India, once believed to have the largest HIV-positive population of any country in the world, today announced that new, more accurate surveillance data suggest India has about 2.5 million people living with HIV – about half the number estimated by UNAIDS based on previous surveys of HIV prevalence among pregnant women.
The new HIV prevalence estimate for India is approximately 0.36%, which corresponds to an estimated 2 million to 3.1 million people living with HIV. UNAIDS had previously suggested the range might lie between 3.4 million and 9.4 million.
The new figures, released by India’s National AIDS Control Organisation (NACO) with the endorsement of UNAIDS, are based on the National Family Health Survey, carried out during 2005-2006. The survey was funded by USAID.
The survey carried out voluntary but anonymised tests on more than 100,000 Indians, chosen to reflect the diversity of the country’s population.
In particular the survey tried to obtain a better balance between urban and rural samples, and to reflect more accurately the presence of vulnerable groups such as injecting drug users and men who have sex with men.
This type of survey has been conducted in many countries in Africa where it has been the basis for improving estimates.
Population-based data from India had previously suggested that HIV prevalence might be over-estimated; researchers from Andhra Pradesh state reported last year that HIV prevalence had been over-estimated two-and-a-half-fold in the south Indian state thought to have the highest HIV prevalence.
The National Family Health Survey data were combined with other, more specific survey data, such as HIV prevalence data from antenatal clinic, to develop a more accurate picture of HIV infection in India.
The new data show a slow decrease in HIV prevalence among the general population in southern states. Although more analysis is required this probably means that the number of people becoming infected with HIV is decreasing, according to UNAIDS. This decrease is more perceptible in states such as Tamil Nadu where the intensity of HIV prevention efforts has been high.
While survey data suggest that HIV prevalence levels are declining among sex workers in the southern states, overall prevalence levels among this group continue to be high, necessitating a scaling up of focused prevention efforts among these groups.
“Only by controlling the epidemic among the vulnerable groups can the dynamic of the epidemic be broken,” said Sujatha Rao, Additional Secretary and Director General of NACO.
HIV continues to emerge in new areas. The 2006 surveillance data have identified selected pockets of high prevalence in the northern states. There are 29 districts with high prevalence, particularly in the states of West Bengal, Orissa, Rajasthan and Bihar.
The 2006 surveillance figures show an increase in HIV infection among people who inject drugs and men who have sex with men. HIV prevalence among injecting drug users (IDU) has been found to be significantly higher in Chennai, Delhi, Mumbai and Chandigarh. The states of Orissa, Punjab, West Bengal, Uttar Pradesh and Kerala also show high prevalence among IDUs.