A tale of two cities: brothel based female commercial sex work, spread of HIV, and related sexual health care interventions in India, using Bombay and Delhi as examples.

HIV/AIDS epidemic was widespread.1 Some believed all Asians to have a natural resistance to HIV infection.1 Others referred to traditional Asian morality: ‘Our younger generation still practice virginity until their nuptial day. The religious customs ... are protection against many social evils. It will be difficult even for HIV to penetrate this shield’, Dr K Abhyambika, AIDS Programme Officer for Kerala, India, 1993.2 Beyond this avoidance of reality, the facts emerged: Since the first documentation of HIV infection in India in 1986,3 there has been an explosion in seroprevalence. By 1993, seroprevalence exceeded 60% among injecting drug users (IDU) in Manipur,4 and 50% among commercial sex workers (CSWs)† in Bombay‡.4 Yet, in some parts of India, prevalence remains low, even among high-risk groups (HRGs)*.5 What is the potential for spread in these areas? How can it be contained? To give substance to these questions, I describe the experiences of two major Indian cities, Bombay and Delhi, where progress of the epidemic has so far been very different. CSWs are believed to play a key role in the spread of HIV infection in these communities.6–9 I compare the rise in seroprevalence in this HRG and discuss factors which may have influenced past infection patterns and which may influence future spread. I then describe and assess interventions that have been implemented to lessen the incidence of HIV infection in this HRG, and discuss considerations for future strategies in Bombay, Delhi, and in India in general. Reviewing the situation in Bombay, I consider whether the need to apply such interventions in Delhi is as urgent.