The tools used for generating HIV estimates and the data used as mentioned above allows for production of estimated HIV prevalence and incidence trends from the beginning of the epidemic to the current year and projection for the future.
National/States/Union Territory estimates of HIV adult prevalence
While the adult HIV prevalence for each state and Union Territory was directly projected through EPP and Spectrum, the national adult HIV prevalence is determined through application of the simple aggregation number of PLHIV from all states divided by the total adult population and calculated as a multiple of hundred to determine a percentage.
The adult HIV prevalence (males and females together) in India in 2008 is estimated as 0.32% with uncertainty bounds 0.26–0.41%, and 0.31% in 2009 with uncertainty bounds 0.25–0.39%. The adult HIV prevalence was estimated at 0.25% for women and 0.36% for men in 2009. It was estimated at 0.26% for women and 0.38% for men in 2008 (). The results of 2008–2009 round of HIV estimates—in terms of trend and levels—are derived from a methodology that allows for readjustment of the prevalence curves on the basis of additional HSS data. Accordingly, the estimated HIV prevalence came out 0.36% for the year 2006 and 0.34% for the year 2007. As these are exactly the same value derived under the 2006 and 2007 round of HIV estimates, the consistency in results are indicative that the process adopted by the Working Group on Estimates and the results derived therein are valid and a sound base for analysis ().
Adult HIV prevalence by sex and number of HIV infections for all ages with uncertainty bounds for the years 2008 and 2009, India
Adult HIV prevalence trend from 2006 to 2009, India.
State-wise HIV adult prevalence
States/Union Territory-wise estimates of adult HIV prevalence were the basis for estimating national adult HIV prevalence as detailed in earlier sections of the report. Over and above this process, an uncertainty analysis was conducted independently for each state in Spectrum. The state-level estimates on adult HIV prevalence is provided in Map 1 and an analysis of central emerging trends is recapitulated therein.
Map 1: Adult HIV Prevalence (%) by state, 2009.
As reflective from , the HIV prevalence is on the decline in all states over the past 4-year period of 2006–2009; although the degree in decline varies slightly. For instance, the HIV prevalence trend appears stable in six high prevalence states, that is, Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu and Mizoram (which is added to this group on the basis of consistently reporting HIV prevalence among ANC clinic attendees >1% over the past 4 years in HSS). Further, in all three moderate prevalence states—Goa, Gujarat and Pondicherry, adult HIV prevalence trends is declining from 2006 to 2009.
Adult HIV prevalence trend from 2006 to 2009, Indian states.
Regarding the low-prevalence States/Union Territories, highlights those where the trend for HIV prevalence is stable to increasing between 2006 and 2009. These include the seven States/Union Territories of Arunachal Pradesh, Assam, Chandigarh, Jharkhand, Kerala, Meghalaya and Orissa.
The relatively greater increase in HIV prevalence is noted in Assam, Jharkhand and Orissa vis-à-vis Arunachal Pradesh, Kerala and Meghalaya. The estimated HIV prevalence for Chandigarh—as reflected in —is not considered a true reflection of the nature of the epidemic in the Union Territory. While noting the increase in the estimated HIV prevalence, it must be considered that the trend is attributable to the services Chandigarh provides to PLHIV from the neighbouring states of Punjab, Haryana and even Himachal Pradesh. As ART information is included as one of the parameters for the projection, the resulted trend is showing an increase, independent of the trend observed in HSS. A separate analysis of the HIV epidemic in Chandigarh is thus required to take into consideration the evidence and the trends of neighbouring states.
highlights the low prevalence states of Delhi, Haryana, Punjab, Rajasthan, Uttar Pradesh and West Bengal where HIV prevalence is either stable or declining. Evidently, the degree for decline in HIV prevalence is not uniform between these states which may be on account of the programmatic impact of ART coverage, and the strength of the prevention interventions, etc. The decline in HIV prevalence is lower in Haryana and Punjab vis-à-vis Delhi, Rajasthan, Uttar Pradesh and West Bengal.
National and State estimates of number of PLHIV
In 2009, the total number of PLHIV in India was estimated at 2.4 million (uncertainty bounds of 1.93–3.04 million) whereas in 2008, it was 2.44 million people who were living with HIV within the uncertainty bounds of 1.97–3.09 millions. Among PLHIV, by sex approximately 61% are male and 39% are female and by age the percentage distribution of HIV infection is estimated at 4% are children below the age of 15 years, 83% are adults aged 15–49 years and the rest 13% are over 50 years of age ().
The four high-prevalence states of South India account for 57% of all HIV infections in the country. While Andhra Pradesh accounts for 500 000 cases; Maharashtra accounts for 420 000 cases, Karnataka accounts for 250 000 cases and Tamil Nadu accounts for 150 000 cases. Over 100 000 PLHIVs are reported in West Bengal, Gujarat, Bihar and Uttar Pradesh and together these states account for 22% of HIV infections in India. The number of PLHIVs in Punjab, Orissa, Rajasthan and Madhya Pradesh range from 50 000 to 100 000 and these states collectively account for 12% of HIV infections. Thus, while the states noted above are with low HIV prevalence; a large number of PLHIVs are reported due to the states’ overall large population size (Map 2; ).
Map 2: Estimated number of HIV infection by state, 2009.
The percentage distribution of HIV burden among high-prevalence states vis-à-vis the remaining states in India is 57% and 43%, respectively. Among the high-prevalence states, Andhra Pradesh accounts for the greatest proportion of cases at 21% vis-à-vis the other states. Following Andhra Pradesh, Maharashtra accounts for approximately 18% of HIV infection, Karnataka and Tamil Nadu reportedly account for 10% and 7% of all cases, whereas Manipur and Nagaland account for 1% of the estimated total.