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For example, around 10% of men who have sex with men in Andhra Pradesh and 5% in Maharashtra are estimated to be living with HIV.16 A 2015 study of men who have sex with men, conducted across 12 Indian cities, found 7% tested positive for HIV.Just under a third (30%) of those who reported having anal or oral sex with a man in the past 12 months were married to a women and engaging in heterosexual sex.17 The study also found evidence of emerging epidemics among men who have sex with men in urban areas not previously recognised as having high HIV burdens.Stigma and discrimination against sex workers restrict their access to healthcare.

Both the sex worker and men who have sex with men population groups have experienced a recent decline in HIV prevalence.7 In 2017, an estimated 1.6% of female sex workers in India were living with HIV, although this figure varies between states.8 For example, prevalence among female sex workers is estimated at 7.4% in Maharashtra and 6.3% in Andhra Pradesh.9 Although sex work is not illegal in India, associated activities such as running a brothel are.

This means that police are often hostile towards sex workers at best and that authorities justify routine brothel raids.

In 2015, NACO reported reaching 77.4% of sex workers with HIV prevention activities.11 In 2017, around 67% of HIV positive sex workers were aware of their status and 91% of sex workers (HIV positive and negative) reported using condoms.12 Sex worker communities in India Since 1992, SANGRAM has worked to unite sex workers and provide access to HIV treatment, prevention and education across six districts in Maharashtra and the border areas of north Karnataka.

These are all places in which the rate of HIV infection is significantly higher than other areas of the country.

However, there is evidence that the number of people who inject drugs is growing.

In addition, evidence of higher HIV prevalence among sub-populations of people who inject drugs is also emerging.

In the same year, around 80% of transgender people in India reported using a condom.

UNAIDS (2018) ‘AIDSinfo’ (accessed September 2018)" href="#footnote29_1wls49x"29 Research worldwide has linked migration to increases in HIV transmission.

NACO (2017) Annual Report 2016-17 [pdf] A 2017 study found HIV prevalence among the wives of migrant workers in rural northern India was higher than among women in the general population at 0.59%.

Only 15.5% of those questioned had heard of HIV.33 A 2011 study on migrants and HIV by UNDP, NACO and the Population Council also found higher levels of HIV among migrants than the general population in certain areas.

A key driver is unprotected sex among key populations and their clients, partners and spouses.

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