On Wednesday, Indian Health Minister Anbumani Ramadoss expressed concern about HIV/AIDS awareness, monitoring and treatment, and suggested the country's official case tally may be short of the real number of infections.

India officially has 5.1 million HIV/AIDS cases, second only to South Africa, but UNAIDS and other groups say the real figure is likely far higher. This month, UNAIDS chief Peter Piot said the Health Ministry's report that new infections dropped from 520,000 in 2003 to 28,000 in 2004 was impossible.

Ramadoss said the World Health Organization verified the figures. He conceded, however, that surveillance is poor in some states, including Uttar Pradesh, India's most populous state with more than 170 million people.

"I am sure there will be people missed out in Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat, Punjab Rajasthan and the northeast," said Ramadoss, referring to some of the country's most populous, largest or remote states. "The problem that we have in some of the states is that the surveillance is not there at the public or government level," he said. "I am definitely concerned."

Ramadoss expressed hope that a new count in 2006 will give a more accurate picture of the epidemic.

According to officials in India, the epidemic has entrenched itself in rural areas where public-health systems are poor. "What is really worrying us is that the epidemic is really getting into the rural areas," said Sujata Rao, chief of India's National AIDS Control Organization. "Until now, we thought HIV/AIDS was an urban phenomena," said Rao. Almost 59 percent of Indians with the disease live in the countryside, and many village men who seek work in the cities visit sex workers and then infect their wives.

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