ABSTRACT
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.