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AIDS Incidence in India Far Lower Than Previously Estimated New Study

Early analysis of the figures suggests that India really has between two and three million victims, and not 5.7 as per UN estimates of last year. The survey was carried out under international supervision with American financing.

The lower figure for India would imply that India has managed to keep its epidemic more like that of the United States, in that the virus circulates mostly within high-risk groups. In Indias case, these are prostitutes and their clients especially truckers; men who have sex with men; and people who inject drugs, especially in the northeast, on the borders with Myanmar.

That is exactly what some experts on AIDS surveillance techniques have been arguing for years, saying that Indians do not have the same kind of sexual networks that are common in southern and eastern Africa, in which both men and women often have two or more occasional but regular sexual partners over long periods of time. Also, outside of prostitution, transactional sex between teenage girls and older men in return for money, food or clothes is much less common in Asia than in Africa.

James Chin, a professor of epidemiology at the University of California, Berkeley, has made the case that the typical way of estimating AIDS prevalence rates sampling the blood of pregnant women who come to urban health clinics and the blood of high-risk groups greatly exaggerates national estimates.

Professor Chin has been vindicated by more recent surveys, paid for by the United States, that take blood samples in randomly chosen households in rural and urban areas. One of those, called the National Family Health Survey, produced Indias new figures. Such surveys, country by country, have led the United Nations AIDS program, Unaids, to slowly scale back its world estimates.

This is a replay of what happened in Kenya, said Daniel Halperin, an expert on AIDS infection rates at the Harvard School of Public Health. When Kenya was more carefully surveyed in 2004, he said, its prevalence rate was halved, to 6.7 percent from the 15 percent that Unaids had estimated in 2001. But Dr. Halperin said that AIDS-fighting agencies had such a stake in portraying the epidemic as an approaching Armageddon that they were hesitant to make revisions. Indias survey was finished last year, but Avahan, an AIDS group here financed by the Gates Foundation, refused to discuss the figures before their formal release, which has not been scheduled.

If the total number of cases in the world is half of what youve been saying, thats a bitter pill to swallow, Dr. Halperin said. So every year they lower the numbers a little bit, and retroactively change the estimates of what it used to be. Its sort of Orwellian. In Africa, infection rates range as high as 30 percent. South Africas is about 22 percent, and that figure is considered relatively accurate because the epidemic is older than Indias and population surveys have been done.

In recent years, several prominent figures have accused India of denying the scope of its AIDS problem, but Indian health officials dispute their conclusions. Richard Feacham, until recently the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said in early 2005, when South Africa was thought to have slightly more cases: The official statistics are wrong. India is in first place. He warned that Indias epidemic could shoot up to African levels, wiping out the surging economy and leaving a nation of orphans.

S. Y. Quraishi, then director of Indias National AIDS Control Organization, took offense, calling such projections technically incorrect and misleading. Health Minister Anbumani Ramadoss noted that the country was spending $2 billion to fight the disease and had 75,000 people on free antiretroviral treatment so far, 2,000 centers giving sex education and condoms to sex workers and clients, and 3,600 free testing c enters.

Indian government workers hand out condoms outside porn theaters, even though pornographic films are illegal. It created a government condom brand called Dipper, which is word play on the advice painted on the backs of many trucks, Use Dipper at Night, meaning switch to low-beam lights. Anjali Gopalan, executive director of the Naz Foundation (India) Trust, which runs an orphanage and fights stigmatization of AIDS victims, said she was skeptical of any estimate as low as two million. But whatever the figure turned out to be, she said, The infection is here and we have a huge burden, adding, We are a very sexually active culture, contrary to what the politicians want to project.

AIDS still conveys tremendous stigma in India. In recent weeks, newspapers have carried reports of an AIDS patient left on the street outside a hospital to die, of five infected children expelled from school, and of a woman beaten to death by her in-laws who feared she would infect the family.


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