[NEW DELHI] International agencies, public health experts and AIDS activists in India have dismissed as incorrect and misleading the Indian government's claim of a 95 per cent drop in new HIV infections between 2003 and 2004.
Last week, India's health minister Anbumani Ramadoss said the country recorded only 28,000 new infections in 2004, compared to 520,000 in the preceding year.
He attributed the decline to the government's awareness campaigns.
In total numbers, with 5,134,000 people infected across the country according to Ramadoss, India ranks second to South Africa, which has 5.3 million HIV infections.
Indian's overall HIV prevalence, however, is low: 0.91 per cent of the population is infected, compared to 21.5 per cent in South Africa.
Ramadoss said there was no national HIV epidemic in India, but that there are "sub-national" epidemics in six of the nation's 28 states.
This includes the southern state of Andhra Pradesh, where the infection has reached two per cent of the population for the first time.
Officials at the Indian health ministry's National AIDS Control Organization say their annual survey of 670 sites across the country was undertaken with the New Delhi-based Institute of Research in Medical Statistics and the National Institute of Health and Family Welfare, and followed the procedures and guidelines of the World Health Organization and the Joint UN Programme for HIV/AIDS (UNAIDS).
But international agencies and public health experts have cast doubt on the government's figures and its claim that its public awareness campaign has been effective.
Denis Broun, the UNAIDS country coordinator for India, says that although UNAIDS believes that the total number of people living with HIV is probably close to the Indian government's estimate, it is wrong to think that there were only 28,000 new infections in 2004.
"The difference in numbers between [2003 and 2004] does not represent the number of new infections because this calculation ignores the fact that people die of AIDS-related causes."
"There has not been a huge decline and HIV is still increasing in India, even if at a slow pace," Broun says, warning that the government should not be lulled into complacency or reduce the intensity of its prevention efforts.
"The figure of 28,000 new infections and the 95 per cent drop are wrong — they are a misreading of the underlying data," agrees a Geneva-based representative of the Global Fund to fight AIDS, Tuberculosis and Malaria.
"The numbers are so uncertain that using them as a reason for complacency is wrong and risky."
"We have a slowly growing epidemic in India and nobody can afford to be complacent about it," he warned. "Epidemics affecting around one per cent of the population are often at a point where they can jump from vulnerable groups to the general population."
In April, Richard Feachem, executive director of the Global Fund, caused controversy in India when he told a meeting in Paris, France, that the HIV epidemic in India was getting "out of control" and that the country's total number of HIV infections had overtaken South Africa's.
NACO immediately dismissed Feachem's April statement as "nonsense", and last week released its estimates.
The estimate of 5,134,000 infected people overall is probably correct, says Ritu Priya, associate professor at the Centre for Social Medicine and Community Health at Delhi's Jawaharlal Nehru University. But she says it is difficult to understand how the government came to the conclusion that new infections dropped by 95 per cent.
Public health experts and AIDS activists are sceptical about the government's claims of a successful public awareness campaign, given the widespread lack of awareness about the epidemic and the huge stigma and discrimination facing those affected and their families.
"There are no studies to show exceptionally high levels of awareness or drastic changes in behaviour to explain such a drop," says Ritu Priya, adding that public awareness alone cannot make that great an impact.
If the government detected so few new infections, it indicates that "something is definitely wrong" in its method of tracking new infections, says Ryan Fernandes, programme manager at Delhi-based Sahara Care Home, which provides care and support to people with HIV/AIDS.
Fernandes says that infected people who are unaware of their status are still passing the virus to others. "What awareness campaign is NACO talking about?" he asks.
"The ground realities are different," says a member of the Delhi Network of Positive People, which represents people with HIV. "We are seeing more and more cases around us. We do not understand how the government observed such an outstanding decline."