Source: thewire.in
While the rate of increase of new HIV infections in India has been dropping over the last decade, it appears the National Aids Control Organisation’s (NACO’s) targeted interventions have been skipping over important vulnerable groups at higher risk of contracting HIV. Part of the problem appears to be that high-risk groups have been using apps, such as Grindr and Blued, and voice-calling services on their mobile phones to find sexual partners, and in the process slip off NACO’s radar.
The last available census of female sex workers and homosexual men happened in 2009-2011, and estimated the size of these two groups to be 11.58 lakh and 4.27 lakh people, respectively.
Maharashtra, Telangana, Karnataka and Andhra Pradesh are the top four states that receive NACO’s targeted interventions. Female sex workers in these states have some of the country’s highest prevalence of HIV. Similarly, Andhra Pradesh, Karnataka and Maharashtra, along with Gujarat, have the most number of identified homosexual men, and HIV prevalence among them is higher than the national average.
Since 2014, NACO claims to have conducted site revalidation exercises once every three, six or 12 months in areas where it implements its interventions, reexamines previously established hotspots, identifies new hotspots, and updates its data pertaining to high-risk groups. However, its own annual reports show that NACO hasn’t revised these groups’ population estimates since the 2009-2011 census.
According to Purnima Parmar, a team leader with the targeted interventions group at the Indian Health Actions Trust (IHAT), Bengaluru, “Plans for conducting a new estimation exercise are already under process in NACO.”
Need for better mapping and estimation
But as more conversations happen within apps designed (rightly) to protect people’s identities, more potential cases of HIV infection disappear from NACO’s radar, and more people are denied its targeted interventions. All together, these gaps increase the risk of HIV entering the bridge and then the general populations.
The 2009-2011 census was restricted to venue-based solicitation, such as at brothels and certain parts of the streets that female sex workers had been known to frequent. So unless the new exercise – the plans for which are already in the works, according to IHAT’s Parmar – is able to account for the rising popularity of mobile phones, it will underestimate the amount of work NACO has left to do, which in turn will postpone the day India can be HIV-free by years.
That said, NACO has been aware of this blindspot – as it indicated in its IBBS report – but hasn’t been doing enough to cover it. Multiple studies, both independent and sponsored, conducted since 2015 have reported the same gaps in its estimation process. A midterm review of NACP 4 published in 2016 recommended upgrading the methods, tools and guidelines used in population estimation and mapping exercises vis-à-vis high-risk groups.
In 2019, NACO published a whitepaper acknowledging that virtual spaces have emerged as a new risk environment for HIV transmission. The paper discussed one pilot density-mapping survey of homosexual men who used one, some or all of Grindr, Hornet, Scruff and Blued in Pune, Mumbai and Vijayawada. Based on its outcomes, NACO members have been deliberating the use of two methods to address the blindspot: a census-based mapping procedure and a capture-recapture method.
However, no one knows when and how the organisation plans to roll the procedure out nor how it will modify its targeted interventions. NACO had not responded to requests for comment at the time of publication.