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Societal variables are central to effective HIV intervention models.

In this issue of the WHOs Bulletin Prasanna Kumar and colleagues highlights HIV intervention model of Nagelkerke et al. In this model highly active antiretroviral therapy targeted at sex workers would have limited sustained effectiveness among sex workers in contrast to behavioral interventions which would drive the epidemic to extinction in India. While Nagelkerke et al. outline many assumptions underpinning their model it was noted that they do not acknowledge the heterogeneity of the HIV epidemic across India. India has multiple HIV epidemics that are driven by distinct patterns of risk and vulnerability. Hence it was pointed out that understanding societal variables such as caste gender relations and power in sexual relationships may help in determining the future spread of the epidemic and contribute to explaining the local effectiveness of public health interventions.