HIV Epidemic in India

New, more accurate estimates of HIV indicate that approximately 2.5 million (2 million–3.1 million) people in India were living with HIV in 2006, with national adult HIV prevalence of 0.36%. Although the proportion of people living with HIV is lower than previously estimated, India’s epidemic continues to affect large numbers of people.

The revised estimates are based on an expanded and improved surveillance system, and the use of more robust and enhanced methodology. The inclusion of the results of the recent national household survey (the National Family Health Survey 3, conducted in 2005–2006) in the estimation process contributed significantly to the revised estimates. Over 100 000 people were tested for HIV in the survey which was the first national population based survey to include a component on HIV (NFHS-3, 2007).

In addition, India has expanded its HIV sentinel surveillance system in recent years and the number of surveillance sites increased from 155 in 1998 to 1120 in 2006. Data from pregnant women attending antenatal clinics, people attending sexually transmitted infections clinics and population groups that are at a higher risk of

exposure to HIV are included in the surveillance.

Prevalence trends in India vary greatly between states and regions. Even in the four southern states (Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu) where the large majority of people living with HIV are residing, HIV prevalence varies and the epidemic tends to be concentrated in certain districts (NACO, 2005a; World Bank, 2005). Reported adult HIV prevalence in six states included in the recent national population-based survey (NFHS-3, 2007) varied from 0.07% in Uttar Pradesh, to 0.34% in Tamil Nadu, 0.62% in Maharashtra, 0.69% in Karnataka, 0.97% in Andhra Pradesh, and 1.13% in Manipur.

Prevalence in all other states together was 0.13%. An earlier analysis of sentinel surveillance data also showed that HIV prevalence in southern states overall was about five times higher than in northern states in 2000–2004 (Kumar R et al., 2006). However, pockets of high HIV prevalence (mainly among population groups at high risk of exposure to HIV) have also been identified in states where overall prevalence is generally low, warning against complacency.

Data from the expanded 2006 sentinel surveillance show stable or declining prevalence among pregnant women in Tamil Nadu, Maharashtra, Karnataka, and Andhra Pradesh, but high HIV prevalence among sex workers, and rising HIV prevalence among injecting drug users and men who have sex with men in a few states. Outside of the north-east of the country, where the use of contaminated drug injecting equipment is a key risk factor, HIV appears to be spreading mainly as a result of unprotected sex between sex workers and their clients, and their respective other sex partners (Kumar et al., 2005). Prevention programmes focusing on sex workers show some success and HIV prevalence is on the decline among sex workers in areas that have been the focus of targeted prevention efforts, especially in Tamil Nadu and other southern states. However, prevention efforts are often complicated by the varied nature of commercial sex. (Char, Piller & Shirke, 2003).