India

With an estimated 2.5 million people living with HIV*, India accounts for around 13% of global HIV infections.

Six of the country’s states and union territories contain two-thirds of reported infections (Andhra Pradesh, Tamil Nadu, Maharashtra, Manipur, Nagaland and Karnataka). In these six, prevalence is four to five times higher than in other states.

Prevalence remains high among sex workers, and is growing among injecting drug users and men who have sex with men. Targeted prevention efforts among sex workers in the southern states have seen some success, but prevention is often complicated by the varied nature of commercial sex and law enforcement. The combination of injecting drug use and paid sex could see increasing numbers of people infected. Interventions for men who have sex with men remain limited.

The low status of women is contributing to the increasing feminisation of the epidemic in India. Orphaned children also carry a heavy burden – facing stigma and discrimination, and heading up households when family members die. It is not known how many children have been orphaned as the result of AIDS, but there are an estimated 25 million orphans in total.

Lack of knowledge is impeding prevention and treatment efforts and perpetuating risky sexual behaviour. Only an estimated 10% to 20% of people living with HIV in India know that they have the virus. Many do not know where to get an HIV test. Despite rising infection rates in the general population, the perception remains that HIV is largely restricted to sex workers, truck drivers and injecting drug users. Discriminatory treatment means that many people living with HIV conceal their status and many are deterred from seeking care.

105,622 people currently receive free antiretroviral treatment through the public sector. The Indian government amended its target of providing free antiretroviral treatment to 300,000 people by 2005 to 300,000 by 2011, due to initial constraints in rolling out the programme.

* In 2007, the estimated number of people living with HIV dropped from 5.2 million to a range of 2.0-3.1 million, due to revised estimation methods.

What we do

Established in 1999, the India HIV/AIDS Alliance comprises the New Delhi-based secretariat, five linking organisations and one state partner, and their networks of over 100 community-based non-governmental organisations across five states.

The core programmes are:

Focused prevention with populations key to the epidemic such as sex workers, men who have sex with men, injecting drug users and people living with HIV (the Avahan Initiative and the Frontiers Prevention Project).
Home- and community-based care and support focusing on those living with and affected by HIV, including children and families (the CHAHA project).
Harm reduction and care and support for injecting drug users , especially those living with HIV, their families, caregivers and communities.
Access to treatment: strengthening links between communities and public health treatment facilities to increase key populations’ access to HIV treatment (the START-AP project, currently being piloted in one district).

The five linking organisations are:

Alliance for AIDS Action, Andhra Pradesh
MAMTA Health Institute for Mother and Child (MAMTA), New Delhi
LEPRA Society, Andhra Pradesh
Palmyrah Workers Development Society (PWDS), Tamil Nadu
Vasavya Mahila Mandali (VMM), Andhra Pradesh.

Social Awareness Service Organisation (SASO), based in Manipur, is a state partner.

Policy and advocacy

India HIV/AIDS Alliance continues to find that basic HIV prevention, treatment, care and support services are not accessible to the most marginalised populations because of restrictive policies and laws, poor service design, limited availability, and stigma and discrimination.

Alliance India is committed to using its programming knowledge and experience to influence and shape national and state-level HIV policies – to create an environment in which community responses to HIV can thrive. (Read more)

What we have achieved

In 2007, the India HIV/AIDS Alliance supported over 120 community-based projects to prevent HIV infection, improve access to HIV treatment, care and support, and lessen the impact of HIV – including reducing stigma and discrimination.

Alliance India’s focused prevention programme (the largest across the Alliance) has been successful in scaling up its services to marginalised groups and involving marginalised groups in programme design, monitoring and advocacy. (Read more)
Alliance India has been innovative in developing community-driven approaches for the care and support of people living with and affected by HIV. Since 2000, over 60,000 adults and children affected by HIV have been reached with a range of support services, including healthcare, education, skills development and psychosocial support. (Read more)
Work to improve injecting drug users’ access to treatment, care and support reached 1,145 people in 2007. Alliance India has been working with its state partner, SASO, in Manipur to provide a variety of services using a comprehensive community approach – from the treatment of sexually transmitted infections to needle exchange programmes. (Read more)
In 2007 Alliance India, in partnership with the Andhra Pradesh State AIDS Control Society, launched the START-AP project – a new initiative that aims to integrate existing focused prevention programmes with improving access to antiretroviral treatment and support. It will strengthen links between key population communities and government district antiretroviral treatment centres through a combination of technical support, community mobilisation, treatment literacy and adherence support. The project builds on the established infrastructure of the Mythri clinics and drop-in centres, and is currently being piloted in the district of Karimnagar.
A project that is addressing the increasing feminisation of HIV in India by giving women better access to health, social and legal support services reached 19,000 women. The project aimed to create an increased demand for information and services and enhance knowledge of HIV and sexual and reproductive health. A particular success of the project was highlighting the impact and scale of injecting drug use among women in Manipur. (Read more)

Looking ahead

From 2008, Alliance India will focus on scaling up quality programming and policy work to contribute to achieving universal access to comprehensive HIV services, and related social and health services.

Specifically, Alliance India will be:

scaling up district-level coverage of home and community based care and support – especially for children affected by HIV and their families – and facilitating community-level access to HIV treatment by strengthening partnerships with the public sector
scaling up focused prevention activities at the district level, particularly with vulnerable and marginalised communities – including people living with HIV, people who sell or buy sex (women, men and transgenders), men who have sex with men and injecting drug users
integrating HIV with broader sexual and reproductive health services for women made vulnerable to HIV by social, cultural and economic inequalities, and at the same time addressing the needs and the active engagement of men and boys
ensuring the meaningful and active involvement of marginalised groups in all aspects of the AIDS response including supporting civil society to be government policy partners and advocating for changes in legislation and policies which exclude, marginalise or criminalise people living with and linked with HIV – such as people who use drugs, sex workers and men who have sex with men.

Alliance India’s strategic priorities have been developed in line with national government priorities (particularly the new National AIDS Control Programme NACP-III), international goals and priorities such as the Three Ones, and within the context of the International HIV/AIDS Alliance’s global Strategic Framework 2008-2010.

The India HIV/AIDS Alliance works in support of the National AIDS Control Programme in India and in collaboration with the National AIDS Control Organisation (NACO), the State AIDS Control Societies (SACS), and other key stakeholders including UNAIDS, UNDP, UNODC and UNICEF. Our work in India is made possible through the support of The Bill and Melinda Gates Foundation, The Global Fund to Fight AIDS, TB and Malaria, The UK Department for International Development and The Clinton Foundation HIV/AIDS Initiative.