HIV Prevalence Among Young People in Southern India Has Declined By About 35%, Study Says

The HIV prevalence among young people ages 15 to 24 in southern India has declined by about 35%, primarily because of prevention campaigns aimed at commercial sex workers and their clients, according to a study published Thursday in the online edition of the Lancet, the AP/Globe and Mail reports (George, AP/Globe and Mail, 3/30). Rajesh Kumar of the Post Graduate Institute of Medical Education and Research in Chandigarh, India, and colleagues examined HIV prevalence among 294,000 women ages 15 to 34 attending prenatal clinics in four states in southern India and 14 states in the north. They also examined HIV prevalence among 59,000 men ages 15 to 34 attending clinics for sexually transmitted infections in the same regions. The researchers found that among women ages 15 to 24 attending prenatal clinics in the southern states of Tamil Nadu, Andhra Pradesh, Maharashtra and Karanataka, HIV prevalence decreased to 1.1% in 2004 from 1.7% in 2001, a relative decline of 35%. Among men ages 20 to 29 attending STI clinics, the researchers recorded a 36% relative decline in HIV prevalence over the same time period (AFP/ChannelNewsAisa.com, 3/30). The researchers found no significant decrease in HIV prevalence among women ages 25 to 34 or among men and women in the northern states, where the epidemic is driven by injection drug use. The study's findings might signify a decrease in the number of new infections acquired through heterosexual contact in India, according to the researchers. They credited the decline among young people to an increase in condom use among commercial sex workers and their clients in the southern part of the country (Chase, Wall Street Journal, 3/30). According to researcher Prabhat Jha of the University of Toronto's Department of Public Health Sciences, condom use among commercial sex workers has increased by 70% since HIV awareness campaigns were launched (AP/Globe and Mail, 3/30).

Reaction, Recommendations
Although UNAIDS has not independently confirmed the study's findings, the agency believes "the analysis of trends in southern India is credible ... and good news," Senior Adviser Karen Stanecki said. However, UNAIDS officials said that too much should not be read into data taken from a subset of people in a particular region, according to the Journal (Wall Street Journal, 3/30). According to Jha, the Indian government should widen its HIV-prevention campaigns -- which are aimed primarily at high-risk groups such as commercial sex workers -- to include the general population (AP/Globe and Mail, 3/30). "HIV remains a huge problem in India and we have to remain vigilant," Kumar said, adding, "We're not saying the epidemic is under control yet. We are saying that prevention efforts with high-risk groups thus far seem to be having an effect" (BBC News, 3/29).

Related Analysis
In a related Lancet analysis, James Shelton and Daniel Halperin of USAID and David Wilson of the World Bank say that the spread of HIV/AIDS seems to have stabilized or slowed in sub-Saharan African countries most affected by the pandemic (Wall Street Journal, 3/30). According to U.S. Census Bureau data cited in the analysis, the number of new infections may have peaked in 1987 in Uganda and Zambia, 1993 in Kenya, 1994 in Botswana and Lesotho, and around 1997 in South Africa. According to Shelton, reasons for the stabilization of the pandemic include the natural cycle of disease outbreaks, as well as the efficacy of various prevention programs. "It gives us hope that behavior can change on a large scale and can affect the course of the pandemic," Shelton said, who was speaking in a private capacity, he added, "I don't think, though, it's happening much in southern Africa yet"(Donnelly, Boston Globe, 3/30). Although UNAIDS has said that HIV incidence has peaked in countries such as Uganda and South Africa, the analysis is a "broad brush" interpretation that "masks what is happening in Central Asia" and other African countries, including Mozambique, Stanecki said. Shelton could not be reached for comment, according to the Journal (Wall Street Journal, 3/30).

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