Though HIV/AIDS has generated more attention than any other healthcare issue in India, we’re still struggling with many basic questions. For example, do we really know the relative importance of the different means of HIV transmission? Does the focus on sexual transmission and injecting drug use shift the responsibility of prevention to individuals rather than the system? How can a prevention programme work if it is targeted at people involved in practices that are seen as illegal? Sandhya Srinivasan gives some answers

At the recently concluded international AIDS conference in Mexico, and other forums, organisations of sex workers have demanded a greater say in AIDS policy formation. Ranjita Biswas reports

UNAIDS's Redefining AIDS in Asia: Crafting an Effective Response, a comprehensive review of the realities and impact of AIDS in Asia, misses some vital causes of the spread of the epidemic such as unsafe practices in public health services and makes some faulty assumptions about Asia’s HIV epidemics, say Mariette Correa and David Gisselquist

Recent studies in Africa have suggested that male circumcision can halve the risk of HIV infection and a WHO meeting declared that male circumcision should now be recognised as an important intervention to reduce the risk of HIV. Mariette Correa assesses the evidence and the implications to public health and cultural concerns if this intervention is widely implemented in India

In 2006, UNAIDS declared that India had 5.7 million HIV-positive people. NACO put the figure at 5.2 million. And, finally, NFHS-3 put the HIV burden at 2.5 million. M Prasanna Kumar demystifies the numbers game

Despite the fact that India is a major producer of cheap generic HIV and AIDS drugs, India’s ART programme is poorly conceived, implemented and monitored, with a shortage of drugs, equipment and personnel. Such an unprepared public health system is in no position to handle such an intensive programme, say Sandhya Srinivasan and T K Rajalakshmi

Do we really know what the various forces driving India’s epidemic are? Some studies report that around 23% of medical injections could be using unsterile syringes or needles. WHO estimated that unsterile medical injections accounted for 24% of HIV transmission in India in 2000. But India has focused almost exclusively on the sexual route of transmission. This has important implications for the prevention programme, says Mariette Correa

All three core groups affected and infected in the HIV epidemic -- men having sex with men, sex workers and injecting drug users -- are criminalised in India. How can any intervention work amongst groups whose behaviour is criminalised? Ashok Row Kavi calls for basic structural changes, including the deletion, or at least reading down, of Section 377 of the Indian Penal Code on sodomy, decriminalising sex work and curbing narcotics trafficking instead of punishing end-users

Female sex workers constitute less than 1% of the infected female population in India. Yet, they are seen as a high-risk group and are the target of various HIV-related interventions. Such targeted interventions only end up further alienating communities instead of empowering them to combat HIV, says Meena Saraswathi Seshu

The prevalence of HIV amongst injecting drug users in India could be more than 5%. But the only government intervention for these hidden, marginalised people is detoxification. Those who cannot obtain treatment and continue to inject drugs, or those who relapse, need other methods for reducing the risk of HIV transmission, including community outreach, the provision of new needles and syringes, condom provision and drug substitution therapy, says Eldred Tellis