HIV and AIDS in India

India has the third largest HIV epidemic in the world. In 2013, HIV prevalence in India was an estimated 0.3%. This figure is small compared to most other middle-income countries but because of India's huge population (1.2 billion) this equates to 2.1 million people living with HIV. In the same year, an estimated 130,000 people died from AIDS-related illnesses.1 Overall, India's HIV epidemic is slowing down, with a 19% decline in new HIV infections (130,000 in 2013), and a 38% decline in AIDS-related deaths between 2005 and 2013. Despite, this 51% of deaths in Asia are in India.1 HIV prevalence in India varies geographically. The five states with the highest HIV prevalence (Nagaland, Mizoram, Manipur, Andhra Pradesh and Karnataka) are in the south or east of the country. Some states in the north and northeast of the country, report rising HIV prevalence.2 Key affected populations in India Among key affected populations, sex workers and men who have sex with men have experienced a recent decline in HIV prevalence while the number of people who inject drugs living with HIV has remained stable.2 However, transgender people are emerging as a group at high risk of HIV transmission. This is despite all four of these groups being prioritised in the Indian national AIDS response since its inception in 1992.1 Sex workers and HIV There are 868,000 female sex workers in India, and 2.8% are living with HIV, although this figure varies between states.2 For example, one study found HIV prevalence among sex workers ranged between 2% and 38% (averaging at 14.5%) among districts in the south Indian states of Andhra Pradesh, Maharashtra, Tamil Nadu and Karnataka.3 Although sex work is not strictly illegal in India, associated activities-such as running a brothel – are. This means that the authorities can justify police hostility and brothel raids. Stigma and discrimination against sex workers restrict their access to healthcare.4 However, it is thought that 84.5% have been reached with HIV prevention activities.2 Male sex workers are a group particularly vulnerable to HIV. One study in suburban Mumbai