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Journalism of Courage
India8217;s epidemics are even more diverse than China8217;s. Latest estimates show that about 5.1 million 2.5-8.5 million people were living with HIV in India in 2003. Serious epidemics are underway in several states. In Tamil Nadu, HIV prevalence of 50 per cent has been found among sex workers, while in Andhra Pradesh, Karnataka, Maharashtra and Nagaland, HIV prevalence has crossed the 1 per cent mark among pregnant women. In Manipur, meanwhile, an epidemic driven by injecting drug use has been in full swing for more than a decade8230; UNAIDS/WHO, 2003. HIV prevalence measured at antenatal clinics in the Manipur cities of Imphal and Churachand has risen from below 1 per cent to over 5 per cent, with many of the women testing positive appearing to be the sex partners of male drug injectors. Several factors look set to sustain Manipur8217;s epidemic, including the large proportion about 20 per cent of female sex workers who inject drugs and the young ages of many injectors 40 per cent of male injectors surveyed in 2002 were under 25 years8230;
There are signs that injecting drug use is playing a bigger role in India8217;s epidemics than previously thought. Most surveillance sites for injecting drug users are in the northern states8230;but other parts of the country have yielded equally troubling evidence. In Chennai, for example, 26 per cent of drug injectors were already infected with HIV when a sentinel site was established there in 2000; by 2003, 64 per cent were injected8230;. Like Manipur, the states of Maharashtra, Tamil Nadu and Andhra Pradesh have long-established HIV epidemics, but theirs are driven mainly by commercial sex. Available evidence suggests that prevention efforts in some of those states have done little to alter the epidemic8217;s advance. Sentinel surveillance has revealed no significant drop in HIV prevalence among female sex workers in Mumbai, for example, despite decades-old safer-sex programmes for sex workers. It appears the programmes have been either too scattered or short-term to reach a large enough proportion of sex workers to make a difference. In some of these states, HIV has been rising steadily among pregnant women, most likely because clients have transmitted the virus to their regular partners. Fortunately, India does boast some significant prevention successes, such as the drop in casual sex reported in the southern state of Tamil Nadu. In 1996, 14 per cent of truck drivers reported recent unprotected sex with a sex worker. By 2002 after concerted prevention programmes were introduced, that had fallen to just 2 per cent8230;
Excerpted from AIDS Epidemic Update,8217;04 UNAIDS/WHO
