Tackling HIV in India
August 4, 2008
International AIDS Conference
August 4, 2008 - Speaking in conjunction with the XVII International AIDS Conference in Mexico City, Mexico, Mariam Claeson, South Asia AIDS Coordinator said that "The world has much to learn from India’s data informed approach to policy and priority setting in its response to the HIV/AIDS epidemic."
While the country faces several challenges, India also invested in more and better data to understand its HIV epidemic. "India is not complacent," Claeson added.
In a recent paper, "Tackling HIV In India: Evidence-Based Priority Setting And Programming," authored with Ashok Alexander, Director of the Gates Foundation’s India AIDS Initiative (Avahan), Claeson said, "Today's challenge is to scale up proven interventions to reach the vast majority of India’s vulnerable populations."
After two decades of HIV infection in india, the government has a greater understanding of the magnitude, trends, and diversity of the largest HIV epidemic in Asia. India vastly increased its data sources. The number of routine HIV surveillance sites increased from 703 in 2005 to 1,122 in 2007. The third National Family Health Survey (NFHS-3), a national population-based survey, included HIV testing of more than 102,000 adults.
The Integrated Biological and Behavioral Assessment (IBBA), a cross-sectional HIV and risk-behavior survey of 24,400 adults from high-risk groups in six states, was conducted as part of the evaluation of a large-scale prevention program. This growing evidence base has enabled the government and stakeholders to mount a well-informed and sharpened national HIV response.
Based on the results from the NFHS-3, India’s 2006 HIV prevalence estimates were revised significantly downward in July 2007.
Distribution of HIV infection in India
The distribution of estimated infections in India has remained almost unchanged, even after the revised estimates. HIV continues to be concentrated in the South, which has about 64 percent of HIV infections but only 30 percent of India’s population, and in the Northeast. There is wide variation in HIV infection rates in the country. About fifty key districts in India have more than half of the country’s HIV cases.
The differences in spread of HIV between and within Indian states result from many factors, such as variations in the effectiveness of ongoing programs and interventions, differences in the underlying sexual partnerships, and biological cofactors.
In India, the state of Tamil Nadu has demonstrated a decline in HIV prevalence among sex workers. HIV prevention interventions were initiated in 1994, and coverage gradually increased over the next decade and was sustained. 28 HIV prevalence in antenatal clinics consistently surveyed over the time period fell from 1 percent in 1998 to 0.6 percent in 2006.
India is also making headway on HIV prevention. The surveys enable a comparison of behavior between 2001 and 2006 among men in the general population, female sex workers and their clients, and other groups. The results show nonregular sexual partners and condom use among men, demonstrating variability across the states and an increase in reported condom use over time.
Despite the recent successes, India still faces several challenges in its fight against HIV and AIDS. They include:
- achieving high-quality program management and execution;
- developing informed and active demand for HIV interventions through community mobilization;
- addressing stigma and discrimination of people living with HIV and AIDS;
- sustaining ongoing efforts in data collection;
- increased use of data locally;
- and monitoring the use of interventions to maximize their effectiveness.
To overcome these challenges, India has invested and will be investing in more and better data to understand its HIV epidemic. It will estimate where infections are occurring, determine the size and location of key target groups, and monitor the effects of interventions. Based on data, India remains committed to the increased allocation of money for HIV programming that addresses prevention and care.
There are no real “innovations” in India’s approach to HIV prevention planning but, rather, sound policy making: investment in good data to inform decisions; analysis of the data to determine the epidemic drivers; and comprehensive plans for scaling up known interventions directed at those populations with the behavior that is responsible for the most exposure to HIV.
India’s response to the HIV/AIDS Epidemic
The first National AIDS Control Program (NACP-I) was launched in 1992, with financial support from the World Bank and a budget of US$99.6 million. The program focused on strengthening the management capacity in the country through the establishment of the National AIDS Control Organisation (NACO) and State AIDS Control Societies; promoting public awareness for HIV prevention focusing on sexual transmission; improving blood safety; and controlling sexually transmitted infections (STIs).
Under NACP-II,with an overall budget of US$460 million, the scope of HIV prevention and control activities was increased—including prevention interventions for groups at risk and the general population, AIDS care, and decentralization of the implementation of services to states and municipal corporations.
In 2007, NACP-III set ambitious targets aiming to achieve the Millennium Development Goals (MDGs) for HIV and AIDS ahead of schedule. The national program budget has quadrupled to around US$2.5 billion. Prevention, with a strategic focus on high-risk groups, is the mainstay of NACP-III. Almost 70 percent of NACP-III’s budget is earmarked for prevention, of which more than a third is focused on scaling up prevention for the groups at highest risk.
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