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India has lowered its estimate of people infected with HIV to 2.47 million for 2006, but health officials and public health experts have warned that the real reduction in HIV prevalence is only marginal.
The revised figure is more reliable than the 5.2 million estimate for 2005 and results from new estimation methods using data from a population survey to complement sentinel surveillance, senior health officials said last week.
India's HIV counts have long been controversial, with projections ranging in recent years from 3.4 million to 9.4 million. Five years ago, a US agency predicted that India could have 20 million people infected with HIV by 2010 (BMJ 2002;325:1132 doi: 10.1136/bmj.325.7373.1132/b).
The revised range—finalised by the National AIDS Control Organisation after taking into account a nationwide family health survey—is two million to 3.1 million.
The revised figures show that although India has faced allegations of underestimating the epidemic, it was in fact overestimating counts, health officials said.
“India still has one of the largest numbers of HIV infected populations,” said Sujatha Rao, director general of the National AIDS Control Organisation. “The epidemic has shown a decline in some areas where intervention has been strong, but there are pockets of high HIV transmission,” Ms Rao said. The national prevalence is 0.36%, but 104 districts have a prevalence of 1%, she said.
Epidemiologists have long attributed the earlier overestimates to the exclusive use of sentinel surveillance data—HIV prevalence among patients in clinics for sexually transmitted diseases and antenatal clinics—to calculate national estimates.
Public health experts said that the lower count is expected to translate into more resources for prevention. The National AIDS Control Organisation last week also launched the third phase of its AIDS control programme for the period 2007-12.
The 115 billion rupees (£1.4bn; €2.1bn; $2.9bn) programme funded by the Indian government, international agencies, and private foundations, will expand education in youth and high risk groups, promote more condoms, increase voluntary testing from the current 10 million to 42 million tests a year, and give free antiretroviral treatment to 340000 people by 2012.
“India needs to replicate what it's achieved in the southern states in the rest of the country,” said Prabhat Jha, professor at the Centre for Global Health Research, at the University of Toronto, Canada. Last year a study by Professor Jha showed that new HIV infections among 15-24 year old women in the southern states had dropped one third, from 1.7% to 1.1% over the past five years.
“The decline suggests that the key focus should be on prevention,” Professor Jha said.
In a document that explains the implications of India's new figure to the global epidemic, UNAIDS, the Joint United Nations Programme on HIV/AIDS, said that the total number of people living with HIV would be lower but within the estimated range of 34.1 million to 47.1 million for 2006.
“This downward revision is not surprising,” said Lalit Dandona, a senior director and public health specialist at the George Institute for International Health, in India. Last year a study by Dr Dandona showed how sentinel surveillance had led to unrealistically high counts in a single district in southern India (BMC Medicine 2006;4:31).