AIDS, up close

Imphal and Churachand has risen from below 1 per cent to over 5 per cent, with many of the women testing positive appearing to be the sex partners of male drug injectors. Several factors look set to sustain Manipur’s epidemic, including the large proportion (about 20 per cent) of female sex workers who inject drugs and the young ages of many injectors (40 per cent of male injectors surveyed in 2002 were under 25 years)…

There are signs that injecting drug use is playing a bigger role in India’s epidemics than previously thought. Most surveillance sites for injecting drug users are in the northern states…but other parts of the country have yielded equally troubling evidence. In Chennai, for example, 26 per cent of drug injectors were already infected with HIV when a sentinel site was established there in 2000; by 2003, 64 per cent were injected…. Like Manipur, the states of Maharashtra, Tamil Nadu and Andhra Pradesh have long-established HIV epidemics, but theirs are driven mainly by commercial sex. Available evidence suggests that prevention efforts in some of those states have done little to alter the epidemic’s advance. Sentinel surveillance has revealed no significant drop in HIV prevalence among female sex workers in Mumbai, for example, despite decades-old safer-sex programmes for sex workers. It appears the programmes have been either too scattered or short-term to reach a large enough proportion of sex workers to make a difference. In some of these states, HIV has been rising steadily among pregnant women, most likely because clients have transmitted the virus to their regular partners. Fortunately, India does boast some significant prevention successes, such as the drop in casual sex reported in the southern state of Tamil Nadu. In 1996, 14 per cent of truck drivers reported recent unprotected sex with a sex worker. By 2002 after concerted prevention programmes were introduced, that had fallen to just 2 per cent…

Excerpted from AIDS Epidemic Update,’04 UNAIDS/WHO