Analysing the Prevalence of HIV in India and States

Dr. Pramod P. Lonarkar

Assistant Professor, School of Social Sciences, S.R.T.M. University, Nanded (MH).

*Corresponding Author Email: prmodlonarkar@gmail.com

ABSTRACT:

HIV being one of the most dangerous communicable diseases has its spread all over the world including India which ranks on the third position in having HIV people. Considering India’s large and growing population and vivid demographic structure of states, it is important to analyse the trend and severity of HIV prevalence in India and its states. It is observed that overall trend of HIV prevalence is decreasing in both Male and Female. Similarly the trend of new infections and the deaths caused by it is also falling. But for child age group the number of new infections were high and number of deaths were low so there was an increase in the people living with HIV in child age group till 2013 and after that it is falling. At the state level it is observed that prevalence of HIV is different in different states in terms of the three indicators namely, number of people living with HIV, number of new infections and number of deaths. But considering these three indicators together there are nine States/ UTs namely Daman and Diu, Dadra and Nagar Haveli, Manipur, Tripura, Sikkim, Andaman and Nikobar, Chandigarh, West Bengal and Orissa showing high prevalence of HIV. The classification of states made in this paper as per the level of HIV prevalence is help full for policy makers to implement suitable mechanism to control the spread of communicable diseases like HIV.

KEYWORDS: HIV, Infection, Deaths, Prevalence of HIV, Dimension Index.

INTRODUCTION:

HIV/AIDS is a global communicable epidemic caused 35 million people to die out of the total 70 million infections since its beginning. As on 2016 around 36.7 million people are reported as HIV infected, worldwide and around 1 million are died due to illness caused after HIV (WHO 2016). There are many sources of getting infection of this disease so around 1.8 million cases are newly reported in 2016 including adults and children. The 0.8 percent of total adults (age between 15 to 49 years) worldwide are living under HIV. The development of medical science stretched down the total number of newly infected people and deaths caused by this epidemic every year. The prevalence this epidemic continued to be different in different countries and in age groups.

The spread of any communicable disease is largely depends on the demographic features such as density, fertility, age composition etc. India being second large populous country and HIV/AIDS being communicable disease, cautious look on its status and spread in states is important. So the focus of this paper is to analyse the overall status of the spread of HIV in India in general and across the states in particular.

OBJECTIVES:

The broader objective of this paper is to focus on the spread of HIV in India and across the States. Considering this objective the following sub objectives are considered for analysing the spread of HIV.

1) To observe the trend of people leaving with HIV in India.

2) To highlight the Male-Female and Adult-Child composition of people living with HIV.

3) To describe the trend of HIV infection and deaths caused by it.

4) To analyse the prevalence of HIV in states.

5) To classify the states as per the level of HIV prevalence by applying a suitable method.

METHODOLOGY:

This study is mainly based on the data of HIV estimates released by National AIDS Control Organization (NACO), National Institute of Medical Statistics (NIMS), Indian Council of Medical Research (ICMR) of Ministry of Health and Family Welfare Government of India. These estimates are released for the period of 2007 to 2015. To arrive at demographic linkages of this disease projected population data released by census of India is used.

For analysis of the data simple tools like trend, growth, percentage are used and graphically presented for clear visualization of the status of each indicator or data. For analysing the HIV prevalence at state level some indicators are developed as follows.

1) To know the state wise current status of HIV prevalence people living with HIV for per thousand populations is measured.

2) To measure the state wise spread of infection, number of new infections in time t (i.e. 2015) for per thousand people living with HIV in t-1 period (i.e. 2014) is calculated.

3) To focus on the risk of the disease and number of deaths in t period (i.e. 2015) for per thousand people living with HIV in t-1 period (i.e. 2014). Further a common dimension index is constructed as

Dimension Index=(Actual Value – Minimum Value)/ (Maximum Value–Minimum Value) By using this dimension index separately for above mentioned three indicators, states are ranked from largest to smallest value and presented graphically. After ranking states are classified in to Four Quartiles. The states falling in first quartile shows low prevalence of that indicator in these states than higher order of quartile and so on.

Further a composite value i.e. the average of three dimension index is computed and finally states are ranked as per the highest value to lowest value and graphically presented.

Prevalence of HIV in India:

Number of HIVs in India:

In the world wise ranking India is on the third position in with 21 lakh HIV infected people after South Africa (71 lakh) and Nigeria (32 lakh) by the year 2016. As per the demographic structure India is having large adult population including reproductive population (Census 2011). So more spread of HIV is seen in adults i.e. around 93.5% of total HIV patients, where as it is 6.5% in child age group. As shown in the following figure (no.1), the overall number of HIVs has fallen continuously from 22.25 lakh in 2007 to 21.16 lakh in 2015 comprising 19.78 lakh adult and 1.39 lakh child HIV patients. The total decreased numbers during this period is 1.09 lakh (NACO Estimates 2015). It is observed that the fall in adult HIV number by around 1.21 lakh persons in contrast to increase in child HIV numbers by around 12.22 thousand. This increase in percentage form is from 5.67% to 6.54% i.e. around one percent point. So the overall fall is reported less than the fall in adults. Trend line of child age HIV numbers is continuously increasing till the year 2013 after that it has fallen and expected to fall further due to anti HIV measures taken by the government.

The Gender Wise Composition of HIV:

The earlier studies shows that the overall sex ratio of the HIV/AIDS infected population impacts males more than women (S Pallikadavath, R W Tones 2003). Here the male-female composition of HIV shows that males are more infected than females during the year 2007 to 2015. Recently the overall composition is around 60% males and 40% females. As explained above (figure no.2) the number of HIV infected people are decreasing. So percentage of total HIV people to total population has fallen by 0.08 percent points from 0.34% in 2007 to 0.26% in 2015 (NACO Estimates 2015). Similarly percentage of HIV males to total male population has fallen by 0.1 percent point from 0.4% to 0.3% during the same period. But in case of female HIV percentage to total female population is showing very small decrease i.e. only 0.04 percent points from 0.26% to 0.22% during the period (NACO Estimates 2015).

Number of New HIV Infections:

Being a communicable disease many new people are getting infected every year. But the trend of new infections is falling over a period of time. As shown in the figure no.3 the fall is reported from 1.27 lakh in 2007 to 0.86 lakh in 2015 i.e. around 32%. Similarly fall in new adult infection is around 29%. But the fall in getting new infection in child age group is around 51% (NACO Estimates 2015). In figure no. 1 we observed that number of child HIVs are increasing and here we observed that, number of Childs getting newly infected is decreasing. This is because the gap between new infections and deaths for child age group was wider till the year 2013 (more infections low deaths) after that it is decreasing. For adults the number of deaths was high and number of infections was low.

HIV Related Deaths:

Being HIV positive doesn’t mean that it is an indication of death. It is an indication of diminishing immune system and hence need for repair through the nutritional support (Rupa Chinai, 2009). But the unawareness and wrong social stigma is taking many lives before it causes by the disease. Here we see the optimistic picture (Figure no. 4) that the total number of HIV related deaths including adults and child age group is showing continuous decline. The reason behind fall is attributed to increased access to ART in country. The total fall is from 1.48 lakh in 2007 to 0.67 lakh in 2015 which is around 54%. The fall in deaths of adult HIV is around 56% and it is around 38% in child age group. This shows the less survival of Children’s having HIV.

Prevalence of HIV in States:

As per the NACO records the first case of AIDS in India was detected in 1986. Initially most of the cases were coming from commercial sex workers in the metro Politian cities. Later on the cases of HIV infections have been reported from various states and union territories. The following analysis will reveal the condition of HIV prevalence in states of Inida.

Percentage Distribution of People Living with HIV in States:

State wise distribution shows that Andhra Pradesh has highest percentage (19%) of HIV, followed by Maharashtra (14%), Karnataka (9%), Gujarat (8%), Bihar and Uttar Pradesh and Tamil Nadu (7%), West Bengal (6%) and Rajasthan (5%) (NACO Estimates 2015). The cumulative percentage of these nine states is around 82. We may find similar states on the top, in ranking of the new infections and the deaths from the illness caused by HIV. The percentage wise distribution of states having HIV numbers is given in the following figure no.5. But only looking at the percentage distribution is a rough measure of HIV prevalence. To measure the prevalence intensively HIV numbers are compared with the population of respective states in preceding discussion.

As mentioned in the methodology states and UTs are classified in four quarter. The first figure from left is showing state wise per thousand people living with HIV in increasing order. The average of first two quarters is (0.74) showing that there is around one person in thousand people living in these (15) states and UTs from Jammu and Kashmir to Punjab. In the states falling in third quarter there are around two persons has HIV in per thousand people. In the fourth quarter average four to five people in thousand are living with HIV, these states are Goa, Maharashtra, Gujarat, Karnataka, Andhra Pradesh, Nagaland, Mizoram, and Manipur. But looking at individual states falling in this quarter we find that in Manipur around 10 people has HIV in thousand people, followed by Mizoram (6), Nagaland and Andhra Pradesh (5), Kerala, Gujarat and Maharashtra (3) and Goa (2).

HIV/AIDS is the first epidemic in the latest era of globalisation. It spreads rapidly because of the acceleration in communication, the rapidity with which desire is reconstructed and marketed globally; and the flagrant inequalities that exist between and within societies (Suneetha Kadiyala, Tony Barnett, 2004). In this context the spread of HIV in India is highlighted. The second (middle) figure is showing the spread of HIV in terms new infection in 2015 from thousand persons leaving with HIV in 2014. The average of first quarter showing that there are 20 persons newly infected for per thousand people living with HIV. The average of second quarter shows that there are 44 people infected, in third quarter there are 57 and in last quarter there are 116 people newly infected for per thousand people with HIV. This fourth quarter comprises Daman and Diu with high prevalence of new infections i.e. 174 persons, followed by Dadra and Nagar Haveli (170), Sikkim (160), Tripura (142), Chandigarh (113), Assam (81), Arunachal Pradesh (70), Chhattisgarh (66) and Gujarat (65).

The third figure is showing number of deaths in 2015 for per thousand HIV people in 2014. In the states falling in first quarter are showing average death 16 people, in second quarter it is 25, in third quarter it is 38 and in fourth quarter there are 56. Looking at the per thousand deaths in individual states falling in fourth quarter it is seen that Andaman and Nikobar is at the top with 92 deaths per thousand HIV people, followed by West Bengal (62), Orissa (58), Arunachal Pradesh (53), Bihar (50), Daman and Diu (49), Dadra and Nagar Haveli (47), Manipur (45) and Kerala (43). The strengthening of healthcare delivery system by incorporating the primary healthcare centres to provide for healthcare needs of HIV will improve the situation by reducing the early deaths caused by HIV (K Ajithkumar, S Irudayarajan, 2006).

(1) No. Of HIV/1000

(2) New Infection/1000

(3) Deaths/ 1000

Figure no: 7

When, the eight states falling in high number of HIV quarter (Q 4) it is observed that only Gujarat is falling in high quarter of new infection and Manipur is falling in high death quarter. In contrast to this Maharashtra, Karnataka, Manipur and Andhra Pradesh are falling in low infection quarter where as Nagaland and Mizoram are falling in the second low infection quarter. It is observed that Arunachal Pradesh and Assam of low number of HIV quarter, Dadra & Nagar Haveli, Chhattisgarh and Daman & Diu of the second low quarter and Tripura and Sikkim of third quarter are falling in high HIV infection quarter.

It is also observe that out of the nine States/UTs falling in high infection quarter, Dadra & Nagar Haveli, Daman & Diu and Arunachal Pradesh are falling in high death quarter. But states like Bihar, Orissa, West Bengal and Kerala from high death quarter are nighters in high infection quarter not in high number of HIV quarter.

From the above observation it is clear that state wise nature of HIV prevalence is different in total number of HIVs, in number of new infections and in number of deaths. So the states are ranked as per the high HIV prevalence collectively for three dimension index.

Three Dimensional Prevalence of HIV:

The following figure shows the distribution of states as per the intensity of HIV prevalence collectively for three dimensions. The states are classified in four quartiles as per the value of dimension index. The first quartile shows low prevalence, second lower quartile shows moderate prevalence, third quartile shows high prevalence and fourth quartile shows very high prevalence. In the fourth quartile of very high prevalence there are nine states/UTs namely, Daman and Diu, Dadra and Nagar Haveli, Manipur, Tripura, Sikkim, Andaman and Nikobar, Chandigarh, West Bengal and Orissa. In the High quartile (Q 3) there are eight states namely Gujarat, Arunachal Pradesh, Bihar, Nagaland, Mizoram, Chhattisgarh, Rajasthan and Jharkhand.

CONCLUSION:

It is concluded that, overall prevalence of HIV in India and is continuously falling in total number of persons living with HIV, total number of infections and total number of deaths. More decrease is observed in Adults than the Child age group. So this study suggests finding out and preventing the sources of HIV infections in child age group. It is also observed Males are more infected than females, so special mechanism of creating awareness in male is required.

On the state level the growth of the people living with HIV, number of new infections and number of deaths is negative for most of the States/UTs. Still states like Goa, Maharashtra, Gujarat, Karnataka, Andhra Pradesh, Nagaland, Mizoram, and Manipur reported high prevalence in numbers. The states like Daman and Diu, Dadra and Nagar Haveli, Sikkim, Tripura, Chandigarh, Assam, Arunachal Pradesh, Chhattisgarh and Gujarat are showing high prevalence in new infections. And states like Andaman and Nikobar, West Bengal, Orissa, Arunachal Pradesh, Bihar, Daman and Diu, Dadra and Nagar Haveli, Manipur and Kerala are showing high prevalence in number of deaths.

Looking at the composite index there are nine states namely Daman and Diu, Dadra and Nagar Haveli, Manipur, Tripura, Sikkim, Andaman and Nikobar, Chandigarh, West Bengal and Orissa showing high prevalence of HIV.

There are various factors responsible for HIV prevalence. Treating men and women differently under orthodox socio-cultural norms, beliefs and practices have a direct effect on vulnerability to HIV infection (Hellman, 2000). Huge population and migration are also responsible for the spread of this disease. As per the NACO assessment there are various factors causing to wider prevalence such as sex with non-regular partners, low condom use, high trafficking of girls and women, and a large number of national highways etc. So considering these sources of infection and the status of HIV prevalence among the states this study suggests focused policy interventions on the high risk states so as the national health policy target will be achieved and people can leave long and healthy life. Apart from this it is important to incorporate the state specific targets in the national health policy. It is also important to incorporate the costly drugs into the essential medical list so as the needy can access it and death numbers can be reduced in the states having high death prevalence. The initiatives like this will make India to walk on the path initiated by WHO on the form of building a strategy to end the HIV-AIDS

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Received on 26.10.2017 Modified on 12.12.2017

Res. J. Humanities and Social Sciences. 2018; 9(2): 383-390.

DOI: 10.5958/2321-5828.2018.00066.9