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HIV Epidemic Slowing in India
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'Best news on AIDS: In South India, HIV down 35 per cent'
Pallava Bagla
Indianexpress.com
Thursday, March 30, 2006 at 0000 hrs IST
NEW DELHI, MARCH 29
In what experts call the "best news on AIDS for India," an Indo-Canadian team of scientists has come up with the first definitive evidence that the AIDS epidemic is slowing down in at least southern India, considered the the cradle of the disease in the country. This essentially means that the prevention program seems to be making headway and gloom-and-doom scenarios of AIDS in India need to be put into perspective.
The study, in the latest issue of the British medical journal The Lancet, reports a one-third decline in new HIV infections in the worst-hit regions of India: Tamil Nadu, Maharashtra, Karnataka and Andhra Pradesh.
While data from north India is still cause for worry, the Lancet study reports that prevalence of HIV-1 (the most common variant of the virus in India) prevalence fell in the southern states from 1.7% to 1.1%-a relative reduction of 35%.
UNAIDS, World Health Organisation and the Government of India all agree on an estimated 5.1 million people infected with HIV, 75% of them in the southern states.
The Lancet study's 10-member team of researchers studied a sample of over 2.9 lakh women and 58,000 men attending 132 sexually transmitted infection (STI) clinics in the north and south from 2000 to 2004.
"This is the best news so far on AIDS in India," Nirmal Kumar Ganguly, director general of the Indian Council of Medical Research, told The Indian Express tonight, adding that intervention strategies based on increasing awareness and imparting adequate information especially among high-risk groups might have helped put a brake on the epidemic.
Corollary: an even bigger effort is needed in the rest of India especially in currently low-prevalence states if the war on AIDS has to be won, said Ganguly.
The Lancet study tracked HIV prevalence among young women between 15-24 years of age attending pregnancy or antenatal clinics in India's southern and northern states. Researchers used HIV trends among young women attending antenatal clinics as an indicator to monitor trends in new infections among the general population.
In India, the male use of female sex workers is the main reason for the spread, which subsequently puts wives in a vulnerable position. According to the research group, in recent years, the Indian government, the World Bank and other agencies have aimed intervention and awareness programmes aimed at sex workers and their efforts appear to have contributed "to a drastic decline."
"There have been many predictions, mostly based on guesswork, that India's AIDS problem will explode-as it did in southern Africa-but we now have direct evidence of something positive," says the study's co-author, Prabhat Jha, of the Department of Public Health Sciences, University of Toronto, Canada, formerly with the World Bank in New Delhi.
"The good news is that HIV in young adults appears to be declining in the south-most likely or perhaps only due to men keeping away from red light area or using condoms more often when they do. The not-so-good news is that trends in the north remain uncertain and poorly studied."
Most of the data emerged from portals of the National AIDS Control Organization, New Delhi. Reinforcing this positive trend, says the lead author of the study, Rajesh Kumar, of the Postgraduate Institute of Medical Education and Research in Chandigarh, is the fact that the decline among young women in the south are broad-based: "among urban and rural women and among educated or illiterate women."
Kumar cautions that while the findings are good news, the battle is far from over. "HIV remains a huge problem in India and we have to remain vigilant," he said. "We're not saying the epidemic is under control yet-we are saying that prevention efforts with high-risk groups thus far seem to be having an effect."
Ashok Alexander, director of Avahan, the AIDS prevention initiative of the Bill and Melinda Gates Foundation, also urges caution: "Prevention works but we have not achieved scaled prevention yet in India."
He suggests that Jha's data shows that the epidemic is not under control in Andhra Pradesh and Karnataka while there is a more positive trend in Maharashtra and Tamil Nadu where there has been the longest record of prevention.
Alexander, who looks after the $200-million AIDS initiative of the Gates Foundation feels that data is misleading as an indicator of epidemic trends in India adding that "we need data from high-risk groups that is highly missing."
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