India: AIDS Statistics Accuracy Is Questioned

A newly released World Bank study called HIV prevalence estimates in India “unreliable,” casting doubt on a recent National AIDS Control Organization claim that new HIV infections in the country are declining. According to NACO's most recent figures, new HIV cases dropped from 610,000 in 2002 to 520,000 last year, and the total number of HIV-infected Indians remained 5.1 million -- out of a population of a billion -- at the end of 2003. But in a country where around 40 percent of births and deaths go unregistered, reliable statistics on HIV/AIDS and other public health issues remain elusive.

Since 1987, NACO has been estimating HIV prevalence by extrapolating data from two sources: sentinel surveillance of women attending about 200 antenatal clinics, and data on men from about 166 STD clinics. “The sample size used in this method is woefully inadequate for such a large population and readily lends itself to all sorts of manipulations not only by NACO, but also a host of funders including the World Bank, bilateral agencies and donors,” charged Purushottaman Mulloli, chief of the Joint Action Council, an umbrella organization of groups working for the rights of HIV-affected people.

In its report, “HIV/AIDS Treatment and Prevention in India: Costs and Consequences of Policy Options,” the World Bank said baseline epidemiological predictions indicate HIV prevalence could rise from the current level of less than 1-4 percent by 2033. It also reported that “unstructured therapy” could result in the number of people with resistant strains of HIV growing faster than the number with non-resistant strains. The report, commissioned by the Indian government, acknowledged the projections were made by “generous use of assumptions” because of unavailable data.

Last week, Union Health Minister Anbumani Ramadoss called for an “external assessment” of NACO's numbers involving the respected Indian Institute of Management and McKinsey and Co.

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