AEGiS-WSJ: AIDS Study Sees Gains in India: Decline of Infection Rate In Some Women Reported, But U.N. Urges Caution

Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.

AIDS Study Sees Gains in India: Decline of Infection Rate In Some Women Reported, But U.N. Urges Caution

Wall Street Journal - March 30, 2006
Marilyn Chase, marilyn.chase@wsj.com

AIDS researchers in India -- where an estimated 5.1 million people are infected -- reported the HIV-infection rate in young women in the southern part of the nation attending prenatal clinics declined more than a third, to 1.1% in 2004 from 1.7% in 2000.

The researchers said a drop in HIV prevalence in the youngest women, aged 15 to 24, as well as in young men visiting clinics for sexually transmitted diseases, could presage falling incidence of new infections acquired through heterosexual contact. The study found little or no decline in older women, aged 25 to 34, or in northern India, where the epidemic is driven by needle sharing among drug users.

The article -- which with a related commentary is being published today in the British journal The Lancet -- is likely to draw some skepticism, given questions raised by public-health officials about the vigor of India's response to AIDS in past years. The researchers credited the decline to condom use by prostitutes and their clients in southern India, calling for stepped-up AIDS education and condom programs. Lead authors of the study were Rajesh Kumar of the Post Graduate Institute of Medical Research in Chandigarh, India, and Nico Nagelkerke of the United Arab Emirates University in Al Ain.

In Geneva, officials of the Joint United Nations Programme on HIV/AIDS cautiously welcomed the study but warned against reading too much into gains in a subset of patients in one region of the world. While UNAIDS hasn't independently confirmed the data, Karen Stanecki, senior adviser to the agency, said, "We feel the analysis of trends in southern India is credible...and good news." UNAIDS has said for several years that the pandemic has stabilized in parts of sub-Saharan Africa -- but at very high levels of 20% to 30%.

A commentary written by James D. Shelton and Daniel T. Halperin of the U.S. Agency for International Development and David Wilson of the World Bank says in hardest-hit countries of sub-Saharan Africa -- ravaged by 25 million cases of HIV-AIDS -- the epidemic's growth has stabilized or slowed. Their commentary is entitled "Has Global HIV Incidence Peaked?"

While UNAIDS has said the rate of new infections peaked in countries like Uganda and South Africa, Dr. Stanecki criticized the commentary as a "broad brush" interpretation that "masks what is happening in Central Asia," and in African countries like Mozambique, where new infections continue to grow. "We are very concerned about that message going out," she said, adding any suggestion that AIDS is over would be "the wrong conclusion." In Washington, the commentary's lead author, Mr. Shelton, couldn't immediately be reached for comment.

Dr. Stanecki said even if confirmed, a rate of 1.1% HIV in young pregnant women in southern India is worryingly high and "would be totally unacceptable in the United States or Western Europe."

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said the study of India seems "solid," but he expressed concern that the tone of both articles might wrongly imply AIDS is in decline. "You've got to be careful you don't come to the conclusion that globally the incidence has peaked. That's overstated."

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