Prophets of doom delighted with miss

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Prophets of doom delighted with miss

By Manoj Jain

July 23, 2007

India has eliminated HIV from 3.2 million of its people in a year!

Well ... sort of.

Analysis of a recent in-depth survey reveals a lower number -- 2.5

million people instead of 5.7 million people -- living with HIV in

India today. The new estimate moves India down from being the most

populous HIV-positive nation in the world to being the third -- after

South Africa and Nigeria.

As an epidemiologist and a former consultant to the World Bank for

AIDS in India, I have experienced the perplexing task of estimating

and projecting HIV in a population. In 1996, my Indian colleague and

I made a bold and dismal prediction in the prominent medical journal

Lancet. We wrote, " We fear there will be over 10 million infected

persons by the end of the decade (year 2000). "

I am not embarrassed to say we were wrong. In fact, I am elated to

discover that we had grossly overestimated the numbers. But our logic

and reasoning was sound. The question we wrestled with while

estimating the number of people with HIV in a nation is whether HIV

would enter the general population including middle-class

shopkeepers, housewives and civil servants; or if it would remain on

the fringes among high-risk groups, such as commercial sex workers

(prostitutes) and their clients.

I spent several years researching the HIV epidemic in India a decade

ago. On a dusty one-lane highway connecting Madras (now Chennai) to

Bangalore, I watched trucks zoom by. Young lanky men with dark

complexions, wearing colorful lungis (a loincloth wrapped around the

waist) stopped at truck stops for meals, rest and a commercial sexual

encounter.

The rate of HIV among commercial sex workers (CSWs) had already risen

to 30 percent by 1992 with a potential parallel rise among the truck

drivers. As we doctored patients in the sexually transmitted disease

and HIV clinic, we began to see young women -- the wives of the truck

drivers -- present with HIV.

A few cases of HIV among rural women, whose only risk factor was

sexual contact with their husbands, was like a canary-in-a coal mine.

We feared HIV was spreading into the general population -- from the

CSWs to their male clients, to the clients' wives, and then to their

children. We dreaded that a calamity was in the making in India -- as

has happened in Africa.

Imagine if HIV enters the general population of 1 billion people. If

1 percent of the population became infected, this would translate to

10 million people with HIV. In Africa, men and women have two or more

occasional but regular sexual partners, and the speed at which HIV

spread was alarming. If the pattern were to repeat in India the virus

would spread like a brush fire, with HIV rates rising from 2 percent

to 30 percent in the general population. However, if the virus

circulated only within the high-risk groups, then HIV would smolder

like cinders with rates rising slowly in the general population, as

seen in the United States.

The question that epidemiologists intensely debated was, " How will

HIV spread in India? " My colleagues and I suggested it would be like

in Africa, and so we came up with an estimate of 10 million. Recent

survey data, however, shows that the pattern is closer to that in the

United States, with HIV remaining in pockets of high-risk populations

with limited spread into the general population.

As I look back, I realize there are distinct advantages to being an

unintentional alarmist. One garners greater attention from the media,

politicians and international donor agencies when there is a

potential brush fire in the backyard. With this attention, much has

changed over the decade: unprecedented international support,

energized nongovernment organizations, and tremendous governmental

efforts for AIDS education, prevention and treatment.

Bill Clinton's and Bill Gates' foundations are committed to funding

their AIDS initiatives in India, and government officials are

steadfast in their efforts to control the spread of the virus.

Epidemiologists are like prophets who predict the future with limited

information. When predicting a calamity, it is heartening if they are

wrong!

Dr. Manoj Jain is chairman of the Healthy Memphis Common Table

Community Partners Council and an infectious-disease physician.

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Contact: Manoj Jain at 6027 Walnut Grove Suite 312,

Memphis TN, 38120

Tel: (901)-681-0778 E-mail: mkjain@...

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