HIV Drops in Worst-Infected Parts of India

These people in New Delhi watched an AIDS awareness program on Dec. 1, World AIDS Day. Five million Indians are thought to have the AIDS virus.
These people in New Delhi watched an AIDS awareness program on Dec. 1, World AIDS Day. Five million Indians are thought to have the AIDS virus. (By Manish Swarup -- Associated Press)
By John Lancaster
Washington Post Foreign Service
Friday, March 31, 2006

BANGALORE, India, March 30 -- Until recently, experts predicted that India, where up to 5 million people are believed to be infected with the AIDS virus, was heading for a health catastrophe to rival that of southern Africa.

But a study published Thursday shows that new infections appear to have fallen sharply in the worst-hit parts of India, underscoring the effectiveness of condoms in stopping the spread of the disease and casting doubt on the dire warnings of an AIDS epidemic in the subcontinent.

The key findings of the University of Toronto-sponsored study are based on an analysis of the prevalence of HIV among pregnant women ages 15 to 24 in four southern Indian states. The study found that the rate of infection within this group fell by 35 percent between 2000 and 2004. HIV prevalence among young pregnant women is seen as reliably reflecting trends within the general population.

"There have been many predictions, mostly based on guesswork, that India's AIDS problem will explode -- as it did in southern Africa -- but now we have evidence of something positive," Prabhat Jha, a professor at the University of Toronto who co-authored the study, said in a statement. The paper was slated for publication Thursday in the online edition of the Lancet, a European medical journal. In an editorial accompanying the study, the Lancet noted that the rate of HIV infection "has also declined in an increasingly impressive number of African settings and elsewhere." The journal said the trend shows that "prevention efforts can work to turn the tide against AIDS at last."

HIV remains a grave threat in India, where the estimated 5 million people thought to be infected with the virus is second only to the number in South Africa. Public health experts noted that the epidemic will continue to grow for some years, even if the rate of new infections declines, and they cautioned against reading too much into a single study. "This is an encouraging finding, but we have to treat it very cautiously in relation to India as a whole," said Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, in a telephone interview from Geneva. "The encouraging findings of this study relate to young women in the south, leaving the question of the north where most Indians live, where the densest populations are and where the availability of data is far weaker."

Because of India's vast population, even relatively low rates of HIV transmission translate into huge numbers of infected people, and many of the forecasts in recent years have been gloomy. A September 2002 report by the CIA's National Intelligence Council predicted 20 million to 25 million AIDS cases in India by 2010, more than in any other country. Antiretroviral drugs used to control the disease are still too costly for most of its Indian victims, despite falling prices and the spread of programs to distribute the medicines.

AIDS is a sensitive political issue in India, where some politicians and pundits have accused foreign donors of hyping the epidemic -- to the detriment of campaigns against such other health threats as malaria and tuberculosis -- and slighting what they contend is the role of conservative Hindu values in curbing its sexual transmission.

In 2002, for example, then-Health Minister Shatrughan Sinha accused Microsoft Chairman Bill Gates of "spreading panic" after Gates warned of the potential for an AIDS explosion during a visit to the country to announce a $100 million grant to fight the disease.

Health experts, in turn, have warned of a dangerous complacency, although they credit some Indian states with effective prevention and awareness campaigns. That is particularly true in the south, where the epidemic is thought to have begun and infection rates are highest. Public health is primarily a state responsibility in India, where, as in Africa, the dominant means of HIV transmission is through heterosexual intercourse.

In the Lancet study, Indian and Canadian researchers examined blood data on 294,050 pregnant women who visited prenatal clinics throughout India between 2000 and 2004. The study divided the data into northern states and four southern states--Karnataka, Andhra Pradesh, Maharashtra and Tamil Nadu -- where the prevalence rate among women ages 15 to 24 fell from 1.7 percent to 1.1 percent, a 35 percent decline.

HIV prevalence did not fall significantly among pregnant women in the northern states or among those between 25 and 34; the rate of infection was about five times higher in the south than in the north. Women typically acquire the virus from their husbands, who get it from prostitutes, according to the researchers.

The researchers also gleaned encouraging news from an examination of data on 58,790 men ages 20 to 29 who sought treatment for sexually transmitted diseases over the same period, finding a 36 percent decline.

The Lancet paper suggested that the new HIV infections may be declining in the south because of programs that promote awareness and condom use. It noted, for example, that in 2004, "about 70-80 percent of female sex workers in Maharashtra and Tamil Nadu reported condom use with their last client."

"We are seeing a decline, and it's real and not due to study biases," Jha, the University of Toronto researcher, said at a news conference Thursday in New Delhi. "Husbands' use of sex workers has changed -- it's less often and with condoms. That's the only plausible explanation." "We're not saying the epidemic is under control yet," added co-author Rajesh Kumar, an epidemiologist at the Post Graduate Institute of Medical Education and Research in Chandigarh, India. "We are saying that prevention efforts with high-risk groups thus far seem to be having an effect."

Special correspondent Muneeza Naqvi in New Delhi contributed to this report.

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