New evidence from India’s third and most comprehensive health survey to date has spurred the government and international agencies like UNAIDS and the WHO to reduce the official estimate of Indians living with HIV by up to 50%

The final report of the third National Family and Health Survey (NFHS-III), released by the ministry of health and family welfare last week, has revised India’s HIV prevalence rate to 0.28%, from the 0.36% it had estimated in its preliminary findings released in mid-2007. That figure was used by the National AIDS Control Organisation (NACO) in July 2007 to rebut claims of India having an HIV prevalence rate of 0.9% and the world’s highest number of HIV infections.

Prevalence rates (infections per population of 100,000) across India vary between 1.13% in the northeastern state of Manipur and 0.97% in the southern state of Andhra Pradesh, says the final report of India’s latest and most comprehensive health indicators survey.

HIV prevalence continues to be high in Andhra Pradesh, Karnataka, Maharashtra and Nagaland, while it has decreased in Tamil Nadu, once among the list of states with a high HIV prevalence.

The NFHS-III estimate for Uttar Pradesh, a low prevalence state, is only 0.07%, which many experts have long claimed is due to under-reporting or lack of healthcare facilities and monitoring of the disease.

Countrywide, the HIV prevalence rate among men is 60% higher than the rate for women -- for men aged 15-49 it is 0.36%, and for women it is 0.22%.

The only exception is the southern state of Tamil Nadu, where the prevalence rate among women is higher, perhaps because infected men had succumbed to the disease and the state was effective in containing a further spread of the disease. HIV in Tamil Nadu had peaked and was now on a downslide, sources at the health ministry claimed.

Among men and women, the prevalence rate is highest in the 30-34 age-group. Alarmingly, the prevalence rate is a whopping 40% higher in Indian cities than in the villages, added the final report of NFHS-III (2005-2006).

For the first time, also, the NFHS carried out a district-wise, community-based household survey of HIV prevalence in selected states. This included consensual HIV testing on a representative sample of more than 100,000 women and men in the age-group 15-49.

Such a large-scale community-based survey to collect data on HIV prevalence has been carried out only once before, in Cambodia, but the number of people surveyed was obviously much smaller.

NFHS-III is independent of the sentinel surveillance system used by NACO to determine HIV prevalence rates.

New evidence from NFHS-III has provided crucial information to understanding India’s HIV epidemic. The survey also spurred government and international agencies like UNAIDS and the WHO to greatly reduce the official estimate of Indians living with HIV from more than 5 million people to 2.47 million. After NACO’s announcement, in July, India became the third worst HIV/AIDS-affected country after South Africa (5.5 million) and Nigeria (2.9 million).

On the subject of HIV/AIDS awareness, only 61% of women and a substantially better 84% of men surveyed had heard of AIDS. Awareness has increased sharply since NFHS-II, conducted in 1998-99, but still remains low among some groups, notes the health survey.

Indian men have more information about preventing HIV/AIDS than women -- seven in 10 men know the ABCs of prevention (abstinence, being faithful and condoms) compared to only four in 10 women.

Misconceptions about HIV/AIDS continue to be worryingly commonplace, NFHS-III found. Only 38% of women and 61% of men were aware that even a ‘healthy looking person’ could be infected by the virus. And about 33% of women and 50% of men mistakenly believe that mosquitoes can transmit the disease.

Encouragingly, the NFHS found that most men and women think that information on HIV/AIDS should be part of the school curriculum. About 80% of men think that school-going boys and girls should learn about HIV/AIDS, compared with 63% of women.

More than 60% of men say that both boys and girls should be taught about sex and sexual behaviour in school; but less than 50% of women feel that this is an appropriate topic to be taught in schools.

NFHS-III is the third in a series of countrywide health surveys in India. A total of 124,385 women in the age-group 15-49, and 74,369 men in the age-group 15-54 were interviewed for the survey. Based on a sample of households, NFHS-III fieldwork was conducted in two phases by 18 research organisations between November 2005 and August 2006.

Source: Business Standard, October 12, 2007
              PTI, October 11, 2007
              The Hindu, October 11, 2007