India's success in reducing new HIV infections in the southern states through awareness and condom-use campaigns could serve as a roadmap for other countries, says an Indo-Canadian expert.//
'There have been many predictions, mostly based on guesswork, that India's AIDS problem will explode - as the disease had done in southern Africa - but we now have direct evidence of something positive,' said Prabhat Jha, director of University of Toronto's department of public health sciences.
Jha has co-authored the book 'HIV Study in Young Adults in India', which appears Thursday in the online issue of the Lancet. The Canadian government, the Bill and Melinda Gates Foundation and the National Commission on Macroeconomics and Health have funded the study.
The study, done with Rajesh Kumar of the Post Graduate Institute of Medical Education and Research in Chandigarh, has revealed that HIV among young women (15 and 24 age) appears to be declining in the hot spots - Tamil Nadu, Andhra Pradesh, Maharashtra and Karnataka.
The four states are estimated to account for 75 percent of the 5.1 million HIV/AIDS cases in India, which is next highest after South Africa.
'The good news is that HIV in young adults appears to be declining in the south - most likely or perhaps only due to males using sex workers less or using condoms more often,' Jha told IANS.
'Indian experiences can serve as a roadmap on how to reduce HIV worldwide. Modest public health effort has turned around what was a worsening HIV epidemic. Globally this lesson could serve countries like China and Vietnam. In fact a large part of the world can be served to avoid the catastrophe seen in Africa,' he said.
From a prevalence rate of 1.7 percent in 2000, it has declined to 1.1 percent in 2004, said Jha.
Overall, the HIV prevalence rate in India is 1.6 percent of the population, with a lower estimated prevalence of 0.3 percent in most othe
r parts of the country barring the northeast, where the incidence of HIV transmission due to drug abuse continues to be a cause of worry.
According to Jha, the not so good news is that 'trends in the north remain uncertain and poorly studied'.
'North is not immune to the infection. Unless the government puts in place an effective peer intervention as has been done by the state governments of Maharashtra and Tamil Nadu in particular, there is a risk of the infection spreading in the northern region,' said Jha.
'Our study shows with condom use and awareness programs, the country's AIDS epidemic is far from hopeless.'
The study has tracked HIV prevalence among young women attending pregnancy or antenatal clinics as also men attending sexually transmitted infection clinics in southern and northern states from 2000-2004 as an indicator of infection among young people.
Indicative of the trend among the general population, the study is based on the premise that male use of female sex workers is the main reason for the spread, which subsequently puts wives in a vulnerable position.
In recent years, the Indian government, the World Bank and other external agencies have aimed intervention and awareness programmes at the sex industry and their efforts appear to have contributed to a drastic decline.
Co-author Rajesh 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 says.
'We're not saying the epidemic is under control yet - we are saying that prevention efforts with high-risk groups seem thus far to be having an effect.'
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