Risk• A hazard; a source of danger; a possibility of incurring loss.• For EMPHASIS it is about a behaviour that can directly result in HIV infection.• the probability that a person may acquire HIV infection.
Risk enhancers• unprotected sex with a partner whose HIV status is unknown,• multiple unprotected sexual partnerships,• lack of adherence to infection-control guidelines in the health-care setting,• repeated blood transfusion, especially of untested blood,• injecting drug use with shared needles and syringes.
What we know: Southern states• ANC HIV surveillance in some districts for 7 years; in all for last 2 years.• 25 - 40% of districts have STI sentinel surveillance among STI patients.• 5 - 25% districts have facility based sentinel surveillance for KPs.• History of prevention programming: • 7 -12 years of FSW and high risk male prevention programming • IDU and MSM prevention programming more recent and more limited.
Southern states: Female sex workers• Transmission risk vary considerably depending on the typology of sex work: where; number of transactions per day; norms around condoms use. Example: In southern states, only 5 - 10% of sex work takes place in brothels, compared with 55% street based and 20 - 30% home based (Avahan).• HIV prevalence among sex workers varies widely. Where reported condom use is high often lower HIV prevalence. Example: Relatively low rate of 9.5% HIV prevalence among FSW in Tamil Nadu correlate with high rates of self-reported condom use.• STI prevalence rates are variable but generally high.
Southern states: Sex between• men Complex tapestry of self classification (kothis; panthis; transgender) and associated sexual behaviour impacts on HIV risk.• Sex between men seems common in both urban and rural areas. Example: Study in 5 rural districts found 10% of single men and 3% married men reported anal sex with another man in the previous year.• Limited reports suggest high rates of STIs in MSM.• Many MSM also have sex with women. Example: In AP, 51% of MSM reported sex with regular female partner in previous 3 months. Condom use with last male partner 44%, with last female partner 16%.
Advocacy: enabling environment• An enabling environment is an environment where public policy, laws, and practices: – protect and promote the rights of PLWHA, SWs, MSM, and IDUs – support effective programmes – reduce vulnerability to HIV/AIDS, and – address its consequences.
Human rights not an optional extra• We know that preventing spread of HIV is not just about individual behavior change.• We need to understand and address the structural barriers that people at risk and living with the virus face.• Stigma and discrimination: – reduces access to information about HIV prevention and care – undermines people’s ability to make informed decisions about their behavior and health – prevents people from implementing safer behaviors.• Health and human rights are mutually reinforcing: where rights are protected, vulnerability to HIV infection is reduced and impacts of HIV/AIDS alleviated.