HIV Epidemiological Data

In a population of over one billion people in India, over 5.206 million in 2005in the age group 15 to 49 years are estimated to be living with human immunodeficiency virus (HIV) which makes India the second highest absolute number of people living with HIV in the world after South Africa. India accounts for almost 9 per cent of 40 million people living with HIV globally and over 69 per cent of the 7.4 million people living with HIV in the Asia and the Pacific region.

The sexual route of HIV transmission accounts for approximately 86 per cent of HIV infections in the country. The remaining 14 per cent are accounted to other routes such as blood transfusion and injecting drug use. Young people in India are among those at high-risk of contracting HIV. Over 35 per cent of all reported HIV cases in India occur among young people in the age group of 15-24 years.

HIV trend across the country shows that there is no galloping HIV epidemic in India as a whole, as no evidence of upsurge in HIV prevalence has been observed overall. However, there are sub-national epidemics in various parts of the country with rapid spread and evidence of high prevalence of HIV among both STI and antenatal clinic attendees. The HIV prevalence has seen a significantly increasing trend among STI clinic attendees in 16 out of 171 sites and among antenatal clinic attendees in 7 sites out of 268 sites located in states of Andhra Pradesh, Maharashtra, Tamil Nadu, Gujarat, Pondicherry, Assam, Bihar, Chhattisgarh, Delhi, Haryana, Himachal Pradesh, Kerala, Orissa, Goa and Manipur.

The HIV epidemic has been evolving in the country since the first case was detected in Tamil Nadu in 1986.  Based on the sentinel surveillance data, the estimated number of HIV-infected persons has gone up from 3.5 million in 1998 to over 5.206 million in 2005 accounting for one eighth of all infections in the world. These estimates indicate that there has been no dramatic upsurge in the spread of HIV infection across the country since 1998.  However, state specific variations in the profile of the epidemic have been observed. Several states in southern India and north-eastern part of the country have shown higher HIV prevalence within states and diversity in predominant patterns of HIV transmission. Even low HIV prevalence states are also characterised by the presence of high risk pockets with potential for increased spread of epidemic in these states. HIV infection during the 80’s and 90’s reflects an increase in the number of AIDS patients and consequent medical, economic and social implications.

Categories of States Based on Prevalence and Vulnerability (as per NACO estimates):

As per NACO estimates, based on antenatal prevalence (ANC), six states in India have been identified as high prevalence states (having more than 1.0 per cent HIV prevalence in general population), three states as moderate prevalence states (concentrated epidemic with more than 5 per cent HIV prevalence in high risk population) and the rest as low prevalence states. However, on the basis of vulnerability factors such as migration, size of the population and weak health infrastructure, the low prevalence States/UTs have been further classified as “Highly Vulnerable” and “Vulnerable” states.

Table 2.1: Categories of States

Facts on Uttar Pradesh (UP) and Basti district of UP 

UP, having population of 164 million is the most populous state in India and is amongst one of the highly vulnerable states. An increase in HIV prevalence by one per cent point translates to cover 8 lakh new HIV infections. Identification of the factors that facilitate the spread of the epidemic and development of a timely and adequate response are the needs of hour in order to prevent adverse impacts. UP had 3.69 lakh HIV infected individuals by the end of 2002. This accounts for an adult prevalence of 0.45 per cent. In UP, patients attending sexually transmitted disease (STD) clinics - representing high-risk populations - and mothers attending antenatal care (ANC) clinics - representing the general population - are under surveillance. In Eastern UP, in nearly all sites, HIV positive cases have been detected. The prevalence rates among STD patients were also relatively higher than among ANC clients in this region.   According to UNAIDS (2002), UP is extremely vulnerable because of its significant migrant population. However, due to the current low HIV prevalence rate in UP, the state has a window of opportunity to put in place strategies to prevent the further spread of the epidemic and address primary prevention in a comprehensive and cost-effective way.

Basti district, which lies between Sant Kabir Nagar district on east and Gonda on west, has a population of 27,50,764 persons according to 1991 census. Basti is one of the 456 sites in UP where female sex workers are professionally active. Since the beginning of the HIV/AIDS epidemic, sex workers have been one of the groups most vulnerable to HIV infection due to frequency of unprotected sex with multiple partners. Because of high infection rates and large numbers of sexual partners, sex workers have been considered a core group for HIV transmission. Targeted interventions (TIs) have led to successful risk reduction and decreased levels of infection. Sex workers in Basti are often in poor position to negotiate safe sex because of social, economic and cultural factors. 

The Global Science Academy extended its support and cooperation during National Baseline High Risk and Bridge Population Behavioural Surveillance Survey on facts pertaining to Female Sex Workers and Clients as done by NACO and ORG-CSR. These findings are helping in interventions planning and in identifying critical areas.