HIV & AIDS in India according to The UNAIDS/WHO Annual Report

[Guest guest]

The annual AIDS Epidemic Update reports on the latest developments

in the global AIDS epidemic. With maps and regional estimates, the

2005 edition provides the most recent estimates on the epidemic's

scope and human toll, explores new trends in the epidemic's

evolution, and features a special section on HIV prevention.

The following is the reference about HIV/AIDS in India (Moderator)

INDIA

Diverse epidemics are underway in India, where an estimated 5.1

million Indians were living with HIV in 2003 (NACO, 2004a). Although

levels of HIV infection prevalence appear to have stabilized in some

states (such as Tamil Nadu, Andhra Pradesh, Karnataka and

Maharashtra), it is still increasing in at-risk population groups in

several other states. As a result, overall HIV prevalence has

continued to rise. State-wide prevalence among pregnant women is

still very low in the poor and densely populated northern states of

Uttar Pradesh and Bihar. Even relatively minor increases in HIV

transmission could translate into huge numbers of people becoming

infected in those states, which are home to one quarter of India's

entire population.

HIV prevalence of over 1% has been found in pregnant women in four

of the industrialized western and southern states of India

(specially Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu,)

and in the north-eastern states of Manipur and Nagaland (NACO,

2004a).

Transmitted mainly through unprotected sex in the south and

injecting drug use in the north-east of the country, HIV is

spreading beyond urban areas. In Karnataka and Nagaland, more than

of 1% of pregnant women in rural areas tested HIV-positive in 2003.

A significant proportion of new infections is occurring in women who

are married and who have been infected by husbands who (either

currently or in the past) frequented sex workers. Commercial sex

(along with injecting drug use, in the cases of Nagaland and Tamil

Nadu) serves as a major driver of the epidemics in most parts of

India. HIV surveillance in 2003 found 14% of commercial sex workers

in Karnataka and 19% in Andhra Pradesh were infected with HIV (NACO,

2004b). The recent finding that 26% of sex workers in the city of

Mysore (Karnataka) were HIV-positive is not surprising given that

just 14% of the women used condoms consistently with clients and

that 91% of them never used condoms during sex with their regular

partners (Reza-, 2005).

The well-known achievements among sex workers of Kolkata's Sonagachi

red-light area (in West Bengal) have shown that safer sex programmes

that empower sex workers can curb the spread of HIV. Condom use in

Sonagachi has risen as high as 85% and HIV prevalence among

commercial sex workers declined to under 4% in 2004 (having exceeded

11% in 2001). In Mumbai, by contrast, available data suggest that

sporadic and piecemeal efforts to promote condom use during

commercial sex have not been as effective; there, HIV prevalence

among female sex workers has not fallen below 52% since 2000 (NACO,

2004b).

HIV information and awareness among sex workers appears to be low,

especially among those working in the streets. Surveys carried out

in various parts of India in 2001 found that 30% of street-based sex

workers did not know that condoms prevent HIV infection, and in some

states, such as Haryana, fewer than half of all sex workers (brothel-

and street-based) knew that condoms prevent HIV. Large proportions

of sex workers (42% nationally) also thought they could tell whether

a client had HIV on the basis of his physical appearance (MAP,

2005b).

In the north-east of India, HIV transmission is concentrated chiefly

among drug injectors and their sexual partners (some of whom also

buy or sell sex), especially in the states of Manipur, Mizoram and

Nagaland, all of which lie adjacent to the drug-trafficking `Golden

Triangle' zone ( et al., 2004). There is a significant

overlap of sex work and injecting drug use in Manipur, where a drug

injection-driven epidemic has been prevalent for at least a decade.

Some 20% of female sex workers said they injected drugs, according

to behavioural surveillance. In other north-eastern states, about

half as many sex workers have reported injecting drugs (MAP, 2005a).

Harm reduction efforts (including needle and syringe exchange, as

well as limited drug substitution programmes) were introduced more

recently in some states, such as Manipur. There, the most recent

data (2003) put HIV prevalence in drug injectors at 24%—the lowest

levels detected among injecting drug users in that state since 1998;

changing inclusion criteria, however, make it dif.cult to directly

compare HIV data from the various studies (NACO, 2004b). Elsewhere

the epidemics among drug injectors appear to be well established,

with HIV prevalence having reached 14% in Nagaland in 2000–2003, for

example (NACO, 2004b).

Injecting drug use is not limited to the country's northern states.

There has been a sharp rise in HIV infections among drug injectors

in the southern state of Tamil Nadu, where 39% were HIV-infected in

2003, compared with 25% in 2001 (NACO, 2004b). In a smaller study in

the city of Chennai (in the same state), almost two thirds (64%) of

injectors were HIV-positive, according to sentinel surveillance done

in 2003 (Monitoring the AIDS Pandemic Network, 2004). As these

(mostly male) drug users can then pass the virus to their sexual

partners, increasing numbers of women are being infected.

Relatively little is known about the role of sex between men in

India's various epidemics. The few studies that have examined this

complex dimension of sexuality in India have found that significant

numbers of men do have sex with other men. One study, undertaken

among residents of slum areas in Chennai, has found that 6% of men

had had sexual intercourse with another man. Almost 7% of the men

who had sex with other men were HIV-positive, and more than half of

them were married (Go et al.,

UNAIDS: AIDS epidemic up date December 2005