The first cases of HIV were diagnosed among sex workers in Chennai in 1986.  Since then, the country has evolved from “low” to “concentrated” epidemic. In 2009, an estimated 2.4 million people (aged 15-49) were living with HIV, slightly lower than the 2.5 million reported in 2001. However, India remains just behind South Africa and Nigeria in numbers of persons living with HIV [1]. The reduction of the overall adult prevalence is not only associated with increased HIV programme and service coverage, but also with a more valid estimation process brought about by improvements in surveillance coverage, quality of data, and methods used for estimation [2].  Women accounted for 38% of people living with HIV while children accounted for 4.4% [1].

As of February 2010, HIV had been mainly transmitted via sexual intercourse (87%) [3]. Additional routes of transmission include perinatal, unsafe blood and blood products, infected needles and syringes and unspecified/other routes of transmission.   

The heterogeneous distribution of the HIV epidemic is evident, as many isolated pockets of high prevalence are identified in several districts of the country [4]. Overall, 108 districts in the country have HIV prevalence >1% in lower-risk populations represented by women attending antenatal clinics (ANCs); 87 districts have HIV prevalence >5% in one or more of the key affected populations [4]. Sixty percent of people living with HIV (PLHIV) were in the six high prevalence states of Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Uttar Pradesh and Manipur [2].

With a concentrated HIV epidemic, India’s HIV prevalence continues to be high among key affected populations (6 to 8 times that of the general population). High HIV prevalence among female sex workers is observed in the South and rising trend is evident in the North East .Higher HIV prevalence among injecting drug users (IDUs) is also found in North Eastern States. However, it is localized in nature, and both rising and declining trends are observed in different North Eastern States thus indicating the dual nature of the epidemic. In 2006, new sites of high HIV prevalence among IDUs were identified in the states of Punjab, Tamil Nadu, West Bengal, Kerala and Maharashtra.  HIV prevalence among MSM is highest in the states of Karnataka, Andhra Pradesh, Manipur, Maharashtra, Delhi, Gujarat, Goa, Orissa, Tamil Nadu and West Bengal .Nationally, HIV prevalence is notably higher among IDUs and men who have sex with men than among female sex workers and other population groups.  Still, sex work continues to act as the most important source of HIV infections due to the large number of clients becoming infected by sex workers [2].

Vulnerability and risk factors that could contribute to spread of the epidemic in India include gender discrimination, stigma and discrimination, and inadequate human resource and technical support that lead to slow progress in the scale-up of prevention, care and support programmes. Furthermore, there is a need to strengthen capacity and systems to effectively implement certain HIV programmes such as a strategic information management system, cohort tracking of ART, and ensuring quality data on children affected or infected by HIV as well as operational and functional governance structures.

Sources:

[1] UNAIDS, Report on the Global AIDS Epidemic, 2010 

[2] India, UNGASS Country Progress Report, 2010

[3] India, Ministry of Health and Family Welfare, NACO, Department of AIDS Control, Annual Report, 2009-10

[4] HIV Sentinel Surveillance, Country Report, NACO 2006 cited by National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India, New Delhi,  in UNGASS Country Report 2008, India