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Skepticism greets India's new AIDS statistics

Indian officials say the slow growth in numbers is proof their strategies are working.

HIV/AIDS infections in India are rising steadily. Credit: Source: NACO

The Indian health ministry in late May announced that new HIV infections in the country had increased by 28,000 over the previous year. The numbers have stoked a lingering controversy over the magnitude of the country's AIDS epidemic.

India's National AIDS Control Organization (NACO) based its numbers on data collected from 659 sentinel sites, including clinics for sexually transmitted diseases, drug rehabilitation centers, prenatal care clinics and groups of female sex workers. The organization says India has an estimated 5.134 million cases, ranking second only to South Africa's 5.3 million.

At 0.91%, the prevalence remains below 1%, considered the tipping point for AIDS. But in some parts of India, more than 4 in every 100 people is infected. The number of high-prevalence districts also rose from 49 to 111 in 2004.

“HIV is still increasing in India and remains a formidable challenge. , Denis Broun, UNAIDS”

Still, the increase in infections in 2004 is a 95% drop compared with 2003, when NACO recorded 520,000 new cases. NACO director S.Y. Quraishi attributes this dramatic drop to the government's strategy to target prevention efforts on high-risk groups in states where the infection rate is greater than 1%. “We are tackling the problem at the root cause and are on the right track,” Quraishi says.

But international experts quickly disputed the numbers, saying there are no studies that show significant behavior change or awareness levels to substantiate the government's claims.

The low numbers could lead to complacency and slow down HIV prevention efforts, the experts warn. “This is the time to have an all-out assault on the epidemic to win the battle,” says Jon Lidén, head of communications for the Global Fund to Fight AIDS, Tuberculosis and Malaria.

If prevention efforts stall, infections could resurge, even in areas—such as the southern state of Tamil Nadu—where incidence has plateaued for the past four years. “HIV is still increasing in India and remains a formidable challenge,” says Denis Broun, UNAIDS country coordinator in India.

A week after the government's announcement, the health ministry, UNAIDS and the World Health Organization clarified that the number 28,000 does not include deaths due to AIDS.

The report reveals other trends: infections in rural India continued to rise to 59% of all HIV infections. Overall prevalence in the southern state of Andhra Pradesh surpassed 2%, and is continuing to rise in both high-risk groups and the general population in several other states.

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Padma, T. Skepticism greets India's new AIDS statistics. Nat Med 11, 695 (2005).

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