The vast size of India makes it difficult to examine the effects of HIV on the country as a whole. The majority of states within India have a higher population than most African countries, so a more detailed picture of the crisis can be gained by looking at each state individually.
The HIV prevalence data for most states is established through testing pregnant women at antenatal clinics. While this means that the data are only directly relevant to sexually active women, they still provide a reasonable indication as to the overall HIV prevalence of each area. 27 Data for six states are also available from a survey of the general population. 28
The following states have recorded the highest levels of HIV prevalence at antenatal and sexually transmitted disease (STD) clinics over recent years.
Andhra Pradesh in the southeast of the country has a total population of around 76 million, of whom 6 million live in or around the city of Hyderabad. The HIV prevalence at antenatal clinics was 1.26% in 2006 - higher than in any other state - while the general population prevalence was 0.97% in 2005-2006. The vast majority of infections in Andhra Pradesh are believed to result from sexual transmission. HIV prevalence at STD clinics was 24.4% in 2006.
Goa is a very small state in the southwest of India, and is best known as a tourist destination. Tourism is so prominent that the number of tourists almost equals the resident population, which is about 1.3 million. The HIV prevalence at antenatal clinics was found to be 0.50% in 2006. Prevalence at STD clinics was 8.6% in 2006, indicating that Goa has a serious epidemic of HIV among sexually active people.
Karnataka - a diverse state in the southwest of India - has a population of around 53 million. In Karnataka the average HIV prevalence at antenatal clinics has exceeded 1% in all recent years. Among the general population, 0.69% were found to be infected in 2005-2006. Districts with the highest prevalence tend to be located in and around Bangalore in the southern part of the state, or in northern Karnataka’s "devadasi belt". Devadasi women are a group of women who have historically been dedicated to the service of gods. These days, this has evolved into sanctioned prostitution, and as a result many women from this part of the country are supplied to the sex trade in big cities such as Mumbai. 29 The average HIV prevalence among female sex workers in Karnataka was 8.64% in 2006, and 19.20% of men who have sex with men were found to be infected.
Mumbai (Bombay) is the capital city of Maharashtra state and is the most populous city in India, with around 20 million inhabitants. Maharashtra is a very large state of three hundred thousand square kilometres, with a total population of around 97 million. The HIV prevalence at antenatal clinics in Maharashtra was 0.75% in 2006, and surveys of female sex workers have found around 20% to be infected. Similarly high rates are found among injecting drug users and men who have sex with men. The 2005-2006 survey found an infection rate of 0.62% in the general population of Maharashtra. This state is home to around one in five of all people living with HIV in India.
Tamil Nadu - When surveillance systems in the southern Indian state of Tamil Nadu, home to some 62 million people, showed that HIV infection rates among pregnant women were rising - tripling to 1.25% between 1995 and 1997 - the State Government acted decisively. Funding for the Tamil Nadu State AIDS Control Society (TANSACS), which had been set up in 1994, was significantly increased. 30 Along with non-governmental organisations and other partners, TANSACS developed an active AIDS prevention campaign. This included hiring a leading international advertising agency to promote condom use for risky sex in a humorous way, without offending the many people who do not engage in risky behaviour. The campaign also attacked the ignorance and stigma associated with HIV infection. 31
The HIV prevalence at antenatal clinics in Tamil Nadu was 0.25% in 2006, though several districts still have much higher rates. The general population survey of 2005-2006 found a rate of 0.34% across the state. Prevalence among injecting drug users was 24.20% in 2006 - the highest of all states and union territories.
Manipur is a small state of some 2.2 million people in the northeast of India. The nearness of Manipur to Myanmar (Burma), and therefore to the Golden Triangle drug trail, has made it a major transit route for drug smuggling, with drugs easily available. HIV prevalence among injecting drug users is around 20%, and the virus is no longer confined to this group, but has spread further to the female sexual partners of drug users and their children. 32 The HIV prevalence at antenatal clinics in Manipur has exceeded 1% in all recent years. The 2005-2006 survey found that 1.13% of the general population was infected - the highest of all states surveyed.
Mizoram - The small northeastern state of Mizoram has fewer than a million inhabitants. In 1998, an HIV epidemic took off quickly among the state’s male injecting drug users, with some drug clinics registering HIV rates of more than 70% among their patients. 33 In recent years the average prevalence among this group has been much lower, at around 3-7%. HIV prevalence at antenatal clinics was 1% in 2006.
Nagaland is another small northeastern state, with a population of two million, where injecting drug use has again been the driving force behind the spread of HIV. In 2006, the HIV prevalence at antenatal clinics was 0.93%, and the rate among female sex workers was 16.40%.