NEW DELHI — An ambitious, large-scale HIV/AIDS public health program prevented an estimated 100,000 new infections in the parts of India hit hardest by the AIDS epidemic, indicating that HIV prevention programmes that target high-risk groups can reduce HIV rates in the broader population.
This is according to a new analysis by the Public Health Foundation of India (PHFI) and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in collaboration with colleagues at the Ministry of Health and Family Welfare.
In three of the six States where the Avahan programme was implemented, the study found significant reductions in HIV infections. But in the smaller north-eastern States, the programme appeared to have little or no significant impact. The researchers say the lack of success in some parts of India shows the need to carefully plan programmes and to include an ongoing evaluation of the programme’s effectiveness from the beginning.
The study, “Assessment of population-level effect of Avahan, an HIV-prevention initiative in India,” has been published in The Lancet.
“The impact of HIV prevention on high-risk groups such as sex workers and injection drug users has been shown before, but this study shows the broad impact that HIV prevention can have on overall incidence of HIV,” says Dr. Marie Ng, the study’s lead author, who is a former IHME Post-Graduate Fellow and now an Assistant Professor at the University of Hong Kong.
India has an estimated 2.4 million people with HIV, making it one of the largest infected populations in the world. Launched in 2003, Avahan targeted the States with the highest HIV rates at the time: four large States in south India — Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu — and two small States in the north east — Manipur and Nagaland. Together, the States had a total population of 300 million.
Avahan focused on high-risk groups, such as sex workers and their clients, men who have sex with men, and injecting drug users. The programme included peer outreach for safe-sex counselling, treatment for sexually transmitted infections, distribution of free condoms, needle and syringe exchanges, and community advocacy activities.
This study shows that Avahan had a significant beneficial effect on HIV prevalence in Andhra Pradesh, Karnataka, and Maharashtra, borderline significant effect in Tamil Nadu, and no significant effect in Manipur and Nagaland. Because of Avahan, between 2003 and 2008 the HIV prevalence in the general population fell at the highest by 12.7 per cent in Karnataka and at the lowest by 2.4 per cent in Maharashtra.
The study estimates the cost for each infection averted to be about $2,500, making the programme cost effective compared to the amount of care required to treat a patient with AIDS over his or her lifetime.
The first phase of Avahan, from 2003 to 2008, was funded by $258 million from the Bill & Melinda Gates Foundation, which also provides funding to PHFI and IHME. The foundation has continued to fund Avahan.