HIV in India

Robert Steinbrook’s March 2007 essays in the New England Journal of Medicine helped me understand more about HIV/AIDS in India, as well as global HIV/AIDS epidemiology. Steinbrook reports that in 2006, UNAIDS estimated that there were 5.7 million people HIV positive people in India. This was shocking news at the time, as it meant India had more HIV positive people than South Africa, which was estimated to have 5.5 million in 2006. Of course, the HIV prevalence in India would have still been much lower than South Africa (0.5-1.5% of 15-49 year-old Indians infected, verses 16.8 to 20.7% of 15-49 year-old South Africans infected), but given the sheer size of the population in India, the raw number of HIV positive people would have been the largest of any country in the world. This brought a lot of attention to HIV/AIDS in India, and expansion of India’s National AIDS Control Organization (NACO).

In 2007, UNAIDS revised the prevalence data for India based on new survey data. As of late 2007, UNAIDS estimates that India has 2.5 million people living with HIV/AIDS, less than half of the 2006 estimate. In fact, the correction of India’s estimated HIV prevalence was the major reason for the 16% reduction of estimated people with HIV/AIDS worldwide in 2007. In the 2007 report, UNAIDS estimated that there were 33.2 million people living with HIV/AIDS worldwide, 16% less than the estimate from 2006 (39.5 million). From the 2007 UNAIDS report:

The major elements of methodological improvements in 2007 included greater understanding of HIV epidemiology through population-based surveys, extension of sentinel surveillence to more sites, and adjustments to mathematical models from better understanding of the natural history of untreated HIV infections in low and middle-income countries. Although prevalence has stabilized, continuing new infections (even at a reduced rate) contributed to the estimated number of people living with HIV. HIV prevalence tends to reduce slowly over time as new infections decline and through the death of HIV-infected people; it can increase through continuing HIV incidence and through reduced mortality of HIV-infected people on ARV treatment.

Steinbrook’s essays on HIV also say that the tradition of female sterilization as a form of contraception in India is a barrier to HIV prevention efforts. In many Indian States more than 50% of woman use sterilization as a method of family planning before they turn 30, the article says. It is nearly impossible for sterilized women to negotiate for condom use. The article quotes Broun of UNAIDS, who says “In Africa, a woman who is not pregnant is probably using condoms as a method of contraception, so is therefore also protected against HIV. In India, a woman who is not pregnant is probably a woman who has been sterilized and her behavior toward HIV is not known. “