India has far fewer HIV/AIDS cases than previously thought, if a new and comprehensive national health survey is to be believed. The survey, which was partially funded by the Bill & Melinda Gates Foundation and which has not yet been released, suggests that the total number of Indians infected by the virus is far lower than the 5.7 million people estimated in previous studies. The New York Times, which first reported the findings, said that early analysis of the data puts the the total number of people infected at somewhere between 2 and 3 million.
The new study combines data from pregnant women reporting at prenatal clinics, a survey of high-risk groups such as sex workers and intravenous drug users, and the Indian government's National Family Health Survey. The old figure, which ranked India as number one globally in cases of HIV/AIDS, was based on extrapolating from prenatal clinic data alone. The new figures would put India back behind South Africa, which has 5.5 million HIV-positive people, and perhaps below other countries as well.
The massive drop follows a similar halving of the official HIV estimate in Kenya, in 2004, following a more comprehensive survey. Some health experts believe that extrapolating from rates among pregnant women is inaccurate and has led to overestimations in some countries. (The figures from South Africa, where the epidemic is more established and many more surveys have been conducted, are believed to be much more accurate.)
The Indian government has long maintained that AIDS is less of a problem in the country than the United Nations and non-governmental bodies such as the Gates Foundation had claimed. Critics of the aid agencies argue that higher numbers help them by drawing in more funding.
But Ashok Alexander, director of Avahan, the Indian AIDS program of the Gates Foundation, says that while "it's good news that overall the numbers are down, the real danger of this is it masks the real prevalence in one third of India: the south." The study, which leans heavily on the national health survey itself is based upon face-to-face interviews with some 200,000 people between the ages of 15 and 54, more than half of them women found that infection rates in southern India are significantly higher than in the north of the country. This could be because the disease has spread more quickly in more affluent areas, just as it has in Africa.
The study also finds that rates are highest among sex workers, IV drug users and men who have sex with men a pattern more similar to that of the U.S. than that of Africa, where the disease has spread from the fringes into mainstream society. "The fear is that with high rates in certain groups that will still happen here," says Alexander. "My big concern is that a complex epidemic is being reduced to a soundbite."