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Prevention of sexual route of HIV – Asian and Indian context
In any kind of multiple sexual relationship scenario, correct and consistent use of condoms in all penetrative sexual acts – peno-vaginal, peno-oral nad peno-anal (100% condom use) should be promoted as the priority strategy and it should be sustained over a period of time to achieve the desired result of prevention of HIV transmission via sexual route. Asia has already experienced the good results of 100% CUPwith the high risk communities like sex workers because the condom promotion strategy was adopted as one of the primary strategies during inception of the AIDS control programs of the Asian countries during the nineties.HIV prevalence among sex workers have already shown downward trend in many of the Asian countries for last several years that clearly indicates effectiveness of 100% CUP to reduce HIV transmission in the context of concurrent multiple partnership within the sex work set ups. The HIV prevention projects should be designed to establish this prioritized primary intervention with the strategic advocacy in place to address the socio-cultural and religious issues that generally revolves around use of condoms.
The Indian context has actually brought the revolution in the HIV/AIDS sector by giving birth to the structural intervention concept which does not stop at BCC but tries the explore the underlying and deep rooted causes of vulnerability to HIV, especially with the high risk groups. Thus for sex workers it is their profession and criminalized status in the Asian countries that increase their vulnerability to HIV, not just behavior. The Indian programs have been designed to address the structural issues to modify the risky behaviors through interventions like collectivization of the community members and their empowerment, formation of CBOs (Community Based Organizations) and finally community ownership by keeping the community members at the driver's seat of the programs.
At the same time prevention initiative remained the topmost priority in India from the beginning of our AIDS control program with maximum resources (almost 70%) allotted to support the prevention activities.