Homosexuality may not be leading to the same number of raised eyebrows as it used to till sometime back, but it has surely rung alarm bells. Homosexual men have high prevalence of Human Immunodeficiency Virus (HIV) infection – far higher than in female sex workers, the most vulnerable category. A Working Group, set up by Planning Commission to chalk out formulation of AIDS Control Programme in the 12th Plan, report says that HIV infection incidences in men having sex with men, transgenders and injecting drug users are occurring in greater number across the country (see table).

The Working Group, headed by Sayan Chatterjee, Secretary, Department of AIDS Control in Ministry of Health and Family Welfare, says that this would be a great challenge in National AIDS Control Programme (NACP) IV to be launched in the 12th Plan (2012-17). Besides this other challenges in the 12th Plan would be transmission through migrants and spouses. Migration is increasingly identified as an important factor driving the epidemic in several north Indian districts. Spousal transmission in the general population has also emerged as an important source of new infections in these states, warranting a special focus and approach to address the same during NACP–IV.

In addition, there is need to shift focus on low prevalence States now from high prevalence States. While the declining trend is evident in most States, some low prevalence States have shown an increase in the number of new infections over the past two years.

Thus there is need to focus more on these States with low prevalence, but high vulnerability. Of the 1.2 lakh estimated new infections in 2009, the six high prevalence States (Tamil Nadu, Manipur, Andhra Pradesh, Karnataka, Maharashtra and Kerala) account for only 39 per cent of the cases, while the States of Odisha, Bihar, West Bengal, Uttar Pradesh, Rajasthan, Madhya Pradesh and Gujarat account for 41 per cent of new infections.

The report says that NACP programme has contributed to a steady decline in overall prevalence of AIDS and there is nearly 50 per cent decrease in new infections over last 10 years. The recent HIV estimates highlight an overall reduction in adult HIV prevalence and HIV incidence (new infections) in India. The estimated number of new annual HIV infections has declined by more than 50 per cent over the past decade. It is estimated that India had approximately 1.2 lakh new HIV infections in 2009, as against 2.7 lakh in 2000.

The group has estimated a total budget of `12,824 crore for NACP IV. However, this quantum of budget would be difficult considering the global economic meltdown since most funding of NACP programme in India comes from Development Partners. During NACP III (2007–12) external resources were substantial and Domestic Budgetary Support to the Department of AIDS Control was less than 5 per cent of the Department’s budget.

“However, in light of the global economic recession external funding for HIV will shrink dramatically. Therefore, the next phase of the programme will primarily depend upon domestic resources. Therefore, one of the critical challenges is to move towards more effective and efficient approaches through convergence and integration of programme components such as basic HIV services, comprehensive care, support and treatment with National Rural Health Mission and general health systems to the extent possible,” says the report.