Good news about HIV in India: Who benefits? Who loses?
What if it turned out that the AIDS epidemic was not as bad as previously thought? What would be the appropriate reaction? What if your interest in the HIV/AIDS epidemic was in some discovery that you believed would reduce the numbers but then you found out the numbers were nowhere near as high as you had thought? Would your discovery then have less value? And if so, what would that mean for you?
India has announced that the most comprehensive study to date is likely to show that the HIV numbers are lower than previously thought in that country. The Bill and Melinda Gates Foundation funded the study. AP reports, "The new estimate comes from combining data collected from prenatal clinics; a survey of high-risk groups, such as sex workers; and from the government's National Family Health Survey — a method [researcher Ashok] Alexander said was more reliable than the previous estimates, which relied largely on extrapolating from the prenatal clinic data."
The reaction of Daniel Halperin of recent fame, a believer in male circumcision as a HIV prevention method, said, "On the one hand there's a real HIV epidemic in India and it needs to be addressed, but on the other, there's an understandable concern that people were worried that funding or attention could be diminished if the prevalence numbers come out lower." How is that an on-the-one-hand/on-the-other-hand concern?
So the AIDS problem needs to be addressed, but people are worried about their funding because the AIDS problem isn't as bad as thought? Huh?? It is clear he is worried about something. Perhaps his funding? I would be rejoicing. Indeed, I am rejoicing.
This means Indian men's risk is not as high as previously thought. India is not Africa. It is a country without the problem of widespread multiple, concurrent partnerships. Its epidemic is concentrated in high risk groups much like the West. This means that even if circumcision had value, it wouldn't be worth anywhere as much as testing, condoms, education, needle exchange, and widespread treatment. Indian men can breathe easier. Their penises are safe -- or should be.
Fair use AP story after the fold.
Study: Fewer Indians with HIV seen
The number of Indians infected with HIV is far smaller than previously believed, according to new data that appears to vindicate critics who said earlier U.N. assessments of the country's epidemic were vastly overestimated.
Experts say the still-unreleased survey is likely to show that India's number of HIV cases, which last year was said to be the highest in the world at 5.7 million, is actually well below that mark.
"The actual number we've come up with in aggregate is likely to be lower, and perhaps substantially lower," said Ashok Alexander, director of the Avahan, the Indian program of the Bill & Melinda Gates Foundation, which helped fund the study.
Alexander declined to estimate what the new number would be, saying the data is still being analyzed and precise numbers would not be released for a few more weeks.
The new estimate comes from combining data collected from prenatal clinics; a survey of high-risk groups, such as sex workers; and from the government's National Family Health Survey — a method Alexander said was more reliable than the previous estimates, which relied largely on extrapolating from the prenatal clinic data.
The health survey — the third conducted since 1992-93 but the first to provide an HIV estimate — is considered the most comprehensive source and carries the most weight in determining the new figures. It covers about 200,000 people between the ages of 15 and 54, more than half of them women, and was conducted through face-to-face interviews all across India between December 2005 and August 2006.
A statement released Friday by the government's HIV control program, UNAIDS and the World Health Organization acknowledged that the new data provided "a more accurate picture of the epidemic because of availability of more information based on population surveys and improved data from high-risk groups."
But in an indication of how sensitive the new data is in India, where billions of dollars have been poured into prevention programs to stop the spread of HIV, the statement made no mention of the lower overall estimate.
Instead, it only pointed out that HIV rates remain high about groups most at risk — sex workers and their clients, especially truckers; men who have sex with men; and intravenous drug users.
Daniel Halperin, an HIV and AIDS expert at the Harvard School of Public Health, said the new data put health officials in a bind.
"On the one hand there's a real HIV epidemic in India and it needs to be addressed, but on the other, there's an understandable concern that people were worried that funding or attention could be diminished if the prevalence numbers come out lower," he said.
While health experts called the new data good news, they cautioned that HIV is still a major problem, particularly in southern Indian states where rates might be as high as 1 percent of the general population.
"This is a bit like declaring victory before even fully fighting the battle," Alexander said.
This is not the first time experts have questioned India's official HIV numbers.
Halperin and colleagues have published several studies in leading medical journals arguing that the number of AIDS victims in India and other parts of the world are actually far lower than the official numbers claim.
In 2006, Indian doctors argued in a published report that the methodology gave a flawed picture because the amount of HIV-positive people reporting to prenatal clinics, sexually transmitted infection clinics and public hospitals was not representative of their true numbers in the population.
The lead investigator behind the report, Dr. Lalit Dandona of the Administrative Staff College of India in the southern city of Hyderabad, estimated the number of infected adults at between 3.2 million and 3.5 million.
In a country with a population of more than 1.1 billion people, that's far fewer than 1 percent.
While Africa has long attracted most of the attention from international HIV experts, some Western AIDS organizations have argued in recent years that the Indian government was underestimating the scale of its HIV problem, Halperin said.
He thought the new data could serve as vindication for Indian officials.
"It turns out that some people in the government years ago were correct in rejecting the notion that the epidemic was spiraling out of control," he said.
Experts found the dramatic revision in line with an improved understanding of AIDS across the globe.
"There are corrections that happen in the data from time to time," said Paul Zeitz, executive director of the Global AIDS Alliance in Washington. "But if India still has millions of infections, there are still risks for increasing those numbers."
Reference
Dolnick, Sam. Study: Fewer Indians with HIV seen. Associated Press. June 8, 2007.
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