NACO conducted the first national level BSS in the year 2001 and

NACO conducted the first national level BSS in the year 2001 and commissioned the second round of the BSS in 2006 to measure the changes in behavioral indicators. The third round of the BSS was conducted in the year 2009. A similar approach and tools were used for data collection across all different rounds of the survey.20,22 Program monitoring data NACO and other program implementation partners have developed a computerized monitoring and information system for indicators of clinic service utilization, condom

distribution, and outreach services over the years. For each targeted intervention program that has been funded, the NGOs or community-based organizations gather data on program indicators and report monthly achievement to each of the state AIDS control societies. State level data are collated centrally to monitor the program at the national level. Although the system for monitoring the program indicators was initiated in 2001, accurate and centralized data on program coverage and uptake of services were available for the period 2008–11. Ethics statement Secondary data that were available with the Department of AIDS Control (DAC/NACO), Ministry

of Health and Family Welfare, Government of India, have been used for this study, and none of the data included any personal identifiers. Use of the secondary data and analyses for the present study was reviewed and approved by the ethical review and data sharing committees of NACO, Government of India. Data presentation and analyses In this study, HIV prevalence and other behavioral surveillance data have been presented

separately for each group of states in order to compare the epidemic trend by geographic variability in the HIV risk environment. Broadly, the Indian states are grouped into four categories that capture 1) extent and availability of data, 2) severity of the epidemic and its drivers, and 3) status and comprehensiveness of response. This way of grouping of states also facilitates comparison of the present data with the earlier information published by Chandrasekaran et al.23 With a total population of 330 million, the states of Maharashtra, Karnataka, Andhra Pradesh, and Tamil Nadu (group I) account for nearly 1.07 million estimated HIV infections.24,25 AV-951 Transmission is largely heterosexual. As a consequence of years of sustained large-scale prevention efforts, fairly comprehensive maps and size estimations of some high-risk groups are present, as well as behavioral, biological, and facility-based studies.24 As per the recent size estimation of MSM, group I states comprise 205,865 MSM, with a program coverage of 134,309 MSMs.26 The second group of states (group II) comprises Manipur, Nagaland, and Mizoram, which have a combined population of 5.7 million, and accounts for an estimated 40,431 persons living with HIV.

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