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A key driver is unprotected sex among key populations and their clients, partners and spouses.
However, injecting drug use in the north and northeast of the country is also pushing HIV prevalence up.6 Key population groups have been prioritised in the national AIDS response since its inception in 1992.
For instance, a 2015 study found prevalence to be more than three times higher among women who inject drugs than men.23 HIV prevalence among transgender people in India was estimated to be 3.1% in 2017, the second highest prevalence among all key populations in the country.
Around 68% of HIV positive transgender people are aware of their status.24 In India, being a hijra (also known as ‘aravani’, ‘aruvani’ or ‘jagappa’ in other areas) is an identity associated with being a transgender woman, intersex or a eunuch.
The organisation has achieved notable successes within these diverse communities.
Peer educators deliver hundreds of thousands of condoms to women each month, and they report that in some areas 100% of sex workers have attended voluntary HIV testing.13Male sex workers are particularly vulnerable to HIV.
However, there is evidence that the number of people who inject drugs is growing.
Of those who engaged in sex work, HIV prevalence was found to be 43.6%, compared to 18.1% among all men who have sex with men attending the clinics.14 Around 2.7% of men who have sex with men in India are living with HIV, of whom around 65% are aware of their status.15 HIV prevalence varies between areas.
In September 2018, India’s Supreme Court decriminalised homosexuality between consenting adults.
The ruling overturned Section 377, a British pre-colonial era law that banned ‘carnal intercourse against the order of nature’ and carried a maximum jail sentence of 10 years.
To date this law meant that HIV services were out of reach for men who have sex with men.
The decision overturned a ruling made by the Supreme Court in 2013 that reinstated Section 377, having previously suspended it in 2009.18 In 2016, 1.7 million people in India were estimated to inject drugs.19 HIV prevalence among this group is high, with injecting drug use the major route of HIV transmission in India’s north-eastern states.