Marking a dramatic shift in the demographic profile of people with AIDS, migrant workers and their wives have emerged as a high-risk group (HRG) for contracting the human immunodeficiency virus (HIV), with an infection rate surpassing that of injecting drug users, commercial sex workers and homosexual men, according to the latest government data.
The change is accompanied by a significant geographical shift from the south and north-east—traditionally considered high-risk—to states in other parts of India such as Maharashtra in the west, Bihar and Orissa in the east and Rajasthan in the north, which now collectively contribute nearly 50% to the new HIV infections.
The data was collected before the roll-out of the next phase of the National AIDS Control Programme, or NACP-IV. The programme, which will start from April, has been submitted to the Planning Commission for approval.
Experts say the findings reflect increasing promiscuity, especially among the migrant population. The emergence of new HRGs and geographies will require a redeployment of resources and a shift in the focus of NACP, which has succeeded in arresting the spread of HIV in states once considered to be the most vulnerable to the virus, they said.
According to the World Health Organization’s 2010 report, India is home to about 2.45 million HIV-infected people.
“Without making any moral judgements, we note that the disease profile is a reflection of the social fibre. Our data reveals that the majority of new infections are coming from migrant workers in the unorganized sector,” said Pragya Mishra, technical officer with the National AIDS Control Organisation (Naco). “Migrants labourers stay away from their families for long periods and tend to be more promiscuous. The rate of infections among housewives who are monogamous has gone up considerably,” with the virus being transmitted by their migrant labour husbands.
As recently as three years ago, injecting drug users, commercial sex workers and men who have sex with other men were considered to be at high risk of being infected by the HIV virus, she noted.
The drastic change in demography is evident in Andhra Pradesh, which was home to the highest number of HIV-infected people in India in the previous phase of the programme, NACP-III (2006-2011).
The sample surveys conducted in Andhra Pradesh indicate a significant decline in the overall prevalence of HIV across districts. Sample surveys in the state indicate that housewives are more at risk of catching the infection than the traditional HRGs, said an official at the Andhra Pradesh State AIDS Control Society (APSACS).
“Due to focused intervention, prevalence among HRGs has drastically come down,” said Kailash Aditya, joint director at APSACS. “In the future, the HRGs will be those who indulge in casual sex instead of the groups that were traditionally considered high-risk. To some extent, this shift in disease prevalence is due to the societal changes such as live-in relationships and the general increase in promiscuity.”
APSACS is turning its focus from the traditional HRGs to families of migrant labourers by launching a special project called Pehchaan.
According to the sample surveys in Andhra Pradesh, HIV prevalence among female sex workers decreased from 11% in 2008 to 7% in 2011. Among injecting drug users, the prevalence rate came down from 7% to 3% in that period. The most significant reduction, however, has been among homosexual men, with the rate dropping from 23% in 2008 to 10% in 2011.
Another shift in focus concerns the transgenders, who will, for the first time, be included in NACP-IV. Transgender refers to people whose gender identity, expression, or behaviour does not conform to that typically associated with the sex assigned at birth.
“The next phase will have increased focus on transgendered persons, with specific interventions designed to suit their needs,” said Dola Mohapatra, national director at ChildFund India, which collaborated with Naco and APSACS for their work among HIV-infected children in Andhra Pradesh.
Naco was launched in India in 1992 with the objective of slowing the spread of HIV to reduce future morbidity and mortality among the infected population.