designing proven, cost-effective HIV prevention efforts; strengthening country health systems for more effective service delivery; and social protection for people affected by HIV. Since 1989, the Bank has committed nearly $4.6 billion in financing for HIV/AIDS-related activities in developing countries. Since the launch of the National AIDS Control Program in 1991, India has worked in close partnership with the World Bank and other development partners to focus on prevention among vulnerable populations at highest risk of contracting HIV.

“There has been a tremendous scale-up of prevention and treatment interventions under this program, which has led to an overall reduction in new infections and AIDS-related deaths in India,” said Sayan Chatterjee, secretary and director general of India’s National AIDS Control Organisation. “With expanding coverage of treatment, the program has to ensure that the treatment requirements are fully met without sacrificing the needs of prevention.”