India's HIV caseload may fall by nearly two-thirds

The number of HIV-positive people in India could be nearly two thirds lower than previously estimated, a senior official said on Thursday, as donors and government worked to establish the true figure.

India is said to have 5.7 million people living with the virus, the world's highest caseload, but faulty data-collection methodology could have resulted in the number being inflated by between 2.5 million and 3.5 million.

A senior official closely associated with India's AIDS programme said the new estimate, drawing from a recent population-based survey, would be lower by at least 43 percent and possibly by as much as 61 percent.

"The new number (of HIV-positive people) will be between 2.2 million and 3.2 million," the official, who asked that his name not be revealed, told Reuters.

The original figure came through monitoring by surveillance - or "sentinel" - sites where blood samples are taken over a four-month period each year from groups such as pregnant women, prostitutes and intravenous drug users.

But the government, United Nations, USAID and other agencies have been trying for weeks to establish the true figure, after the population-based National Family Health Survey (NFHS), which took blood samples from 102,000 people, produced data showing the earlier number to be too high.

The NFHS data indicate a prevalence rate in India of 0.28 percent, against 0.9 percent given a 5.7 million caseload.

Sentinel sites are located in the government health sector frequented by poorer people, who are worst hit by the epidemic. It was one reason health experts gave for an exaggerated figure.

Another possible reason cited was that India suddenly set up hundreds of surveillance sites last year in the populous north, which has been far less affected than high-prevalence southern states where most sites are located.


Action still needed

Activists fighting the epidemic say the lower number should not result in a fall-off in efforts to combat the virus in India.

"There is probably some upward bias in the sentinel site data," said Ashok Alexander, director of Avahan, the Bill and Melinda Gates Foundation's programme for HIV prevention in India.

"The overall number, I believe will be lower to some extent ... this is a little bit of good news but the fire is still burning," Alexander said.

He added that Avahan had no plans for now to change its future funding plans. It has committed $258 million to its programmes in India.

Even at the disputed 0.9 percent, populous India's prevalence rate is far lower than those of countries like South Africa, where the infection rate is estimated at 12 percent, and Botswana, where over a third of the population are thought to be HIV-positive.

Globally, nearly 40 million people are HIV-positive.

India plans to unveil a new anti-AIDS plan in July that will span five years and envisages spending $2.8 billion.

The senior health official said the surveillance site data was good for discerning trends among high-risk groups but not accurate at all for arriving at an overall number.

"It's a thermometer which tells us whether it is getting hotter or colder but does not tell us the temperature."