Some good news on the AIDS prevention front. The number of AIDS deaths annually has declined by 70-81 per cent during 2007-2015 in Tamil Nadu, Karnataka and Maharashtra. However, this does not represent the true picture as far as Tamil Nadu is concerned.
Overall, India is estimated to have registered a 66 per cent decline in new HIV infections from 2000 and 32 per cent decline from 2007, according to the latest round of HIV Sentinel Surveillance and estimations conducted by the National AIDS Control Organisation (NACO), released by the Union Health Ministry. In the case of Tamil Nadu, the state has reported new infections in the range of 3,000-4,000.
But the state continues to face challenges including access to resources, anti-retrovirals, kits and vulnerable groups. Comparing the data between 2012 and 2014, the number of AIDS treatment centres has remained static at 156. From 2012 to 2014, there has been a drop in the number of condoms distributed from 3.10 lakh to 3.02 lakh. Information on the number of distribution centres has not been made available.
In terms of its response to HIV, Tamil Nadu was the first state in the country to set up an AIDS control program.
The state was on the high prevalence map for seven years and was the first state in India to halt and reverse the epidemic. "In halt and reverse, as the number of cases keeps rising, there is a tipping point which indicates that a turnaround or a success in the fight against HIV," says B Jayashree, a Communications Specialist who has worked in the field of HIV awareness for years.
"Tamil Nadu was the first state to do that. Why we also have an upper hand is because across india, reporting systems have not been as effective in other states. The State AIDS Control Society is a great model for other states to replicate."
But here's the catch. While a centralised unit is a good idea to make reporting systems on HIV effective, it can lead to the risk of stereotyping. "Keep in mind, that the next step is to mainstream collection of HIV data, we don't want the HIV testing centres to be known for this because it can have a ripple effect and create more stigma. It shouldn't be known as the only point place because it might just stop people from coming in for treatment."
As for funding, many international donors have been pulling out of the state, according to Jayashree. Complacency remains the biggest enemy.
"As soon as donors see numbers dropping and awareness increasing, there is this idea that they should pull out since the state is doing well. Flow of funding is as important as quantum."
Currently, many community NGOs in Tamil Nadu are running on their own funding - fundraisers, programs and CSR initiatives are what keep them going.
The state has benefitted from specialized target intervention programmes that go beyond focusing on vulnerable groups such as sex workers. But another marginalised group, MSMs (men who have sex with men) has also been afflicted.
These men may be openly gay, closeted, in monogamous marriages or may openly identify themselves as straight. But a large number of them have multiple partners. And according to Bharathi Kannama, who has worked in the field of community HIV prevention for over 20 years, prevalence of cases among them is rising.
"The stigma that transgender persons faced 20 years ago, has now reached MSMs. They go anywhere and everywhere for sex, in parks and beaches even. They don’t use condoms, and we are trying to devise a strategy to reach out to them," she says. It's a task because they can’t come out openly either.
Bharathi is specifically starting with MSMs who are above 40 years old. "There are also sex workers who don’t use condoms despite having awareness of condoms and HIV prevention. Why don't they use them then? "They don't want to lose customers. Other MSMs turn to middle-aged sex workers with this condition," she says.
The other major hurdle facing the state is a sizable population of closeted MSMs in monogamous marriages with women. "They in turn, infect their wives and children after having sex with men, and reporting systems are increasingly difficult in this case because of internalised homophobia, shame and fear of a failing marriage," Bharathi says.