Number of HIV/AIDS Cases in India Might Be Lower Than Current Estimates, Survey Says
The number of actual HIV/AIDS cases in India might be millions fewer than current estimates, according to a new, unreleased household survey, the New York Times reports. UNAIDS estimates from 2006 show that there are about 5.7 million people living with HIV/AIDS in India. However, a preliminary analysis of the National Family Health Survey -- which was conducted under international supervision and with U.S. funding -- suggests that India has between two million and three million people living with HIV/AIDS, according to several sources, including U.S. epidemiologists and the Indian Ministry of Health and Family Welfare. The survey concluded last year.
According to the Times, the methods used to calculate HIV/AIDS rates in countries are a "subject of debate, with some experts contending that the rates in many places may be exaggerated," the Times reports. Standard methods for calculating a country's HIV/AIDS prevalence include testing high-risk groups and pregnant women who come to health clinics. Some more recent U.S.-financed studies, including the Indian survey, have taken blood samples in randomly chosen households in rural and urban areas. According to the Times, the survey's results suggest that India's HIV cases are contained within high-risk groups, including commercial sex workers, truck drivers, injection drug users and men who have sex with men.
The results mirror "exactly what some experts on AIDS surveillance techniques have been arguing for years," according to the Times. According to experts, the same sexual networks that exist in Southern and Eastern Africa, where men and women have at least two occasional but regular sex partners over long periods of time, are not common in India. Transactional sex outside of commercial sex work also is less common in Asia than in Africa, the Times reports.
Several prominent people in recent years have "accused India of denying the scope of its AIDS problem," while Indian health officials "dispute their conclusions," according to the Times. "Everyone transiting through here says, 'This is a pandemic,'" but "I am very confident that we will not turn into a generalized epidemic," Anbumani Ramadoss, India's health minister, said. Ramadoss added that he wants the "world [to] acknowledge the efforts India is making" in fighting HIV/AIDS. He noted that the government is spending $2 billion to fight the disease and has provided 75,000 people with access to no-cost antiretroviral treatment. In addition, 2,000 centers have provided sex education and condoms to sex workers and clients, and the country has established 3,600 public HIV testing centers, according to Ramadoss. "India is glaringly not in a denial phase," Ramadoss said, adding that he is grateful for the pressure from critics because it had forced the country to move faster.
According to Daniel Halperin of the Harvard School of Public Health, some HIV/AIDS groups have been hesitant to make revisions of their estimates. "If the total number of cases in the world is half of what you've been saying, that's a bitter pill to swallow," he said, adding, "So every year they lower the numbers a little bit, and retroactively change the estimates of what it used to be." Anjali Gopalan -- executive director of the Naz Foundation (India) Trust, which runs an orphanage and addresses the stigmatization of people living with HIV/AIDS -- said she is skeptical of any estimate as low as two million. However, she added that whatever figure is determined, the "infection is here, and we have a huge burden" (McNeil, New York Times, 6/8). "There are corrections that happen in the data from time to time," Paul Zeitz, executive director of the Global AIDS Alliance said, adding, "But if India still has millions of infections, there are still risks for increasing those numbers"
In a statement released on Friday, India's National AIDS Control Organization, UNAIDS and the World Health Organization said that the new data provide a "more accurate picture of the epidemic because of availability of more information based on population surveys and improved data from high-risk groups." The statement did not mention the overall lower estimate of the number of HIV-positive people in India, according to the AP/International Herald Tribune (AP/International Herald Tribune, 6/8). The statement added that although HIV prevalence in prenatal clinics has shown a decline in some of India's southern states, the high number of cases among high-risk groups -- including MSM and IDUs -- are "of concern." In addition, although data suggest that HIV prevalence is declining among "sex workers in areas where targeted interventions have been implemented, particularly in the southern states," overall HIV prevalence "among this group continue[s] to be high, necessitating focused prevention interventions" (NACO/WHO/UNAIDS release, 6/8). Ashok Alexander -- director of Avahan, the Bill & Melinda Gates Foundation's Indian HIV/AIDS initiative, which helped fund the survey -- said that the survey's estimates are "good news," adding, "The (infection) rate is coming down." He added the new estimates should not result in relaxed efforts to control the spread of HIV, which affects up to 1% of the population in India's more developed, southern states (Goering, Chicago Tribune, 6/9).