| As per latest data made available by National AIDS Control Organisation, the India HIV estimates 2008-09 highlight an overall reduction in adult HIV prevalence and HIV incidence (new infections) in India. Adult HIV prevalence at national level has declined from 0.41% in 2000 to 0.31% in 2009. The estimated number of new annual HIV infections has declined by more than 50% over the past decade.
Improved methodology for generating HIV estimates
The 2008-09 India HIV estimates—developed by NACO with support from National Institute of Medical Sciences, National Institute of Health and Family Welfare, UNAIDS and WHO — utilised improved methodology and updated epidemiological data from the latest rounds of HIV Sentinel Surveillance and other information on High Risk Groups for more accurate understanding of the Indian epidemic. The estimates were generated using Estimation Projection Package and Spectrum Package, that had been customised using Indian data. This methodology allows international comparison of the HIV estimates.
Key findings of the 2008-2009 HIV estimates
HIV Incidence One of the key characteristics of this round of estimations is that it allowed for generating estimates of the HIV incidence (number of new HIV infections per year). Analysis of epidemic projections revealed that the number of new annual HIV infections has declined by more than 50% during the last decade. This is one of the most important evidence on the impact of the various interventions under National AIDS Control Programme and scaled-up prevention strategies. It is estimated that India had approximately 1.2 lakh new HIV infections in 2009, as against 2.7 lakh in 2000.
While this trend is evident in most states, some low prevalence states have shown a slight increase in the number of new infections over the past two years, that underscores the need for the programme to focus more on these states with low prevalence, but high vulnerability.
Of the 1.2 lakh estimated new infections in 2009, the six high prevalence states account for only 39% of the cases, while the states of Orissa, Bihar, West Bengal, Uttar Pradesh, Rajasthan, Madhya Pradesh and Gujarat account for 41% of new infections.
Adult HIV prevalence
- The estimated adult HIV prevalence in India was 0.32% (0.26% – 0.41%) in 2008 and 0.31% (0.25% – 0.39%) in 2009.
- The adult prevalence is 0.26% among women and 0.38% among men in 2008, and 0.25% among women and 0.36% among men in 2009.
- Among the states, Manipur has shown the highest estimated adult HIV prevalence of 1.40%, followed by Andhra Pradesh (0.90%), Mizoram (0.81%), Nagaland (0.78%), Karnataka (0.63%) and Maharashtra (0.55%).
- Besides these states, Goa, Chandigarh, Gujarat, Punjab and Tamil Nadu have shown estimated adult HIV prevalence greater than national prevalence (0.31%), while Delhi, Orissa, West Bengal, Chhattisgarh & Puducherry have shown estimated adult HIV prevalence of 0.28-0.30%. All other states/UTs have lower levels of HIV. (See Annex-1)
Declining Trends of Adult HIV Prevalence
The adult HIV prevalence at national level has continued its steady decline from estimated level of 0.41% in 2000 through 0.36% in 2006 to 0.31% in 2009. All the high prevalence states show a clear declining trend in adult HIV prevalence. HIV has declined notably in Tamil Nadu to reach 0.33% in 2009. However, the low prevalence states of Chandigarh, Orissa, Kerala, Jharkhand, Uttarakhand, Jammu & Kashmir, Arunachal Pradesh and Meghalaya show rising trends in adult HIV prevalence in the last four years.
A clear decline is also evident in HIV prevalence among the young population (15-24 yrs) at national level, both among men and women. Stable to declining trends in HIV prevalence among the young population (15-24 yrs) are also noted in most of the states. However, rising trends are noted in some states including Orissa, Assam, Chandigarh, Kerala, Jharkhand and Meghalaya.
People Living with HIV/AIDS (PLHA)
The total number of people living with HIV/AIDS (PLHA) in India is estimated at 24 lakh (19.3 – 30.4) in 2009. Children (<15 yrs) account for 3.5% of all infections, while 83% are the in age group 15-49 years. Of all HIV infections, 39% (9.3 lakh) are among women. The four high prevalence states of South India (Andhra Pradesh – 5 lakh, Maharashtra – 4.2 lakh, Karnataka – 2.5 lakh, Tamil Nadu – 1.5 lakh) account for 55% of all HIV infections in the country. West Bengal, Gujarat, Bihar and Uttar Pradesh are estimated to have more than 1 lakh PLHA each and together account for another 22% of HIV infections in India. The states of Punjab, Orissa, Rajasthan & Madhya Pradesh have 50,000 – 1 lakh HIV infections each and together account for another 12% of HIV infections. These states, in spite of low HIV prevalence, have large number of PLHA due to the large population size. (See Annex-1)
HIV concentrated amongst injecting drug users and Men who have Sex with Men
This round of estimates has confirmed the clear decline of HIV prevalence among Female Sex Workers at national levels and in most states. However, the evidence shows that Injecting Drug Users and Men who have Sex with Men are more and more vulnerable to HIV with increasing trends in many states.
AIDS deaths:
Using globally accepted methodologies and updated evidence on survival to HIV with and without treatment, it is estimated that about 1.72 lakh people died of AIDS related causes in 2009 in India. Wider access to ART has resulted in a decline of the number of people dying due to AIDS related causes. The trend of annual AIDS deaths is showing a steady decline since the roll out of free ART programme in India in 2004.
Sustained action for advancement towards Universal Access
India's response to the HIV epidemic and the broad social mobilisation of stakeholders has achieved significant results in controlling the HIV epidemic. The achievements warrant the need for further commitment and coordinated joint action that is guided by the best available scientific evidence and technical knowledge.
Evident from the 2008-2009 HIV estimates, NACP-III has yielded significant results in addressing previously existing gaps in the AIDS response, as well as the social and structural constraints. There is need, however, to build on the gains and focus on the emerging areas of concern. Spread of HIV in the low prevalence and vulnerable states must be thwarted through sustainable effort and investment on prevention, coupled with innovative strategies.
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