Making Sound Choices in the Fight Against AIDS in India

The Challenge

India has made significant progress in the fight against HIV/AIDS in recent years. The number of annual new infections has decreased from about 300,000 in the mid 90s to 120,000 in 2009.  While 2.4 million people are currently living with HIV in India, adult prevalence has been declining over the past decade, and now stands at just 0.31 percent in 2009. More than 400,000 Indians are benefitting from life-extending antiretroviral therapy. India now faces the challenge of sustaining this momentum by continuing to prevent future infections and expanding treatment coverage, at a time when the national economy is growing rapidly but external funding for AIDS is drying up.

In the above context, the Indian government is preparing its fourth 5-year national strategic plan for addressing HIV/AIDS during 2013-17. It faces a serious of tough choices, such as: Which geographic areas (states and districts) and population groups should be given the highest priority for HIV prevention? What is the optimal mix of prevention activities, from condom promotion to clean needles and prophylaxis for HIV positive pregnant women? How early should HIV positive individuals be put on treatment as their immune systems begin to break down? How can a limited budget for the national AIDS program best be used to have the largest possible impact?

The Opportunity

To help answer these key policy questions, the National AIDS Control Organization (NACO) asked the Bill & Melinda Gates Foundation to back a program of modeling, analysis, and technical advisory work by R4D in support of NACO. R4D initiated this effort in mid 2011, with the goal of completing the work by the middle of 2012, in time to make an input to the formulation of the 2013-17 plan.

Our Work

The work of the R4D team, led by Senior Fellow Richard Skolnik and the highly respected AIDS modeler and consultant John Stover, and overseen by Managing Director Robert Hecht with input from Program Officer Kira Thorien and Senior Program Associate Gabrielle Partridge, includes:

  • Building a customized model that reflects the diversity and dynamics of the AIDS epidemic in India, and enables policy makers to simulate a series of “what if?” questions regarding the coverage, intensity, and effectiveness of HIV prevention and treatment activities in different parts of the country.
  • Using the model to create a series of projections for the next five years of the estimated impact of program choices on new infections and AIDS illness and deaths and the corresponding financial costs
  • Boosting the capacity of Indian researchers and modelers to conduct this kind of policy scenario modeling, so that they can conduct such analysis on their own in the future.
  • Presenting the results of the AIDS options analysis to senior government officials and donor representatives, in order to build consensus around the most effective and efficient ways to use limited resources to stop and reverse AIDS in India.





Bill & Melinda Gates Foundation


National AIDS Control Organization



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