New study: India's HIV burden overestimated

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Opinion - News Analysis: New study: India's HIV burden overestimated

Jaya Shreedhar

Researchers involved in the project warn against complacence.

Countrywide survey needed for accurate picture. India has millions of HIV

infections irrespective of estimation method

THE ACTUAL number of People Living with HIV (PLHIV) in India might

be a third lower than the present estimate of 5.2 million, according

to a new population-based study by Indian researchers. The study was

done in Guntur district of Andhra Pradesh and was based on antenatal

care patterns from the recent National Reproductive and Child Health

Survey. The study cautiously extrapolates the findings to make

indicative estimates of the national HIV burden. According to the

researchers, extrapolation of their findings to the country overall

await confirmation. That might well happen later this year when the

results of a countrywide National Family Health Survey become known.

The study gives no cause for complacency, warned the researchers. A

generous downward revision of HIV prevalence would still leave the

country with a massive smouldering epidemic of about 3.5 million

people, and hotspots of infection with the imminent danger of

explosive spread. Financial, technical, and human resources will

remain a high priority to enable a rapid countrywide scale-up of

services to prevent new infections and provide care and treatment to

the millions of people living with HIV.

Lalit Dandona, Professor of Health Studies from the Administrative

Staff College (ASCI), Hyderabad whose team collaborated with the

Nizam's Institute of Medical Sciences to conduct the study,

said: " The method NACO [National AIDS Control Organisation] follows

to gather and process HIV data is doubtless useful, but population-

based surveys like the Guntur study probably give us a picture

closer to reality. India's HIV figures are likely [to be] a gross

overestimation. "

India's HIV prevalence rate is presently calculated from data

collected each year by the various State AIDS Control Societies

through HIV Sentinel Surveillance (HSS). For a few months each year,

blood samples are collected from incoming patients at `sentinel'

sites in the public health sector. These are located in the clinics

for pregnant women coming to the large government hospitals (Ante-

Natal Centres or ANCs) and in the departments treating people with

sexually transmitted infections (STI). The data are then collated

and processed to come up with estimates for the general population.

HSS 2005 indicated that Tamil Nadu, Andhra Pradesh, Karnataka, and

Maharashtra together accounted for 3.7 million infections — close to

three fourths of India's present estimate of about 5.2 million

infections. The extrapolation of the patterns found in the Guntur

study would lower the total of HIV infections in the four Southern

States to 2 million and bring down India's total to 3.5 million.

Reacting to the new findings, Sujata Rao, Director-General of NACO,

said that " the Guntur study is a well researched one. "

What explains the higher burden that was estimated last year? The

HSS-based estimate relies on the assumption that 5-6 per cent of the

general population each year get STIs, says Professor Dandona. " When

the high HIV rates among STI patients attending large government

hospitals are used for this assumption, the HIV estimates for the

general population gets inflated. Inclusion of the STI data in the

HIV estimation method is a major distortion factor. "

Though the Guntur study adjusted the HIV burden upwards for groups

usually left out of HIV surveys such as hostel inmates, prisoners

and military recruits all of who may have higher risk of HIV

exposure, it adjusted the HIV burden downward based on the finding

that ANC sites were picking up a higher number of HIV positive women

because private practitioners shunt their HIV positive patients to

government hospitals, and because there was overrepresentation of

poor women who are likely to have a higher HIV rate.

The see-saw swing of " sudden drops " and " steep increases " in the HIV

burden estimates in India points to the need for good science and

accurate estimation methods. Bollinger of the s Hopkins

School of Medicine said: " Comparing estimates from varying methods

is like comparing apples and oranges. If India wants more accurate

estimates of where the epidemic is heading, it needs to apply

similar estimation methods in a consistent way over time. " Perhaps

the Guntur study and the National Family Health Surveys this year

will give India its first real snapshot of how many people are

likely to be living with HIV in the country.

(Jaya Shreedhar of Internews Network specialises in areas related to

HIV/AIDS.)

http://www.thehindu.com/2006/08/21/stories/2006082104351100.htm

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