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Prevention/Epidemiology
Belief That HIV Transmitted Mainly Through Sex in India "Inconsistent With Evidence," Study Says

October 27, 2006

The Indian government's assumption that HIV in the country is transmitted mainly through sex, especially with commercial sex workers, is "inconsistent with evidence and very likely wrong," according to a study published in the November issue of the Royal Society of Medicine's International Journal of STD and AIDS, AFP/Yahoo! News reports (AFP/Yahoo! News, 10/26). Researchers David Gisselquist and Mariette Correa examined the process of HIV/AIDS surveillance in four high HIV prevalence districts in southern India. The researchers also interviewed physicians, counselors, officials of the State AIDS Control Societies and people living with HIV/AIDS in an effort to determine the reliability of the country's National AIDS Control Organization's figures that attribute 86% of HIV transmission to sexual risk, 3.6% to vertical transmission, 2.4% to injection drug use, 2% to blood transfusions and 6% to other or not specified actions (Correa/Gisselquist, International Journal of STD and AIDS, November 2006). According to three studies "that have helped underpin the country's AIDS strategies," sex workers account for 27% of India's HIV cases, AFP/Yahoo! News reports. According to the researchers, sex workers account for 2% to 13% of HIV cases, substantially less than NACO estimates. In addition, the number of sex workers, their clients and the frequency of client visits also likely are overestimated, the researchers report. The study also found evidence suggesting that sex workers are more likely to use condoms and less likely to be HIV-positive, compared with current estimates. NACO's estimates are far from accurate, the researchers report. Estimates of HIV transmission routes come from the assessments of hospital staff, who routinely report that transmission was the result of sexual activity without determining if other factors might have been a variable, according to AFP/Yahoo! News. "The official sexualization of the HIV epidemic has blinded just about everybody to considering (and protecting against) nonsexual routes of transmission," such as the reuse of unsanitary instruments in hospitals, dental surgeries, tattoo parlors and cosmetic services, according to the authors (AFP/Yahoo! News, 10/26). "The system does not distinguish high from lower risk sexual behaviors; all cases with sexual risks are reported in one category," the researchers said, concluding, "We propose changes in forms and practices to improve the reliability and usefulness of [NACO] information on risks from AIDS case reporting" (International Journal of STD and AIDS, November 2006).

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