India in the spotlight. The Lancet

June 10, 2006

India in the spotlight

The Lancet 2006; 367:1876. DOI:10.1016/S0140-6736(06)68818-1

In the past few weeks, India made headlines for two very different

reasons. The good news was that India's economy grew at the fastest

pace in more than 2 years, surpassed only by China. The bad news

soon followed, however. India has overtaken South Africa as the

country with the highest number of people living with HIV/AIDS,

according to the latest figures from the Joint United Nations

Programme on HIV/AIDS (UNAIDS).

In its 2006 Report on the Global AIDS Epidemic, released ahead of

the UN General Assembly Special Session on HIV/AIDS in New York,

UNAIDS estimated that India now has 5•7 million HIV-positive people.

India's government disagrees with these figures, which for the first

time include estimates of children younger than 15 years and adults

older than 50 years.

India's HIV-infection pattern is complex. Infection spread differs

from state to state and from urban to rural areas. Most infections

are due to unprotected heterosexual intercourse and a substantial

proportion of those affected are married women with permanent

partners. However, in the north eastern states, and increasingly

also in major cities, injecting drug use is the main driver of the

epidemic, fuelled by overlap with paid sex work. Transmission

between men who have sex with men is not uncommon, but data for this

group are scarce. Stigma, poverty, lack of education, and gender

inequality make HIV prevention and treatment a gigantic task for a

country with a dissatisfied health workforce and very patchy public-

health infrastructure.

Yet, India has the will and the means and must not lose momentum in

its efforts. It must continue to protect its right to produce cheap

generic antiretroviral drugs and to roll out free treatment to those

who need it. India can point to measurable successes of prevention

strategies, especially in high-risk groups. The failure to mention

these groups in the final UN Political Declaration of June 2, and

the omission of hard targets for prevention and treatment, is deeply

regrettable. Countries such as India must now accelerate their own

strategies and set targets to turn the corner in the fight against

HIV.

The Lancet

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