AIDS and its tentacles in India

May 23: With over one billion inhabitants, India is one of the largest and most populated countries in the world. Only next to China, the second most populous country in the world also inhabits the greatest number of people infected with HIV, according to some reports. At least five million of its total population is currently reported to be living with HIV. In a country where poverty, illiteracy and poor health are widespread, the spread of HIV presents a daunting challenge.

Even though HIV emerged later in India than it did in many other countries, but this has not limited its impact. Ever since 1990 the infection kept on increasing and in recent years it has just intensified. The crisis continues to deepen, as it becomes clear that the epidemic is affecting all sections of Indian society, not just the groups – such as sex workers and truck drivers – that it was originally associated with.

People living with HIV in India come from incredibly diverse backgrounds, cultures and lifestyles. The vast majority of infections occur through heterosexual sex, members of such groups, including sex workers, men who have sex with men, truck drivers and migrant workers, do face a proportionately higher risk of infection.

India’s first cases of HIV were diagnosed among sex workers in Chennai, Tamil Nadu in 1986. It was noted that contact with foreign visitors had played a role in initial infections among sex workers, and as HIV screening centers were set up across the country there were calls for visitors to be screened for HIV. Gradually, these calls subsided as more attention was paid to ensuring that HIV screening was carried out in blood banks.

In 1987 a National AIDS Control Programme was launched to co-ordinate national responses. Its activities covered surveillance, blood screening, and health education. By the end of 1987, out of 52,907 who had been tested, around 135 people were found to be HIV positive and 14 had AIDS.

Most of these initial cases had occurred through heterosexual sex, but at the end of the 1980s a rapid spread of HIV was observed among injecting drug users in Manipur, Mizoram and Nagaland - three north-eastern states of India bordering Myanmar (Burma).

There is difference over how many people are currently living with HIV in India. UNAIDS (the United Nations agency that co-ordinates global efforts to fight HIV) estimates 5.7 million people in India living with HIV up to 2005, suggesting that India has the highest number of HIV patients than any other country in the world. On the other hand, NACO has established an estimate of 5.2 million people, which indicates India is second to South Africa. Either way, it is clear that the number affected by the epidemic is huge.

Overall, around 0.9 per cent of India’s population is living with HIV. While this may seem a low rate, India’s population is vast, so the actual number of people living with HIV is remarkably high. There are so many people living in India that a mere 0.1 per cent increase in the HIV prevalence would increase the estimated number of people living with HIV by over half a million.

The national HIV prevalence has risen dramatically since the start of the epidemic, but a study released at the beginning of 2006 suggests that the HIV infection rate has fallen in southern India, the region that has been hit hardest by AIDS. In addition, NACO has released figures suggesting that the overall rate of new HIV infections in the country is slowing. Researchers claim that this decline is the result of successful prevention campaigns, which have led to an increase in condom use.

However Some AIDS activists are doubtful of the suggestion that the situation is improving, though:

“It is the reverse. All the NGOs I know have recorded increases in the number of people accepting help because of HIV. I am really worried that we are just burying our head in the sand over this,� said Anjali Gopalan from the Naz Foundation.

The HIV epidemic is misunderstood and stigmatized among the Indian public. People living with HIV have faced violent attacks; been rejected by families, spouses and communities; been refused medical treatment; and even, in some reported cases, denied the last rites before they die.

While such strong reactions to HIV and AIDS exist, it is difficult to educate people about how they can avoid infection. AIDS outreach workers and peer-educators have reported harassment, and even in schools, the teachers often face negative reactions from the parents of children that they teach about AIDS.

A 2002 report by the CIA's National Intelligence Council predicted 20 million to 25 million AIDS cases in India by 2010 - more than any other country in the world. However the government has claimed that these figures are ‘completely inaccurate’, and has accused those who cite them of ‘spreading panic’.

On the other hand Ruben del Prado, deputy UNAIDS country coordinator for India, has predicted that “there is going to be a reversal of the epidemic by 2008 and 2009�. But this does not correlate with other UN-related estimates, which have suggested that India's adult HIV prevalence will peak at 1.9% in 2019.

However the other figures state that the number of AIDS deaths in India (which was estimated at 2.7 million for the period 1980-2000) will rise to 12.3 million during 2000-15, and to 49.5 million during 2015-50. Also the economic growth in India will slow by almost a percentage point per year as a result of AIDS by 2019.

Whatever the exact figures turn out to be, it is clear that HIV and AIDS will have a devastating effect on India in the future, and that as much as possible needs to be done to minimize this impact. The challenges India faces to overcome this epidemic are enormous. Yet India possesses in ample quantities all the resources needed to achieve universal access to HIV prevention and treatment, defeating AIDS will require a significant intensification of our efforts, in India, just as in the rest of the world.

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