Which key population group accounts for the largest proportion of new HIV infections in India?

Explanation

## Key Populations and HIV Transmission in India **Key Point:** According to recent NACO data (Annual Report 2022–23), **Men who have sex with men (MSM)** account for the **largest single proportion of new HIV infections** in India among key populations, reflecting a significant epidemiological shift in India's concentrated epidemic. ### Distribution of New Infections by Key Population (NACO 2022–23) | Key Population | % of New Infections | Estimated HIV Prevalence | | --- | --- | --- | | MSM | ~30–35% | 4–6% | | Sex workers & clients | ~25–30% | 5–10% | | PWID | ~15–20% | 10–15% | | Transgender persons | ~5–8% | 3–5% | | Healthcare workers (NSI) | < 1% | < 0.1% | | General population | Residual | 0.21% | **High-Yield:** India's HIV epidemic remains **concentrated** (not generalized). While historically sex workers and their clients were considered the primary driver, more recent NACO surveillance data indicate that MSM now contribute the largest share of new infections, particularly in urban metros such as Mumbai, Delhi, and Chennai. ### Epidemiological Significance - **MSM prevalence:** HIV prevalence among MSM is estimated at 4–6% nationally, with higher rates in urban centers; this group has seen rising incidence due to underreporting, stigma, and limited access to prevention services. - **Geographic hotspots:** Southern and western states (Karnataka, Maharashtra, Tamil Nadu, Andhra Pradesh) continue to bear the highest burden. - **Prevention focus:** NACO's National AIDS Control Programme (NACP-V) prioritizes targeted interventions for MSM including community-led testing, PrEP scale-up, and peer outreach. **Mnemonic:** **MSPT** — MSM, Sex workers, PWID, Transgender — key populations driving India's concentrated epidemic, with MSM now leading new infection counts. **Clinical Pearl:** Healthcare workers exposed to needlestick injuries (NSI) carry a very low per-exposure risk (~0.3% for HIV per percutaneous exposure) and account for < 1% of new infections nationally, making option D a clear distractor. [cite: NACO Annual Report 2022–23; Park's Textbook of Preventive and Social Medicine, 26th ed., Ch. 8]