Public-health approach for HIV control in India needs to become more scientific

The 2007 UNAIDS/WHO AIDS epidemic update released last week has revised the global estimate of HIV/AIDS primarily due to a major reduction of the estimate for India to 2.5 million people living with HIV/AIDS, which is less than half of the previous official estimate of 5.7 million people.

This revision is based on new population-based data from the National Family Health Survey in India.

A commentary published in the Lancet on World AIDS Day today, by health research experts at The George Institute India, explains the basis of this drop and the implications for future planning of HIV/AIDS control in India. Author Professor Lalit Dandona, Senior Director of The George Institute India and Chair of International Public Health at The University of Sydney School of Public Health, said today, “The data from the recent National Family Health Survey support the findings from similar studies we conducted in southern India, where we showed that the previously used official method for estimation of HIV burden in India was in fact not valid, and led to a 2.5 times higher estimate than what is actually the case.”

Professor Dandona explains that well-designed scientific population-based surveys provide a more reliable representation of HIV in India, compared to the official method used so far, which extrapolated data directly from large public-sector hospitals to the population. “The official method overestimated the burden of HIV in India as the profile of patients visiting large public-sector hospitals is quite different from the population at large, in terms of disease distribution including HIV,” he said.

Professor Dandona believes that the new and much reduced HIV estimate for India has several implications. “We can now see that the official method for annual estimation of HIV prevalence in India needs revision. The new figures show the projected number of people needing HIV treatment over the next decade, and the associated resources needed, will be less than previously anticipated.”

Importantly, the new HIV estimate for India indicates that HIV rates as seen in sub-Saharan Africa will not occur in India, says Professor Dandona. HIV prevention efforts in India should therefore be targeted directly at high-risk groups, such as sex workers, men who have sex with men, mobile populations (migrant labourers and truckers), people with other sexually transmitted infections, and injection drug users. Other areas of focus should include counselling, testing, prevention of transmission from mother to child, and blood-transfusion safety.

In addition, Professor Dandona says the public-health approach for HIV control in India needs to become more scientific. “The establishment of a reliable estimate of HIV burden in India is only an initial step, what's needed now is more scientific effort to understand the dynamics of HIV spread in India and the impact of interventions on HIV control in India,” he said.

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