India alarm over the rapid spread of HIV/AIDS

*By Sunil Raman
BBC News, Delhi

Candlelit Aids vigil in Delhi, May 21, 2007

India has more HIV infections than any other country, the UN says

India health officials are alarmed by the growing numbers of pregnant
women infected with HIV/Aids in the key states of Uttar Pradesh (UP) and
Bihar.

The northern states are among India's most backward, with huge
populations but poor literacy and health services.

Officials say workers who migrate to cities in search of work bring the
infection back to the states with them.

They say unless the state governments get serious about tackling the
disease, there could be an Aids epidemic.

According to UN estimates, India has the highest number of HIV
infections with 5.7 million people carrying the virus.

Concerned

The head of India's government-run National Aids Control Organisation
(Naco), Sujatha Rao, told the BBC that urgent measures were needed in UP
and Bihar to "stem the epidemic".

There is a shift from urban to rural and from high risk to low risk
categories
RP Mathur,
Uttar Pradesh Aids Control Authority

She was speaking after a countrywide survey to collect India's latest
HIV/Aids figures. Full results of the annual Aids survey will be made
public in early June.

Ms Rao said the districts of Etawah, Banda and Lalitpur in UP had been
found to have more than 1% of pregnant mothers infected with the virus.

A high number of pregnant woman infected with HIV had also been
identified in the districts of Lakhiserai and Saharsa of Bihar.

Ms Rao says she is concerned over the slow response of the two state
governments in dealing with the problem.

The two state governments have "not realised" the seriousness of the
problem but "we remain hopeful", she says.

Ms Rao says the situation in UP and Bihar compares with that in the
southern state of Tamil Nadu 10 years ago.

Tamil Nadu is another high prevalence state as far as HIV infections are
concerned, but what makes matters far more serious in the two northern
states is their poor healthcare system.

To compound matters, Ms Rao says, most cases of HIV/Aids infection in UP
and Bihar go unreported because of the social stigma attached to the
disease.

Migrant labour

The Naco chief's concern is shared by representatives of Aids control
programmes in Uttar Pradesh and Bihar, which together have a population
of more than 280 million people.

Indian HIV positive patient Rimi Sardar (r) and his mother watch as
performers stage a magic show against AIDS during a rally on the eve of
world AIDS day in Calcutta
Officials say the virus is spreading to low-risk groups

Health officials say the main cause of the growing incidence of HIV/Aids
is migrant labour.

RP Mathur of the Uttar Pradesh Aids Control Authority says around 60% of
HIV cases reported come from the socially and economically backward
eastern part of the state.

"There is a shift from the urban to rural and from high-risk to low-risk
categories" in the last few years, he says.

Mr Mathur says it is estimated that UP has more than half a million HIV
positive cases, but only 20,000 of them have been reported, due to the
stigma attached to the disease.

Bihar Aids Control Authority representative Vishal Singh says most of
the infections have been detected in people who had migrated to work in
places outside the state.

"They get infected in industrial cities like Surat [in Gujarat] and
return home to Bihar and have unprotected sex with their wives. This has
to be controlled," he says.

Mr Singh says given the poor economic situation in Bihar, it is
important that more developed states like Gujarat take steps to educate
migrants labourers working there.

'Community problem'

Rashmi Sharma of the Population Foundation of India, a non-government
organisation involved in spreading awareness about HIV/Aids, says
migrant labourers cannot solely be blamed.

"A local community will have to take the blame for its inability to
control the problem," she says.

"The problem lies within the community and they have to be involved in
looking for a solution."

UP and Bihar are two of India's states which rank lowest on the human
development index - they have high levels of illiteracy, unemployment
and poor social infrastructure.

Officials say it is only the wide gap between the estimated and reported
cases which has kept the two states off the list of high prevalence states

Andhra Pradesh, Tamil Nadu and Karnataka in the south, Maharashtra in
the west and Manipur and Nagaland in the north-east are considered high
HIV prevalence states in India.

There has been much debate about whether India does indeed have more
people living with HIV than any other country.

A study by British journal BMC Medicine last December suggested that
methods used to estimate the number of infections in India were flawed
and that the true figure could be about 40% of the estimated numbers.