New Delhi: The world’s top institution fighting HIV/AIDS, UNAIDS, and Indian non-governmental organizations have expressed concern over the increasing incidence of HIV infections in four previously low-prevalence states that could potentially create a pandemic-like situation because anti-AIDS efforts are not focused on those states.
The four states are Orissa, West Bengal, Rajasthan and Gujarat.
The Union and state governments’ HIV/AIDS programmes have concentrated much of their efforts and resources so far in the six so-called “high-prevalence” states of Manipur, Andhra Pradesh, Maharashtra, Tamil Nadu, Karnataka and Nagaland.
“We have seen increasing prevalence (of the HIV virus) in certain districts of West Bengal, Orissa and Rajasthan. We are on the lookout very, very carefully in these states,” says Denis Broun, UNAIDS’ country coordinator in India.
If the upward trend in HIV/AIDS incidence in these states continues, the agency will swing into action and won’t “wait until these states crossed into the high-prevalence bracket”, promises Broun, who also wants the government to help ascertain the trends.
But the government-run National AIDS Control Organization, or Naco, which will receive some Rs11,585 crore in anti-AIDS funding over five years through April 2011, says it doesn’t see immediate reason to change strategy.
“The high-prevalence states have 70-75% of the infection. The focus has to be there. If you don’t control it there, the infection will be pushed out onto the other states,” said K. Sujatha Rao, director general, Naco.
While acknowledging emerging “hot spots of infection”, Rao says Naco’s strategy will concentrate on high-risk groups in these low-prevalence states. Naco categorizes female sex workers, intravenous drug users, homosexual males, migrants, truckers, transgenders and people going into special clinics for sexually transmitted diseases as high- risk groups.
A local member of the Gujarat chapter of patient group, the Indian Network of Positive People (INPP), claims as many as 70 new HIV-infected cases emerge every month in Surat, a migration hub due to its textile and diamond polishing industries, alone. More HIV-positive people will get reported as the patient group expands its activity in the state, says Umesh Patel, a member of INPP, adding that “densely populated” Ahmedabad, too, was showing a rise in such cases.
According to a July estimate of HIV incidence by Naco, an apex body under the ministry of health and family welfare that looks into HIV prevention, care and treatment, India has some 2.47 million HIV-positive people (down from the earlier estimated 5.2 million) and an adult prevalence rate of 0.36%. This rate—a percentage of the population between 15 and 49 years—was a high 1.67% in Manipur and 1.05% in Andhra Pradesh.
INPP’s president Elango Ramachandran says his organization’s state chapters are seeing many new cases every day. Between 2005 and 2006, years when HIV prevalence rates fell in Maharashtra from 0.80% to 0.74% and in Tamil Nadu from 0.47% to 0.39%, the numbers have risen in West Bengal from 0.21% to 0.30% and in Rajasthan from 0.12% to 0.17%.
While Orissa’s is at 0.22%, Gujarat, at 0.43%, is higher than the national average.
“The projections label them as low-prevalence, but our experience says there could be a lot of under-reporting. The government is focusing on high-prevalence states and high-risk groups and missing the (emerging) numbers,” says Ramachandran, who advocates “a change in outlook” among AIDS policymakers.
The July Naco study estimates India has 118 districts with a prevalence rate of over 1% of HIV/AIDS infected. A large majority—92%—of these districts are in the six high-prevalence states. Of the remaining 26, half are in the four off-the-radar states: Gujarat, West Bengal, Orissa and Rajasthan.
The four states where the alarm has been sounded see increased trucking activity on their highways and seasonal movement of migratory labour, which, combined with high illiteracy levels and poverty, provide a fertile setting for the spread of the AIDS virus. Some, like Rajasthan, also have castes that have traditionally practised prostitution.
Ganjam and Koraput districts in Orissa; Ganganagar, Jhalawar, Jodhpur and Jaipur in Rajasthan; and Kolkata, Malda, North and South Parganas in West Bengal, besides Surat and Ahmedabad in Gujarat, have been identified by local affiliates of INPP with increasing HIV incidence, though they couldn’t provide estimates.
Naco said it was difficult to corroborate this. “We don’t have incidence studies as the tools have been (only) recently developed. We need to take it up further and identify the age of (HIV) infections in new areas,” said Rao, adding data to compare changing levels of the infection over time was sparse in these states.
INPP’s workers point out that Orissa, West Bengal, Rajasthan and Gujarat have just eight centres providing antiretroviral therapy to fight AIDS and related infections while the six high-prevalence states account for 78 of India’s 127 such centres.
“Government’s efforts are not making a difference here. We are losing out on the best government health facilities and infrastructure because of this definition of high and low prevalence,” says Brijesh Dubey, head of the Rajasthan chapter of INPP. Dubey has led rallies to New Delhi to bring the growing incidence in his state to the Central government’s notice, and had even threatened to go on a hunger strike. “Are we waiting for low prevalence to become high-prevalence states before we are focused on (them)?” he asks.
Naco’s Rao says there aren’t enough patients in these states to justify a higher number of antiretroviral therapy centres. The body has recommended to state governments that they provide a transport subsidy to help patients travel for their medicines if needed.