Overall figures and trends in HIV infection in India
India’s first known HIV infection was diagnosed in a female sex worker in Chennai in February 1986. It is highly probable that HIV had been circulating for some years before that, since screening during 1986-87 found as many as 3%-4% of sex workers infected in Vellore and Madurai, and 1% of STD patients infected in Mumbai. As there were already over 20,000 cases in the world before any case was identified in India, screening for HIV infections began in India in 1985, almost as soon as tests for the HIV antibody were available.
Across the world, country estimates have been revised with better data through community based and population surveys. In India, too, for the first time in 2006, HIV testing was a part of the National Family Health Survey (NFHS). The results of NFHS-III give us more accurate information about the estimates of those infected with HIV in the country.
National Family Health Survey-III
According to NFHS-II figures, India had an estimated 2.5 million people (range 2 and 3.1 million) between the ages of 15 and 49 years living with HIV in 2006 – less than half the previous year’s estimate of more than 5 million. The country’s adult HIV prevalence is halved as well, and is now estimated to be approximately 0.36%. HIV prevalence among adult women is 0.29%; for men it is 0.43%. This puts India behind South Africa and Nigeria in numbers living with HIV.
Overall, HIV prevalence was higher among urban than rural populations. However, some states had a slightly higher HIV prevalence among rural populations than urban populations, namely, Punjab, Tamil Nadu and Uttar Pradesh.
HIV prevalence was highest among women whose spouses were employed in the transport industry. In Manipur and Nagaland, HIV prevalence was the highest among women whose spouses were industry/factory workers.
Prevalence among injecting drug users is 8.71%; it is 5.69% among MSMs (in selected southern and northeastern states it has remained at an average of around 10% for the past few years) and 5.38% for female sex workers (FSWs).
In 2006, HIV prevalence among mothers attending antenatal clinics (a measure of HIV prevalence in the general population) is more than 1% in 118 districts. Eighty-one districts have an HIV prevalence of more than 5% in one or more of the high risk groups.
The 2006 estimates indicate that the epidemic has stabilised or seen a drop in Tamil Nadu and other southern states with a high HIV burden. Prevalence has fallen in some major states – Maharashtra from 0.80% in 2005 to 0.74% in 2006, in Tamil Nadu from 0.47% in 2005 to 0.39% in 2006. However, the southern states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu continue to have the highest HIV prevalences. Finally, despite an overall decline in prevalence, there are many pockets of high HIV transmission: 107 sentinel surveillance sites in 76 districts have HIV seropositivity greater than 1% among antenatal clinic attendees. Seventy sentinel surveillance sites in 44 districts have HIV prevalence greater than 5% in high risk groups.
The HIV epidemic in the north-eastern states of Manipur, Mizoram and Nagaland continues unabated. In 2006, HIV seropositivity among pregnant women was 1.39%, 1.36% and 0.94% in Manipur, Nagaland and Mizoram respectively. Although HIV prevalence among IDUs in Manipur has declined over the years, all four IDU sentinel surveillance sites in Manipur still have HIV prevalence of more than 10%. In addition, HIV prevalence among sex workers appears to be increasing in Nagaland and Mizoram.
Further, there has been a rise in HIV prevalence in the northern and eastern regions: 26 districts -- mostly in Madhya Pradesh, Uttar Pradesh, West Bengal, Orissa, Rajasthan and Bihar – are high prevalence districts. In West Bengal, prevalence has gone up from 0.21% in 2005, to 0.30% in 2006. In some districts of West Bengal high HIV transmission is seen among sex workers and IDUs. Among migrants at one site in Orissa, HIV prevalence was 5%. In Rajasthan, HIV prevalence has gone from 0.12% in 2005 to 0.17% in 2006. HIV prevalence continues to be higher among vulnerable groups such as IDUs in Chennai, Delhi, Mumbai and Chandigarh.
The HIV prevalence data for most states is established through testing pregnant women at antenatal clinics. While this means that the data is only directly relevant to sexually active women, it still provides a reasonable indication of the overall HIV prevalence of each area. Data for six states is also available from a survey of the general population. The following states have recorded the highest levels of HIV prevalence at antenatal and sexually transmitted disease (STD) clinics over recent years:
HIV prevalence at antenatal clinics in Andhra Pradesh was around 2% in 2004 and 2005 - higher than in any other state. A survey in the general population found a prevalence of 0.97% in 2005-2006. HIV prevalence at STD clinics was 22.8% in 2005.
The HIV prevalence at antenatal clinics was found to be above 1% in both 2002 and 2004, but was 0.5% in 2003 and 0% in 2005; the 2005 survey included only two antenatal sites. Prevalence at STD clinics was 14% in 2005.
HIV prevalence at antenatal clinics in Karnataka has been over 1% for some years. A 2005-2006 survey found that 0.69% of the general population was infected. The average HIV prevalence among female sex workers in Karnataka was 18% in 2005.
HIV prevalence at antenatal clinics in Maharashtra has been above 1% for some years, Surveys of female sex workers have found HIV prevalence of above 20% and the prevalence among injecting drug users and men who have sex with men is also high. A 2005-2006 survey in the general population found a prevalence of 0.62%.
HIV prevalence at antenatal clinics in Tamil Nadu was 0.88% in 2002 and 0.5% in 2005, though several districts still have rates above 1%. The general population survey of 2005-2006 found a rate of 0.34% across the state. Prevalence among injecting drug users was 18% in 2005.
HIV prevalence among injecting drug users is above 20%. The virus has spread further to the female sexual partners of drug users and their children. The 2005-2006 survey of the general population found that 1.13% was infected - the highest of all states surveyed.
The HIV epidemic was first recorded in 1998 with some drug clinics registering HIV prevalences of more than 70% among their injecting drug user patients but the average prevalence among this group is now around 5%. HIV prevalence at antenatal clinics has exceeded 1% in most recent years, but was 0.88% in 2005.
Injecting drug use has again been the driving force behind the spread of HIV. In 2005, the HIV prevalence at antenatal clinics was 1.63%, and the rate among injecting drug users was 4.51%.
InfoChange News & Features, March 2008