Indian sex worker Shaalu is using fewer condoms when she meets her clients in New Delhi – not out of choice, but because a funding crunch and procurement delays in the state-run HIV/AIDS programme have disrupted supplies of free condoms.
"I am more scared of HIV now," said Shaalu, 32, who often resorts to unsafe sex as free condoms are scarce and she is hard pressed for funds to repay a debt of $4,500 (±R62 000).
Less than a month's supply
India provides free condoms under its community-based AIDS prevention programme that targets high-risk groups like sex workers. That strategy, the World Bank estimates, helped avert 3 million HIV infections between 1995 and 2015.
But government data released last week showed about two-thirds of India's 31 state AIDS units had less than a month's supply of condoms. Some states only have enough for a few days.
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Reliable supplies are key experts fear that the shortage could lead to more unsafe sex and increased infections, especially among the poor.
The human immunodeficiency virus (HIV) that causes AIDS can be transmitted via blood, breast milk or unprotected sex. The incurable infection killed 130,000 people in India and 1.5 million globally in 2013, the World Health Organisation says.
"Not having the only barrier method at the doors of those who need it is catastrophic," said Mona Mishra, an activist who runs a national AIDS Momentum campaign.
The shortages come after Prime Minister Narendra Modi slashed federal AIDS funding in February by a fifth. Modi hoped states would fill the gap, but the cut came as regional AIDS units faced bureaucratic payment delays.
An official at India's National AIDS Control Organisation (NACO), which runs the programme, blamed the condom shortage on the federal cuts and a delayed procurement tender that was recalled due to technical discrepancies.
Condoms in the open market are cheap, but female sex workers often hesitate to buy them from a medical store due to social taboos.
Mostly from poor families, these women were under pressure to have unsafe sex if clients didn't carry their own condoms, said Kusum, head of the All India Network of Sex Workers that represents 200,000 women.
In the western state of Maharashtra, the stock of free condoms was one-eighth of its monthly requirement of 3.3 million condoms on 17 October.
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Despite recent hiccups, India's AIDS programme has won praise globally. HIV prevalence among female sex workers almost halved to 2.67 percent during 2007-2011 and new infections have fallen in recent years.
The NACO official in New Delhi said free condom supplies should improve in the next 15-20 days.
But for Shaalu, who only gave her working name, AIDS budget cuts and condom shortages are a double shock – she last received her R639 (3,000 rupees) monthly salary for promoting safe sex as a "peer educator" in April.
"The government should at least give us condoms so that we can earn money," she said. "If we get infected, we will die."
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Image: from iStock