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[NEW DELHI] The number of HIV cases has levelled out in Tamil Nadu, the southern state with the country’s highest incidence of the virus, according to Indian health officials, who say that the main reason appears to have been the effectiveness of preventative measures.

The news has been welcomed as the first signal that interventions appear to be working in some areas, and as a sign of hope to a country that has seen its total number of HIV infections rise sharply by 600,000 over the past year.

 "Tamil Nadu has been showing [signs of] levelling off for the past three years," says Rajeev Sadanandan from the New Delhi-based National AIDS Control Organisation (NACO). For example, the incidence of sexually transmitted diseases in urban males —  the most likely group to have HIV — has stabilised at around 14 per cent.

There are other positive signs too, says Sadanandan. States such as Kerala and Gujarat that were widely feared to have high rates of infection, due to the presence of high-risk groups such as migrants and commercial sex workers, are showing low prevalence. Sadanandan attributes this to effective interventions in these groups, such as promoting safer sexual practices and improving treatment facilities for sexually transmitted diseases.

The new estimates, released by NACO last month, are based on revised figures from 1998 onwards, and use data collected from 384 surveillance centres, such as sexually-transmitted-disease and antenatal clinics. They show that at the end of 2002, India had between 3.8 million and 4.6 million cases of HIV — a considerable rise on the 2001 estimate of 3.3 million to 4.0 million.

Despite this, the overall percentage of adults infected with the virus remains relatively small at 0.8 per cent. "The figures are very low compared to sub-Saharan Africa," says NACO project director Meenakshi Datta Ghosh.

 Sadanandan, however, warns that the real test lies in the central and northern states, which have experienced rapid population growth, have poor health indices, and lack accurate data on the prevalence of HIV. "Like any other communicable disease, this is where the final reservoir of infections will be stationed," he says. "We have the opportunity to respond. But that opportunity is not being availed of."

Ritu Priya, associate professor at the Centre for Social Medicine and Community Health at the Jawaharlal Nehru University in New Delhi also predicts that the worst of the epidemic may be yet to come across India as a whole. "We are still in the upswing phase of the epidemic which will peak in a few years and then stabilise," she says.

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