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Urban and Rural HIV Estimates among Adult Population (15 - 49 Years) in Selected States of India Using Spectrum Data

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DOI: 10.4236/wja.2015.53026    3,911 Downloads   4,865 Views   Citations


HIV estimation has become a standard tool for understanding the epidemic. Although the majority of India’s population lives in rural areas, to date, an exploration of the urban and rural HIV epidemic has not been undertaken. The objective of this study is to develop HIV estimation based on urban and rural adult populations in selected states of India to understand the difference in HIV related indices geographically. Ten states were selected based on HIV prevalence levels-Andhra Pradesh, Tamil Nadu, Karnataka, Maharashtra, Manipur, and Nagaland, Mizoram, Punjab, Odisha and Jharkhand. Spectrum, version 4.53 beta 19, was used. Data files of Indian national estimation, 2010-11 which included population, HIV Sentinel Surveillance, Integrated Bio Behavioral Assessment and program coverage data, were used and alterations made wherever necessary. The urban and rural sub epidemic structures and their subpopulations were separately configured in the Estimation projection package and curve fitting done. Outputs for each state were separately analyzed. Findings show that HIV prevalence is lower in urban than rural areas in Tamil Nadu and Maharashtra; in Karnataka there is no difference in HIV prevalence in the urban and rural populations; and in the remaining seven states urban HIV prevalence is higher as compared to rural HIV prevalence. In the states of Andhra Pradesh, Tamil Nadu, Maharashtra, Odisha and Punjab, the number of people living with HIV, new HIV infections and deaths among people living with HIV is higher in the rural than in the urban population. An early and lower peak in HIV prevalence and incidence in the urban population was seen in Andhra Pradesh, Tamil Nadu, Karnataka and Naga-land, while in Maharashtra the rural peak was earlier and higher. Mizoram shows an earlier and lower peak in the rural population while Manipur shows an earlier and higher urban peak. In Odisha, the epidemic peaked earlier and was lower in the rural than the urban population. HIV prevalence in the urban population in Punjab was still peaking while HIV incidence was earlier and lower in the rural population. In Jharkhand, both urban and rural HIV prevalence and incidence are still increasing. Our findings indicate lower levels of HIV prevalence and incidence in the urban population as compared to the rural populations in Maharashtra and Tamil Nadu. In the remaining eight states, urban prevalence and incidence are higher than their rural counterparts. Future estimations of the HIV epidemic in the country need to adopt a similar approach to inform the design of appropriate state-level strategies for HIV prevention in urban and rural areas.

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The authors declare no conflicts of interest.

Cite this paper

Choudhury, L. and Prabakaran, J. (2015) Urban and Rural HIV Estimates among Adult Population (15 - 49 Years) in Selected States of India Using Spectrum Data. World Journal of AIDS, 5, 226-237. doi: 10.4236/wja.2015.53026.


[1] Joint United Nations Program on HIV/AIDS (2014) The Gap Report. Geneva.
[2] Joint United Nations Programme on HIV/AIDS (2014) The Cities Report. Geneva.
[3] Kayirangwa, E., Hanson, J., Munyakazi, L. and Kabeja, A. (2006) Current Trends in Rwanda’s HIV/AIDS Epidemic. Sexually Transmitted Infections, 82, i27-i31.
[4] Ethiopian Health and Nutrition Research Institute (2012) HIV Related Estimates and Projections for Ethiopia—2012. Addis Ababa.
[5] National AIDS Control Council (2014) Kenya AIDS Response Progress Report 2014: Progress towards Zero.
[6] National Institute of Medical Statistics and National AIDS Control Organisation (2012) Technical Report India: HIV Estimates—2012. New Delhi.
[7] Sgaier, S.K., Claeson, M., Gilks, C., Ramesh, B.M., Ghys, P.D., Wadhwani, A., et al. (2012) Knowing Your HIV/ AIDS Epidemic and Tailoring an Effective Response: How Did India Do It? Sexually Transmitted Infections, 88, 240-249.
[8] Ministry of Home Affairs Government of India. Rural Urban Distribution of Population and Proportion of Rural and Urban Population—India/State/Union Teritory: Census 2011 (Provisional). Office of the Register General & Census Commissioner, New Delhi.
[9] World Health Organisation (2005) Summary of Country profile for HIV/AIDS Treatment Scale-Up.
[10] Kang, G., Samuel, R., Vijayakumar, T.S., Selvi, S., Sridharan, G., Brown, D., et al. (2005) Community Prevalence of Antibodies to Human Immunodeficiency Virus in Rural and Urban Vellore, Tamil Nadu. The National Medical Journal of India, 18, 15-17.
[11] International Institute for Population Sciences and Macro International (2008) Maharastra: National Family Health Survey (NFHS-3), India 2005-06.
[12] Dandona, L., Dandona, R., Kumar, G.A., Reddy, G.B., Ameer, M.A., Ahmed, G.M., et al. (2008) Risk Factors Associated with HIV in a Population-Based Study in Andhra Pradesh State of India. International Journal of Epidemiology, 37, 1274-1286.
[13] Ramachandran, P. (2012) ICMR’s Tryst with HIV Epidemic in India: 1986-1991. Indian Journal of Medical Research, 136, 13-21.
[14] Stover, J., Brown, T. and Marston, M. (2012) Updates to the Spectrum/Estimation and Projection Package (EPP) Model to Estimate HIV Trends for Adults and Children. Sexually Transmitted Infections, 88, i11-i16.
[15] Brown, T., Bao, L., Raftery, A.E., Salomon, J.A., Baggaley, R.F., Stover, J., et al. (2010) Modelling HIV Epidemics in the Antiretroviral Era: The UNAIDS Estimation and Projection Package 2009. Sexually Transmitted Infections, 86, ii3- ii10.
[16] Pandey, A., Sahu, D., Bakkali, T., Reddy, D., Venkatesh, S., Kant, S., et al. (2012) Estimate of HIV Prevalence and Number of People Living with HIV in India 2008-2009. BMJ Open, 2, Article ID: e000926.
[17] Kundu, A. (2006) Trends and Patterns of Urbanization and Their Economic Implications: India Infrastructure Report 2006.
[18] IBBA, India [Internet].
[19] Somi, G.R., Matee, M.I.N., Swai, R.O., Lyamuya, E.F., Killewo, J., Kwesigabo, G., et al. (2006) Estimating and Projecting HIV Prevalence and AIDS Deaths in Tanzania Using Antenatal Surveillance Data. BMC Public Health, 6, 120.
[20] NERCHA (2007) Swaziland HIV Estimates and Projections Workshop Report.
[21] National AIDS Control Organization and National Institute of Health and Family Welfare (2006) Annual Sentinel Surveillance for HIV Infection in India: Country Report 2004.
[22] Dandona, L., Lakshmi, V., Sudha, T., Kumar, G.A. and Dandona, R. (2006) A Population-Based Study of Human Immunodeficiency Virus in South India Reveals Major Differences from Sentinel Surveillance-Based Estimates. BMC Medicine, 4, 31.
[23] Kresge, K.J. (2007) IAVI-Report-11(4)-HIV Prevalence Estimates: Fact or Fiction.
[24] Gouws, E., Mishra, V. and Fowler, T.B. (2008) Comparison of Adult HIV Prevalence from National Population-Based Surveys and Antenatal Clinic Surveillance in Countries with Generalized Epidemics: Implications for Calibrating Surveillance Data. Sexually Transmitted Infections, 84, i17-i23.
[25] Nelson, K.E., Costello, C., Suriyanon, V., Sennun, S. and Duerr, A. (2007) Survival of Blood Donors and Their Spouses with HIV-1 Subtype E (CRF01 A_E) Infection in Northern Thailand, 1992-2007. AIDS, 21, S47-S54.
[26] Rangsin, R., Piyaraj, P., Sirisanthana, T., Sirisopana, N., Short, O. and Nelson, K.E. (2007) The Natural History of HIV-1 Subtype E Infection in Young Men in Thailand with up to 14 Years of Follow-Up. AIDS, 21, S39-S46.
[27] Neogi, U., Bontell, I., Shet, A., De Costa, A., Gupta, S. and Diwan, V. (2012) Molecular Epidemiology of HIV-1 Subtypes in India: Origin and Evolutionary History of the Predominant Subtype C. PLoS ONE, 7, e39819.
[28] John-Stewart, G.C., Nduati, R.W., Rousseau, C.M., Mbori-Ngacha, D.A., Richardson, B.A., Rainwater, S., et al. (2005) Subtype C Is Associated with Increased Vaginal Shedding of HIV-1. The Journal of Infectious Diseases, 192, 492-496.
[29] Gaffey, M.F., Venkatesh, S., Dhingra, N., Khera, A., Kumar, R., Arora, P., et al. (2011) Male Use of Female Sex Work in India: A Nationally Representative Behavioural Survey. PLoS ONE, 6, e22704.
[30] National AIDS Control Organisation (2007) Strategy and Implementation Plan: National AIDS Control Program Phase-III [2006-2011].
[31] Sarkar, S., Das, N. Panda, S., Naik, T.N., Sarkar, K., Singh, B.C., Ralte, J.M., Aier, S.M. and Tripathy, S.P. (1993) Rapid Spread of HIV among Injecting Drug Users in North-Eastern States of India. Bulletin on Narcotics, 45, 91-105.
[32] Saggurti, N., Mahapatra, B., Sabarwal, S., Ghosh, S. and Johri, A. (2012) Male Out-Migration: A Factor for the Spread of HIV Infection among Married Men and Women in Rural India. PLoS ONE, 7, e43222.
[33] Dhapola, M., Sharan, M. and Shah, B. (2007) Migration, Youth and HIV Risk: A Study of Young Men in Rural Jharkhand. Economic and Political Weekly, 42, 40-47.
[34] Kumar, R., Jha, P., Arora, P., Mony, P., Bhatia, P., Millson, P., et al. (2006) Trends in HIV-1 in Young Adults in South India from 2000 to 2004: A Prevalence Study. Lancet, 367, 1164-1172.
[35] Kumar, R., Mehendale, S.M., Panda, S., Venkatesh, S., Lakshmi, P., Kaur, M., et al. (2011) Impact of Targeted Interventions on Heterosexual Transmission of HIV in India. BMC Public Health, 11, 549.
[36] Alary, M., Banandur, P., Rajaram, S.P., Thamattoor, U.K., Mainkar, M.K., Paranjape, R., et al. (2014) Increased HIV Prevention Program Coverage and Decline in HIV Prevalence among Female Sex Workers in South India. Sexually Transmitted Diseases, 41, 380-387.
[37] National AIDS Control Organization and National Institute of Health and Family Welfare (2009) Link Worker Scheme Operational Guidelines.
[38] Donnell, D., Baeten, J.M., Kiarie, J., Thomas, K., Stevens, W., Cohen, C.R., et al. (2010) Heterosexual HIV-1 Transmission after Initiation of Antiretroviral Therapy: A Prospective Cohort Analysis. The Lancet, 375, 2092-2098.
[39] Cohen, M.S., Chen, Y.Q., McCauley, M., Gamble, T., Hosseinipour, M.C., Kumarasamy, N., et al. (2011) Prevention of HIV-1 Infection with Early Antiretroviral Therapy. The New England Journal of Medicine, 365, 493-505.
[40] Department of AIDS Control (2009) Annual Report 2008-2009.
[41] National Institute of Health and Family Welfare and National AIDS Control Organization (2007) Annual HIV Sentinel Surveillance Country Report 2006.
[42] National AIDS Control Organization and National Institute of Health and Family Welfare (2010) Operational Guidelines Link ART Centre.
[43] Rewari, B. (2013) Indian Experience with Treatment as Prevention Key Approaches & Challenges. 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Kuala Lumpur, 30 June-3 July 2013.
[44] Department of AIDS Control (2013) National AIDS Control Program Phase-IV (2012-2017) Strategy Document.
[45] Carnegie, N.B. and Morris, M. (2012) Size Matters: Concurrency and the Epidemic Potential of HIV in Small Networks. PLoS ONE, 7, e43048.
[46] Schneider, J.A., Saluja, G.S., Oruganti, G., Dass, S., Tolentino, J., Laumann, E.O., et al. (2007) HIV Infection Dynamics in Rural Andhra Pradesh South India: A Sexual-Network Analysis Exploratory Study. AIDS Care, 19, 1171-1176.
[47] Population Council (2007) Injecting Drug Users in India: Understanding Sexual Behaviour and Sexual Networks to Design Effective Behaviour Change Strategies.
[48] Medhi, G.K., Mahanta, J., Adhikary, R., Akoijam, B.S., Liegise, B., Sarathy, K., et al. (2011) Spatial Distribution and Characteristics of Injecting Drug Users (IDU) in Five Northeastern States of India. BMC Public Health, 11, 64.
[49] Potterat, J.J., Muth, S.Q., Rothenberg, R.B., Zimmerman-Rogers, H., Green, D.L., Taylor, J.E., et al. (2002) Sexual Network Structure as an Indicator of Epidemic Phase. Sexually Transmitted Infections, 78, i152-i158.
[50] Kohler, H. (2007) Sexual Network Structure and the Spread of HIV in Africa: Evidence from Likoma Island, Malawi. AIDS, 21, 2323-2332.
[51] Rai, T., Lambert, H.S., Borquez, A.B., Saggurti, N., Mahapatra, B. and Ward, H. (2014) Circular Labor Migration and HIV in India: Exploring Heterogeneity in Bridge Populations Connecting Areas of High and Low HIV Infection Prevalence. The Journal of Infectious Diseases, 210, S556-S561.
[52] Verma, R.K. and Collumbien, M. (2004) Homosexual Activity among Rural Indian Men: Implications for HIV Interventions. AIDS, 18, 1845-1847.
[53] Becker, M.L., Ramesh, B.M., Washington, R.G., Halli, S., Blanchard, J.F. and Moses, S. (2007) Prevalence and Determinants of HIV Infection in South India: A Heterogeneous, Rural Epidemic. AIDS, 21, 739-747.
[54] Banandur, P., Rajaram, S.P., Mahagaonkar, S.B., Bradley, J., Ramesh, B.M., Washington, R.G., et al. (2011) Heterogeneity of the HIV Epidemic in the General Population of Karnataka State, South India. BMC Public Health, 11, S13.
[55] Saggurti, N. and Malviya, A. (2009) HIV Transmission in Intimate Partner Relationships in India. India.
[56] National Institute of Epidemiology, Social and Rural Research Institute (IMRB) (2013) Technical Report Mapping and Size Estimation of Hijras and Other Transgender Populations in 17 States of India.

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