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HIV/AIDS in India and UttaranchalFigure 2Percentage3.02.52.01.51.00.5Sentinel Surveillance for HIV InfectionHIV prevalence among antenatal wom en inmetropolitan cities–1998attendees, and is now steadily spreading throughout thelow-risk population (Figure 3). The time lag for HIVinfection to spread from high-risk groups to low-riskgroups is between three and five years. The infectionspreads from CSWs to their clients, which act as a bridgepopulation, and then to the clients’ wives.Among IDUs, the infection has spread sharply inManipur, with HIV prevalence at more than 70% (Figure4). It is also spreading in Nagaland.0Figure 3MumbaiHyderabadBangaloreChennaiCalcuttaAhmedabadD elhiHIV prevalence Maharashtra in three sub groupsWindows of opportunities for other states757065605550454035302520151050CSWSTDANCTime lag infectionhigh to low risk(3-5 years)Source: NACO, 1998Figure 49080HIV prevalence among IDU in ManipurTrends of HIV infection among various risk groups inIndia, especially among the states, can be summarized asfollows.l Although HIV prevalence is low in the majority ofstates, the number of HIV infections is high.l There are wide regional variations in HIV prevalence.l There are simultaneous epidemics in certain states,such as the heterosexual epidemic in Maharashtraand Tamil Nadu, and the IDU epidemic in Manipur.Estimation of HIV Infection among theAdult Population, 2001In the Indian context, it is difficult to estimate the exactprevalence of HIV because of the varied culturalcharacteristics, traditions, and values with specialreference to sex-related risk behaviours. The westernAfrican model of making estimates cannot be easilyapplied to the Indian scenario; however, it is possible tohave rough estimates within a range that may be used forplanning of the AIDS Prevention and ControlProgramme. These estimates can also be useful formapping specific vulnerable groups and areas in order toplan targeted interventions in major urban areas andother areas in the states.Percentage706050403020100To estimate the total burden of HIV infection in thecountry, some effort was made previously by the WorldHealth Organization (WHO) and UNAIDS by using thedata generated by the National AIDS ControlOrganization (NACO) and other publications fromvarious research institutes in India. Although the HIVsentinel surveillance data have been primarily used formonitoring trends (i.e., to assess how rapidly HIV178
HIV/AIDS in India and Uttaranchalinfection increases or decreases over time in different groups and areas), it can also provide anestimate of the total burden of HIV infection in the country.The concept of using HIV sentinel data to estimate the burden of HIV infection was demonstratedin the August 1996 WHO document, HIV/AIDS/STD Surveillance Data: Management and Use. Thedocument suggests that sero-surveys of a sentinel population are often the most popular methodsof estimating the burden of HIV infection. A reliable estimate can be determined by using datafrom sero-prevalence studies of different sub-populations at different levels of risk. The HIVprevalence level is then applied to the population that the study group represents. For example, inepidemics in which heterosexual transmission is predominant, the HIV prevalence rate inantenatal women is applied to the sexually active population (15–49 years). For estimating HIVprevalence among various risk groups, an estimation of the size of these groups is necessary. Thecaution here is that risk groups should not overlap.Such estimates are made by applying the following formula.V = Σ (P/T) (R)Here, V is the total estimate, P is the number of HIV-positive population, T is the number ofsamples tested, and R is the estimated size of the population.Given that the extent of reliability of HIV estimates will depend on the accuracy of the estimationof the size of the risk-group population, careful assumptions are required in respect of variousparameters, such as urban–rural mix, male–female ratio, STD prevalence in urban and ruralareas, and so forth. Various assumptions were developed after intensive consultations withnoted epidemiologists and bio-statisticians in the country. The following assumptions coveringdifferent parameters for the estimation of the size of risk-group populations have beenrecommended.1. The 2001 census figures and the projected figures for 2000 will be the basis for state-specificassumptions forl mid-year population (in the age group of 15–49 years),l urban population and rural population, andl male–female ratio.2. STD prevalence rates in both urban and rural populations will be as follows:l STD prevalence in urban areas will be 10% in high prevalence states, 7% in mediumprevalence states, and 5% in low prevalence states. It will be the same for both males andfemales.l There will be five per cent prevalence in rural populations in all states and unionterritories for both males and females.3. For the purpose of HIV estimation in high-risk populations, urban–rural differential will be3:1 in all states. Similarly, for HIV prevalence in the low-risk population, the urban–ruraldifferential will be 8:1 in all states.4. As there are more infected males than females, the following ratio would be applied.l In high prevalence states, for every infected female there are 1.2 males; in moderate179
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Health Policy IssuesandHealth Progr
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ContentsContentsPrefaceList of Part
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I would also like to thank our tech
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List of ParticipantsIndu Kumar Pand
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List of ParticipantsMohmed ShaukatD
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List of ParticipantsR K PurohitAddi
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GlossaryGlossaryAbbreviationsAIIMSA
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GlossaryLHVLILMISMAPMCMCHMDRTBMDTM&
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GlossaryTHRTRCTRIPsTTTUUDCUIPUPUTVC
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Inaugural Sessionwould be the first
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Inaugural SessionOnly 18% of the pr
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Inaugural SessionMadhukar Gupta, Ch
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Inaugural Sessionrotational basis f
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Inaugural Sessiontell you more abou
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Public Health Issues, Priorities, a
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National Health Programmes: An Over
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Implementation of National Health P
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Use of Epidemiological Surveillance
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Designing a Surveillance SystemFurt
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Designing a Surveillance Systemsurv
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National Health Programme in Uttara
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IEC Strategies for Health in IndiaS
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IEC Strategies for Health in Indial
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IEC Strategies for Health in IndiaS
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IEC Strategies for Health in IndiaA
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IEC for Health Programmes in Uttara
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Session 3Private and Public SectorP
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Public-Private Interaction in Healt
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Cost Recovery Measures in Governmen
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Arogya Raksha: Health Insurance Sch
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Page 140 and 141: Arogya Raksha: Health Insurance Sch
Page 142 and 143: Session 1Session 4Health Financing
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Page 170 and 171: Session 5STI/RTI, AIDS, and TB Cont
Page 172 and 173: Quality of RTI/STI Case Management
Page 182 and 183: HIV/AIDS: International Perspective
Page 188 and 189: HIV/AIDS in India and UttaranchalSe
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Page 198 and 199: Tuberculosis Control Efforts in Ind
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Sanitation and Public Health Issues
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Ayurveda and Unani Department and t
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Specific Health Policy and Programm
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