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Medicine (Baltimore). 1995 Mar;74(2):97-106.

The human immunodeficiency virus epidemic in India. Current magnitude and future projections.

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Division of Infectious Diseases, Johns Hopkins Medical School, Baltimore, Maryland 21205.


Since the first case of the human immunodeficiency virus (HIV) infection was documented in India in 1986, there has been an explosive increase in HIV transmission. In this review we describe the chronology of the HIV epidemic in India, preliminary information about the clinical presentation of the acquired immunodeficiency syndrome (AIDS), the biological and behavioral aspects of HIV transmission in the Indian setting, and projections regarding the future of the HIV epidemic in India. Using recent data obtained by searching the computerized literature and published abstracts, conference proceedings, and publications from the government of India, we show that India is experiencing a major epidemic of HIV transmission in high-risk populations of commercial sex workers, sexually transmitted disease clinic patients, intravenous drug users, and commercial blood donors. There is also evidence of recent spread of the epidemic from these high-risk groups to other risk groups in India, and from urban centers to rural populations. It is estimated that 1.6 million people are currently infected with HIV in India. At the present rate of transmission, India will have the largest number of HIV-infected individuals of any country in the world by the end of this decade, with more than 5 million infected individuals. Because limited data are available, comprehensive and well-designed epidemiologic surveys are urgently needed to adequately characterize the HIV epidemic in India and to help implement targeted and effective educational and prevention-oriented programs.


A review of government publications, conference proceedings, and computerized literature and published abstracts reveals an explosive increase in human immunodeficiency virus (HIV) in India since the first case was identified in 1986. In fact, if present rates of transmission persist, India will have more than 5 million HIV-infected persons by the year 2000--the largest number in the world. By 1990, at least 40% of Bombay's 50,000 commercial sex workers were infected. Other high-risk groups include sexually transmitted disease clinic patients, intravenous drug users, and commercial blood donors. The lack of a uniform case definition for AIDS or of a standardized national program to register AIDS cases have impeded research on the natural history of the disease in India. Co-infection with tuberculosis appears to be the predominant clinical pattern. Community awareness of AIDS has been limited by a 50-60% literacy rate, poor access to the mass media in rural areas, and government neglect of AIDS education. Knowledge about HIV and its transmission is alarmingly low, even among health workers. Before 1991, government responses to AIDS were limited to calls for quarantine, the restriction of foreigners, denial of health care to HIV-infected patients, and offers to pay infected prostitutes to retire. Preparation in 1991 of a government document, "Strategic Plan for Prevention and Control of AIDS in India 1992-96," represented a major reversal and a commitment to provide the necessary resources to contain the spread of the epidemic. International aid will be required, however, for the diagnosis and treatment of opportunistic infections, maintenance of an HIV surveillance program, provision of a safe blood supply, prospective studies, and an aggressive educational campaign for health workers and the public.

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