Is the HIV burden in India being overestimated?

Dandona, Lalit; Lakshmi, Vemu; Kumar, G. Anil; Dandona, Rakhi
January 2006
BMC Public Health;2006, Vol. 6 Issue 1, p1
Academic Journal
Background: The HIV burden estimate for India has a very wide plausibility range. A recent population-based study in a south Indian district demonstrated that the official method used in India to estimate HIV burden in the population, which directly extrapolates annual sentinel surveillance data from large public sector antenatal and sexually transmitted infection (STI) clinics, led to a 2-3 times higher estimate than that based on population-based data. Methods: We assessed the generalisability of the reasons found in the Guntur study for overestimation of HIV by the official sentinel surveillance based method: addition of substantial unnecessary HIV estimates from STI clinics, the common practice of referral of HIV positive/suspect patients by private practitioners to public hospitals, and a preferential use of public hospitals by lower socioeconomic strata. We derived conservative correction factors for the sentinel surveillance data and titrated these to the four major HIV states in India (Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu), and examined the impact on the overall HIV estimate for India. Results: HIV data from STI clinics are not used elsewhere in the world as a component of HIV burden estimation in generalised epidemics, and the Guntur study verified that this was unnecessary. The referral of HIV positive/suspect patients from the private to the public sector is a widespread phenomenon in India, which is likely causing an upward distortion in HIV estimates from sentinel surveillance in other parts of India as well. Analysis of data from the nationwide Reproductive and Child Health Survey revealed that lower socioeconomic strata were over-represented among women seeking antenatal care at public hospitals in all major south Indian states, similar to the trend seen in the Guntur study. Application of conservative correction factors derived from the Guntur study reduced the 2005 official sentinel surveillance based HIV estimate of 3.7 million 15-49 years old persons in the four major states to 1.5-2.0 million, which would drop the official total estimate of 5.2 million 15-49 years old persons with HIV in India to 3-3.5 million. Conclusion: Plausible and cautious extrapolation of the trends seen in a recent large and rigorous population-based study of HIV in a south Indian district suggests that India is likely grossly overestimating its HIV burden with the current official sentinel surveillance based method. This method needs revision.


Related Articles

  • Senior German health officials sacked. Abbott, Alison // Nature;10/14/1993, Vol. 365 Issue 6447, p594 

    Reports on the sacking of the president and director of Germany's federal public health bureau. Suppression of information about the extent of HIV contamination of blood products in the 1980s; Ineptitude for overseeing health regulations; Complaints by health minister Horst Seehofer regarding a...

  • IT STARTS WITH YOU!  // BOYZ;5/15/2014, Issue 1185, p14 

    The article focuses on the campaign "It Starts With Me" by Public Health England that highlights the risk of unprotected sex and men testing for tackling with undiagnosed infection of HIV.

  • Fighting HIV/AIDS: is success possible? Okware, Sam; Opio, Alex; Musinguzi, Joshua; Waibale, Paul // Bulletin of the World Health Organization;2001, Vol. 79 Issue 12, p1113 

    Abstract The fight against HIV/AIDS poses enormous challenges worldwide, generating fears that success may be too difficult or even impossible to attain. Uganda has demonstrated that an early, consistent and multisectoral control strategy can reduce both the prevalence and the incidence of HIV...

  • HIV infects.  // Discover;Jan99, Vol. 20 Issue 1, p42 

    Reports on the rate of HIV infection among adults in nine African countries.

  • In Cambodia.  // Discover;Jan99, Vol. 20 Issue 1, p42 

    Reports on the rate of HIV infection among pregnant women, soldiers and prostitutes in Cambodia.

  • Evaluation of Early Infant Diagnosis of HIV 1 in Government hospital, Dhule. DRAVID, MRUDULA NANDKUMAR; KHADSE, RAVINDRA KASHINATH; KULKARNI, SHUBHANGI DEVIDAS; ADCHITRE, HITESH RAMESH // Journal of Clinical & Diagnostic Research;Sep2013, Vol. 7 Issue 9, p2104 

    A letter to the editor is presented regarding assessment of early infant diagnosis of HIV 1 in government hospital in Dhule, India.

  • Public support wanes for South African doctors striking. Sidley, Pat // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;7/11/2009, Vol. 339 Issue 7712, p68 

    The article reports on the waning support of the South African people to the strike staged by doctors in South Africa since May 2009. The doctors have rejected an offer from the South African government intended to address several issues, including poor pay, conditions and facilities. The...

  • Challenges facing effective implementation of cotrimoxazole prophylaxis in children born to HIV-infected mothers in the public health facilities. Kamuhabwa, Appolinary A. R.; Manyanga, Vicky // Drug, Healthcare & Patient Safety;2015, Vol. 7, p147 

    Background: If children born to HIV-infected mothers are not identified early, approximately 30% of them will die within the first year of life due to opportunistic infections. In order to prevent morbidity and mortality due to opportunistic infections in children, the World Health Organization...

  • Late diagnosis/entry into HIV care can result in early deaths among infected.  // AIDS Alert;Mar2008, Vol. 23 Issue 3, p29 

    The article focuses on a study which suggested that despite public health initiatives pushing routine HIV testing, too many people infected with the virus are diagnosed later in the disease, leading to poor health outcomes.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics