Breaking Down the Numbers

Breaking Down the Numbers

In terms of geographical break-up, 118 districts have HIV prevalence more than 1 percent among mothers attending ante-natal clinics. 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. Yet, new areas have seen a rise in HIV prevalence, particularly in the northern and eastern regions. Twenty-six districts have been identified with high prevalence, largely in the states of Madhya Pradesh, Uttar Pradesh, West Bengal, Orissa, Rajasthan and Bihar.

HIV prevalence continues to be higher among vulnerable groups. For instance, there is a significant population living with HIV and AIDS among IDUs in four of India’s biggest cities – Chennai, Delhi, Mumbai and Chandigarh. Young people are at greater risk, with the under-15 category accounting for 3.8 percent of all HIV infections, as against 3 percent in 2002.

Between 2005 and 2006, prevalence has fallen in some major states – Maharashtra from 0.80 to 0.74 percent, in Tamil Nadu from 0.47 to 0.39 percent – for instance. Yet, new areas of concern have emerged. In West Bengal, prevalence has gone up from 0.21 to 0.30 percent and in Rajasthan from 0.12 to 0.17 percent.

Districts Needing Special Attention

Number of districts with HIV prevalence > 1% among ANC clinics attendees	118
Number of districts with HIV prevalence > 3% among ANC clinic attendees	14
Number of districts in low prevalence states with HIV prevalence > 1% among ANC clinic attendees	26
Number of districts with HIV prevalence > 5% among STD clinic attendees	48
Number of districts with HIV prevalence > 15% among STD clinic attendees	14
Number of districts with HIV prevalence > 5% among HIV high-risk groups	53

The Big Picture

In terms of treatment and prevention interventions, lower estimates for HIV positive people are both heartening and challenging for NACO. At one level, the need for treatment and the need to access ART may be lower. Yet, this makes it is all the more imperative that an effective and universal roll-out of the ART programme is completed at the earliest.

More accurate data is a sort of force-multiplier and allows the country to fine-tune and pinpoint its responses. New AIDS estimates will allow NACO, its partners and State AIDS Control Societies (SACS) to focus on emerging districts of concern even if these be located within states that show low prevalence overall. Indeed, this is also the strategy being followed in the Third National AIDS Control Programme (NACP-III), which makes the district, the unit of intervention. As the new numbers indicate, national figures alone are not enough; they have to be seen in the context of local and district-level HIV and AIDS situation.

Though overall trends are encouraging, injecting drug use and homosexual route among men have emerged as important routes of HIV transmission in different parts of the country. In the North East, besides IDU, HIV prevalence among the FSW is increasing, suggesting a dual nature of the epidemic. Rising HIV prevalence among ANC clinic attendees in North Indian states is an alarming signal for focused attention.

Yet it is important to understand that a more accurate model indicating lower estimates than before does not mean a decline in the epidemic. It only points out that the epidemic is under control because of enormous effort and mobilisation over the past decade. This guard cannot be lowered. While the percentage of adult population affected by HIV and AIDS may have dropped, in absolute numbers, India’s AIDS figure is still substantial. It is the third largest in the world, and remains the largest in Asia.

That is a sobering indicator of the challenges still before us. The imperatives of NACP-III beckon.