United Nations Population Fund - India
HIV/AIDS
It is ironic that a microscopic virus jeopardises the well-being of millions of people.
Indeed, HIV/AIDS has emerged as possibly one of the greatest contemporary threats
to global development and security. Nearly 2.4 million people are living with
HIV/AIDS (PLHA) (Source: http://www.nacoonline.org). Although the global HIV
incidence rate (annual number of new HIV infections as a proportion of previously
uninfected persons), which peaked in the late 1990s, has levelled off, AIDS is among
the leading causes of death globally. Since it was first recognised in 1981, AIDS has
caused over 25 million deaths across the world.
Recent surveys reveal that sustained, intensive programmes in diverse settings are
reducing HIV incidence through behaviour changes, such as increased condom usage,
delayed sexual initiation and fewer sexual partners. The HIV estimates 2008-09
highlight an overall reduction in adult HIV prevalence and HIV incidence (new
infections) in India. Adult HIV prevalence at national level has declined from 0.41% in
2000 to 0.31% in 2009, Taking note of all these manifestations of the HIV pandemic,
the Millennium Development Goals (MDGs) committed all countries to reverse the
spread of HIV/AIDS by 2015.
Need to Address High-Risk Groups
The HIV epidemic in India is concentrated among high-risk groups, with HIV prevalence
continuing to be as high as six to eight times within these groups as compared to the
rest of the population.
Approximately 0.31% of India’s adult population is living with HIV. Revised national
estimates reflect the availability of improved data rather than a substantial decrease
in actual HIV prevalence. This means that the proportion of people living with HIV in
India is lower than previously estimated, but the epidemic continues to affect large
numbers of people.
The transmission route is still predominantly sexual (87.1%); other routes, in order of
proportion, include parent to child (5.4%), infected needles and syringes (1.6%), men
who have sex with men (1.5%), unsafe blood and blood products (1%) and
unspecified/other routes (3.3%).
Sex work continues to act as the most important source of HIV infections in India due to
the large size of clients that get infected from sex workers. After the sexual mode,
parent to child has emerged as an important mode of transmission in India. Higher HIV
prevalence among intravenous drug users (IDUs) is an important feature of the northeastern states. However, in 2006, new sites of high HIV prevalence among IDUs have
been identified in the states of Kerala, Maharashtra, Punjab, Tamil Nadu and West
Bengal, suggesting diversified drivers of the epidemic. The distribution of HIV districts
in the country is heterogeneous, given that several isolated pockets of high prevalence
have been identified in several regions.
Based on data from HIV sentinel surveillance systems, 195 districts are categorised as
A and B for priority attention in the National AIDS Control Programme. Among highburden states, the epidemic shows a stable trend in states like Karnataka and Andhra
Pradesh, while it is on the decline in other high-burden states. Rising HIV prevalence is
observed among different population groups in the low-burden north Indian states.
Extremely vulnerable groups: Women, youth, migrants
The general reasons for people’s vulnerability to HIV infection are illiteracy, cultural
taboos and lack of information on transmission and prevention. It has been noted that
more men are infected than women. Indeed, when AIDS emerged in the 1980s, it
mostly affected men. However, today, women account for nearly half of all people
living with HIV worldwide. In fact, the number of HIV-positive women and girls has
risen in every region of the world. Physiological factors aggravate women’s
vulnerability.
In India, the prevalence of early marriage, illiteracy and ignorance about risk factors,
and gender inequalities increase women’s vulnerability. Moreover, limited roles in
decision-making and negligible spaces for negotiation within domestic relationships
limit women’s access to HIV prevention methods and other related sexual/reproductive
health (RH) services. National Aids Control Organization (NACO) statistics report only
0.29 per cent of all AIDS cases among women. This feminizations of HIV/AIDS brings
into stark focus the inequity inherent in people's behaviour, which limits women’s options
to safeguard themselves. Several women are extremely vulnerable to HIV even though
they do not practise high-risk behaviour. In some cases, marriage itself is a risk.
Significant proportions of new infections are reported from monogamous women in
stable marital relationships.
Prevalence is also high in the 15–49 age group (83%of all infections), indicating that
AIDS still threatens a critical section of society, those in the prime of their working lives.
Early sexual initiation and increase in premarital sex combined with lack of
information, skills and access to safe sexual practices, exacerbate vulnerability.
Increased drug use is also an important factor in the spread of HIV amongst young
people.
Migrant and mobile populations are not only highly vulnerable to HIV infection due to
long periods of absence from homes and families, but also carry infections from highrisk groups like commercial sex workers to the general population. They are an
important bridge population group in the epidemic.
Government policies
In June 2001, along with other member states, India adopted the Declaration of
Commitment on HIV/AIDS at the United Nations General Assembly.
The National AIDS Prevention and Control Policy (2002) has been the overall
framework within which national response to the HIV/AIDS threat has been crafted.
The implementation of this policy is guided by the National Council on AIDS, chaired
by the Prime Minister. With the growing complexity of the epidemic, policy
frameworks and approaches have been realigned. The focus has shifted from raising
awareness to facilitating behavioural changes, and from a national response to a
decentralized response. There is also increasing engagement of NGOs and networks
of people living with HIV.
The National AIDS Control Programme 2007–12 (NACP III) is the third phase of India’s
HIV Control Programme. It aims to halt and reverse the spread of HIV epidemic in the
country. Its four-pronged approach focuses on:
1. Prevention of new infections,
2. Provision of greater care, support and treatment to the already infected,
3. Strengthening of infrastructure, systems and human resources, and
4. Development of strategic information management systems.
Mid-term Review of NACP-III: A comprehensive evaluation of strategies, plans,
resources and activities undertaken in the first half of NACP-III was conducted in 2009.
Prevalence among Antenatal Clinic attendees, Sexually Transmitted Infections patients,
Female Sex Workers and Men having Sex with Men is declining. Vast majority of new
infections and existing burden of disease were concentrated in 5-15 percent of
districts. Impressive gains have been made in ART services, upscaling of ICTCs and
identifying PLHAs. There was significant scale-up of Targeted Interventions; and
condom distribution had increased.
Urgent need to scale up interventions
The HIV/AIDS epidemic is a serious and deeply entrenched global health crisis, which
demands a robust, evidence-informed and strategically sustained response. Since a
cure is not in sight yet, the only hope of reversing the impacts of AIDS is prevention.
The scale and scope of HIV-prevention measures that have demonstrated results need
to be intensified.
Preventing infections, therefore, is top priority. Given that targeted interventions are
showing results, there is need to saturate coverage of high-risk behaviour groups such
as sex workers, men having sex with men (MSMs) and IDUs. Programs also need to
reach out to bridge population (truckers, migrants and vulnerable youth). For the
general population, the focus needs to be on scaling up interventions such as behaviour
change communication, access to counselling and testing services, prevention of parentto-child transmission, comprehensive condom programming with a focus on dual
protection, greater convergence with RH interventions, and prioritizing the prevention
needs of adolescents and youth. There is need to prevent other Sexually Transmitted
Infections (STIs) as well. BSS (2006) and Sentinel Surveillance reports from NACO have
reported that the incidence of HIV/AIDS is higher among those with pre-existing STIs.
Another important requirement is the provision of Care, Support and Treatment
(including management of Opportunistic Infections) and Anti-retroviral Therapy (ART).
This holistic approach is vital for suppressing viral multiplication. This helps in restoring
pathogen fighting systems, slows or halts disease progression and improves quality of
life. Availability of ART also helps mitigate the stigma associated with the disease, and
consequent socioeconomic discrimination.
It must also be highlighted that HIV prevention gets a big boost by successful HIV
treatment. By alleviating the social stigma linked with the disease, it makes voluntary
testing and counselling more acceptable to high-risk groups. It is believed that a dualsolution strategy, combining prevention and treatment, will have the greatest impact in
reducing both the number of new infections as well as AIDS-related deaths. Without
treatment opportunities, however, prevention efforts can stall. Likewise, prevention is
needed to help keep new infections at bay, and thus to make treatment sustainable.
The ultimate goal is universal access to prevention, treatment, care and support.
What UNFPA India does
UNFPA works with range of stakeholders such as Ministry of Health and Family
Welfare, Ministry of Human Resource and Development, Ministry of Youth Affairs and
Sports, NACO, selected state AIDS control societies and civil society organizations to
strengthen prevention interventions of NACP III in the context of the “Three Ones
approach”: one national programme action framework, one national coordinating
authority and one agreed country-level monitoring and evaluation system for resultsbased management.
In keeping with the division of labour within UN organisations, UNFPA’s action priorities
are prevention of infections among sex workers, carrying out HIV/AIDS awareness
amongst adolescents, and enabling comprehensive interventions. In the area of
condom programming, UNFPA would also assist the government in enabling
convergence of Reproductive Health and HIV interventions.