India should widen focus to migrants in AIDS fight – U.N.

December 1, 2013

India has been “fairly successful” in fighting AIDS by targeting key affected populations such as intravenous drug users, transgendered people, sex workers and homosexuals, but its focus must broaden to high-risk mobile communities to keep the disease under control, the United Nations said.

Policies focused on prevention and a huge social mobilisation have allowed India to reduce new infections of HIV, the virus which causes AIDS, by as much as 57 percent in 10 years; and more than 650,000 people living with HIV are receiving antiretroviral therapy, the second-largest number in the world by country, according to UNAIDS.

There are about 2.1 million people living with HIV in India, with an estimated 130,000 new infections per year.

While focus on the “core” communities has helped keep the disease in check, authorities must “follow the epidemic” and target internal migrants and truckers to widen the scope of prevention efforts, two UNAIDS officials said in an interview with India Insight ahead of World AIDS Day, which is observed on Dec. 1.

“Internal migration is a concern in India. You see changes and patterns of the epidemic in association with migration/mobility,” said Oussama Tawil, country coordinator, UNAIDS.

Focusing on the mobile population is important because many clients of sex workers are known to be single male migrants and truck drivers.

While prevalence of HIV does not go beyond 2 percent among migrants and truck drivers, applying that figure to about 7 million people means that there are hundreds of thousands of people who are HIV positive, said Taoufik Bakkali, senior strategic information adviser at UNAIDS. And many of them will pass on the disease to their wives or their future wives in other places, thereby changing the pattern of the epidemic.

“Whatever infection happened beyond the (core) group happened. And now it’s leaking, it’s showing up somewhere else, so it has to be controlled. The lesson from India is that we should not only look at these groups but look beyond,” said Bakkali.

Here are edited excerpts from the interview:

Q: How many people are covered under the AIDS prevention programme?

A: Oussama Tawil – About 90 percent for key affected populations.

Q: How would you describe the overall AIDS situation in India?

A: Oussama Tawil – The general trend is a positive one … It does not mean there are no challenges.

Q: Which communities are most vulnerable?

A: Oussama Tawil – Persons who inject drugs, it’s the highest. On the sub-community of men who have sex with men, particularly transgender have high prevalence. Among female sex workers, in general the trend has declined.

Q:  What about high prevalent states? Are there any success stories?

A: Taoufik Bakkali – Six high prevalence states were the focus of the previous intervention programme – Manipur, Nagaland, Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu. A very strong focus happened on these six states since the early 2000s till recently, while work continued on the rest of the country but at lesser focus.

Now that strategy gave big results. All these six states have seen very strong decline of HIV prevalence (76 percent reduction of new infections over 10 years, compared to 57 percent for the country), so the epidemic is fairly under control.

The other states which do not have big prevalence, we see some trends rising, so they need some focus to control it now while it (prevalence) is still low.

Q: There are so many NGOs and civil society groups involved in the AIDS programme, especially in places like the north east. Has there been any concern that the situation may be hyped to keep the funds flowing?

A: Oussama Tawil – This question comes from the time, 5-6 years ago where there was a high point in funding on AIDS … The reality is NGOs, even community-based groups have in certain sense become reliant on these resources on AIDS.

They provide services but let’s look at reality in the face, that they also have people sustain the NGO and the work and staffing and so on. So there is that concern. But there is no evidence of creating a problem or over exaggerating a problem.

Q: What are the areas where India is successful in its fight against HIV/AIDS?

A: Oussama Tawil – One is they have focused strongly on prevention and they have focused on key population. They have developed their own methodology of work and their own ability to scale up.

If you compare India with regard to many countries, they are doing quite well. They have scaled up treatment. They have also involved civil society organizations in their response. Their reflecting commitment is in how much domestic resource they have been able to mobilize for this programme.

Q: What are the areas where the country is lacking?

A: Oussama Tawil – Although some major policy changes have occurred, they have to continue to address key policy changes to fight stigma and discrimination, to make access more readily available to people and so on.

They have shown the capacity to do alert scale response. They need to look at more specific issues. For example, where are services more effective, where they are not effective. Do more assessment and qualitative analysis and try to resolve these type of problems.

They have to address these new kinds of challenges, look into the future and sustain what they have achieved.

(Editing by Robert MacMillan; follow David on Twitter at @davidlms25 and Robert @bobbymacReports. This article is website-exclusive and cannot be reproduced in any form without permission)

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