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Shifting trends of HIV epidemiology among most at risk groups (MARGs) in India

Rajesh Nair, Sapna Sachdeva Nair, Sunita Malhotra, Ashuma Sachdeva.


Background: HIV/AIDS is one of the major barriers for community development. HIV epidemic in India is mainly concentrated among Most at Risk Groups (MARGs)/ High Risk Groups (HRGs) i.e. Injecting Drug Users (IDUs), Female Sex Workers (FSWs), Men who have sex with men (MSM) & Transgender and their sexual partners. National AIDS Control Programme (NACP) phase- II (year 1999-2006) & phase-III (year 2007-2012) envisaged and implemented Targeted Interventions (TIs) across country which has helped in somewhat containing the HIV epidemic among HRGs in various pockets. The implementation of Targeted Intervention programme has remained invariably different based on the response of respective State AIDS Control Societies (SACS).

Objective: To analyze the shifting trends of HIV epidemiology among MARGs, identify lessons learnt and examine future aspects of public health interventions among MARGs.
Materials and Methods: Present research has systematically reviewed HIV epidemiology among Most at Risk Groups (MARGs) using 16 peer reviewed research papers, HIV Sentinel Surveillance Survey (HSS) reports (years 2007 and 2008-09), National Family Health Survey (NFHS)-3 report, epidemiological studies, public health intervention reports via online database ‗PubMed‘ and ‗Web of Science‘ are analysed.

Results: Findings of various studies defining the HIV prevalence among MARGs highlights HIV prevalence ranging between 3.0 % to 70.0% in some pockets. These findings may not be generalized considering the limited sample size used in such studies. Annual rounds of HIV Sentinel Surveillance Survey (HSS) are considered more reliable and generalizeable. The trend of HIV prevalence among MARGs based on three years moving average show a consistent fall in HIV prevalence among FSWs in erstwhile high prevalence states. Whereas the trend of HIV prevalence among MSM & Transgender show initial decrease between period 2003 to 2006 and then rise from 2006 to 2007. HIV prevalence among IDUs show decrease from 2003 to 2008 in Manipur, Nagaland, and Chennai and notable increase reported in Meghalaya, Mizoram, West Bengal, Mumbai, Kerala and Punjab. There are regional variations in HIV prevalence among MSM & Transgender and Injecting Drug Users.

Conclusion: Review has outlined that despite reduction of new HIV infections (by 50% from 2000 to 2009) and reported decline in HIV prevalence among Female Sex Workers, a sustained focus on prevention is required among MARGs and their partner to contain HIV. However selection bias, non response bias, under reporting bias, surveillance bias in these studies might have also affected the results. There is felt need for more qualitative and behavioural researches to corroborate with HIV epidemiology and trends among MARGs.

Key words: HIV/AIDS, Epidemiology, Trends, Most at Risk Groups (MARGs)

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