Recent analysis by the Public Health Foundation of India, the Institute of Health Metrics and Evaluation, and India’s Ministry of Health and Family Welfare has found that from 2003 to 2008 Avahan, a large-scale HIV/AIDS prevention initiative in India, prevented 100,000 new infections of HIV. The initiative, which is aimed at at-risk groups across six Indian states, significantly decreased the risk for HIV in three of the states.[1]

 

Avahan-supported programs, funded by the Bill & Melinda Gates Foundation, target groups that are most vulnerable to HIV, including sex workers, their partners, men who have sex with men, and injection drug users, with the goal of reducing HIV in the general population.[2] Avahan partners with both governmental and nongovernmental organizations to implement programs that provide condoms, risk-reduction counseling, treatment for sexually transmitted diseases, and other prevention services.[3] There are three primary goals of Avahan: to build an HIV-prevention model to scalein India, encourage others to take over and replicate the model, and foster and disseminate lessons learned in India and worldwide.[4]

 

Avahan is implemented in Tamil Nadu, Karnataka, Andhra Pradesh, and Maharashtra, which are large states in the south of India, and Nagaland and Manipur, small states in the northeast; in 2003 these six states had the largest identified HIV-positive populations in the country.[5]  The initiative showed significant progress in prevention in Andhra Pradesh, Karnataka, and Maharashtra, while only borderline success occurred in Tamil Nadu.[6] The most significant results occurred in Karnataka, where HIV infections in the general population fell by 12.7 percent.[7] The variance of success across these six states may be due to the mode of transmission of HIV, with sex being the primary mode in the southern states whereas injection drug use is the primary mode in the northeast.[8]

 

India has one of the largest HIV-positive populations in the world, with an estimated 2.4 million people infected.[9] The positive results of the Avahan program can act as a model for other countries to follow, and the study supports funding for similarly planned and implemented HIV-prevention programs in other low- and middle-income countries.[10]

 

“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,” comments Dr. Marie Ng, lead author of the study and an assistant professor at the University of Hong Kong.[11]

 

During the first phase of the program, from 2003 to 2008, the Gates Foundation provided $258 million to the project, which was criticized as a waste of money.[12] However, the study indicates that, based on the aversion of costs of care and treatment for an AIDS patient, the program is cost-effective.[13]

 

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