Diverse realities: Understanding sexually transmitted infections and HIV in India

Sexually transmitted infections (STIs) including HIV currently have high salience on the health care agendas of many countries including India. Strategies for their control are ideally based on a number of well-recognized principles. These include: assessments of the burden of disease; the availability of interventions at policy and program levels to influence behavior change and technical solutions; and the calculated cost-effectiveness of these interventions. In this case of India data to inform these principles are often lacking in the case of STI control. In this paper the authors have reviewed the evidence base for STI control in the Indian context. The paper is split into a number of sections: a review of sociodemographic and structural level factors which may indicate vulnerability to epidemics of the STIs; a compilation of the available evidence on the prevalence and epidemiology of these infections; individual level risk factors for infection; responses to risk and infection--both at the individual level and within the pluralistic health service; and a detailed review of the STI/HIV control program in the country. The authors conclude with a summary of the evidence base and make suggestions for areas where further work is needed to strengthen this base. (authors)