AIDS ain't so big

Number of new infections dips in 2004, but is it false relief?

By Vibha Varshney
Published: Thursday 30 June 2005

-- there is no galloping hiv epidemic in India, the Union ministry of health and family welfare (mohfw) asserted recently . A sharp decrease in the number of new cases of hiv infection has been observed in 2004: 28,000 as against 2003's 520,000. But the ministry's claims have been met with widespread scepticism and the allegation of it being in a "denial mode".

The government maintains that the decrease in new infections will not make it complacent. "The results do not have any policy implications. It has programme implications regarding areas that need enhancement, such as scaling up services like treatment and control," says Mohammed Shaukat, joint director, National aids Control Organisation (naco), which comes under mohfw. But organisations working with hiv/aids patients disagree with the latest projections. "...the number cannot go down so much...[it] is rising each year and is big. The government just wants to look good," alleges Anjali Gopalan of the naz Foundation (India) Trust, Delhi, a non-governmental organisation.

The secret behind the plummeting number seems to be a simple change in the method of estimating infections. In 2002, naco used a formula that assumed that for every eight people infected in urban areas, there was one infected person in rural areas (8:1). But after consulting experts, the Indian Council of Medical Research, an autonomous research body under mohfw, modified the ratio to 2.4:1 in 2003. Consequently, the estimated rural cases jumped, as did the total number of infections. But such a jump didn't happen in 2004, when the same formula was re-applied.

Estimating the number of infected people is crucial, as it determines all prevention and control efforts and resource allocation. The government has always objected to suggestions that the disease is spreading fast in the country. It points out that though India stands second only to South Africa in the total number of infections, it is way behind in the extent of infection spread. In South Africa, 25 per cent of the population is hiv positive, while the corresponding figure in India is only 0.91 per cent, it points out. In April 2005, naco refuted the claim of a representative of the Global Fund to Fight aids, Tuberculosis and Malaria that India had the highest number of hiv patients in the world.

Two Delhi-based organisations estimate the number of hiv cases in the country: the National Institute of Health and Family Welfare and the Institute of Research in Medical Statistics. Both carry out their surveys as per the rules of the World Health Organization and unaids. std clinics and drug de-addiction centres provide information on high-risk groups while places like antenatal clinics furnish the data on the general population.

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