India's AIDS scare just got halved

The number of people infected with HIV/AIDS in India is between 2.5 and 3.1 million, almost less than half of previous official estimates, according to a new survey released by the government today and backed by the United Nations.

Not only does this put a question mark on the veracity of earlier counts, it also removes the country's so-far dubious distinction of having the world's biggest HIV-positive caseload with 5.7 million infections reported last year. The new estimate puts it below South Africa and Nigeria.

The prevalence level of the infection is now estimated to be around 0.36 percent of the population, down from the earlier 0.9 percent.

"In terms of human lives affected, the number is still large, in fact very large. This is very worrying for us," said Health Minister Anbumani Ramadoss. "We have spent so much on the programme and, finally, the results are there. But we have a long way to go. States like Tamil Nadu and Maharashtra have shown good results, we want to replicate the success story all over the country. The declining figures will not mean reduction in funding, in fact it's going to be more vigorous."

Key to the reduction in the count is the use of a new survey methodology considered more precise. Previously, UNAIDS arrived at the 5.7-million figure by using hundreds of surveillance centres to test the blood of pregnant women and high-risk groups such as drug users and prostitutes over four months each year.

The fact that government surveillance centres are mainly frequented by the poor - who are more affected by HIV - and high-risk groups led to the national estimate to be skewed upwards, experts said.

But the latest method involved both surveillance data and a population-based survey. This tested blood samples and covered about 200,000 people (ages 15-54), including face-to-face interviews, across the country between December 2005 and August 2006.

"In the earlier method, HIV surveillance among pregnant women attending antenatal clinics was used as proxy for prevalence in the general adult population. This pushed estimates higher than the ground reality since that method is suitable for countries with a generalised epidemic, not those were epidemic is low or concentrated, like in India," said Arvind Pandey, director National Institute of Medical Statistics, the ICMR-headed body which conducted the survey.

"The latest approach depends on knowing the population size as well as behaviour of both the high-risk and general population. This time we used data from surveillance sites and also from the community based study of National Family Health Survey," added Pandey.

"This is a much better way of estimation and we completely stand by the figures as the study this time has community-based figures," said Denis Broun, UNAIDS country representative in India speaking to The Indian Express from Paris.

This change of approach hasn't come easy. In fact, UNAIDS differed with official figures on the number of AIDS deaths each year. While official figures were 10,000, UNAIDS estimated that in 2004-2005, over 1 lakh people died due to the disease.

When a research article published in a British Journal claimed that the number of people living with HIV in India could be lower than government estimates, the UN warned against drawing "hasty conclusions".

Then, scientists who studied HIV prevalence in a district in the southern state of Andhra Pradesh - the state has the highest HIV rate in India - found it was less than half the government's figure. Instead of 112,600 HIV cases in Guntur, the number estimated was 45,900.

Early last month, The New York Times reported the decrease in cases for the first time, quoting National Family Health survey figures. International agencies then chose not to

comment then.

A Lancet study in March 2006 had also said that the number of cases of HIV/AIDS has reduced from 2000 to 2004.

The encouraging results, according to Ramadoss, is a reason to be happy about. "Many of us know that we have always been found to be at fault for underestimating the seriousness of the epidemic. That was a disturbing allegation. Today, we have a far more reliable estimate of burden of HIV disease in India".

Ramadoss said there was no plan to reduce funding for AIDS because of the lower estimate and added the government may actually increase funding, as 140 of India's 604 districts had a HIV prevalence of more than 1 per cent.

Said Sujatha Rao, head of the National AIDS Control Organisation: "Even as the general prevalence is reported to have come down, the trends of HIV infection continue to remain the same. It's more in rural areas and amongst women. Andhra Pradesh has the highest number of cases and government is taking notice of this. It is such a state where authorities didn't take action when they should have. The state started taking initiatives only in 2000. A lot of good work was done since then but there is lot more to be done."