Identifier
Created
Classification
Origin
07KOLKATA258
2007-08-24 12:53:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
Consulate Kolkata
Cable title:  

THE HIV/AIDS SCENARIO IN INDIA'S EAST AND NORTHEAST

Tags:  PGOV KHIV TBIO KWMN SENV ELAB IN 
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FM AMCONSUL KOLKATA
TO RUEHC/SECSTATE WASHDC PRIORITY 1652
INFO RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHC/DEPT OF LABOR WASHINGTON DC
RUEHC/USAID WASHDC
RUEHPH/CDC CDC ATLANTA GA PRIORITY
RHEHAAA/NSC WASHINGTON DC
RUEAIIA/CIA WASHINGTON DC
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHCI/AMCONSUL KOLKATA 2032
UNCLAS SECTION 01 OF 04 KOLKATA 000258 

SIPDIS

SENSITIVE
SIPDIS

HHS FOR STEIGER AND HICKEY
NEW DELHI FOR USAID

E.O. 12958: N/A
TAGS: PGOV KHIV TBIO KWMN SENV ELAB IN
SUBJECT: THE HIV/AIDS SCENARIO IN INDIA'S EAST AND NORTHEAST

REF: KOLKATA 250

KOLKATA 00000258 001.2 OF 004


UNCLAS SECTION 01 OF 04 KOLKATA 000258

SIPDIS

SENSITIVE
SIPDIS

HHS FOR STEIGER AND HICKEY
NEW DELHI FOR USAID

E.O. 12958: N/A
TAGS: PGOV KHIV TBIO KWMN SENV ELAB IN
SUBJECT: THE HIV/AIDS SCENARIO IN INDIA'S EAST AND NORTHEAST

REF: KOLKATA 250

KOLKATA 00000258 001.2 OF 004



1. (SBU) Summary: In July, India's National AIDS Control
Organization (NACO) released the results of an analytical
exercise supported by UNAIDS and the World Health Organization
(WHO) that provided new, lower estimates of HIV prevalence in
India. The exercise, conducted in 2006, found that
approximately 0.36 percent of India's population (an estimated 2
million to 3.1 million people),was infected with HIV/AIDS. The
analysis, reportedly based on better methodologies,
significantly reduces the number of infections from earlier
estimates of 5.2 to 5.7 million. However, the report does not
diminish concern over increased HIV/AIDS infections in districts
of the "highly vulnerable" Eastern states of Bihar, Orissa and
West Bengal and over a generally worsening situation in the
"high prevalence" Northeastern states of Manipur and Nagaland.
GOI health officials and international partners need to focus on
these growing pockets of infections in Eastern India and the
Northeastern states to effectively combat HIV/AIDS in India.
End Summary.


2. (SBU) On July 6, NACO released the results of its 2006
estimates on HIV/AIDS infections in India. This latest report
found an HIV/AIDS prevalence of approximately 0.36 percent,
which corresponds to an estimated 2 million to 3.1 million
people living with HIV in the country. This number is down
significantly from early estimates of 5.2 to 5.7 million. Union
Minister for Health and Family Welfare Dr. Anbumani Ramadoss,
commenting on the significant drop in estimated infections, said
that "Revision of estimates based on more data and improved
methodology marks a significant improvement in systems and
capabilities to monitor the spread of HIV, a sign of the
progress we have made in understanding the epidemic better.
This is welcome progress. Unfortunately, the new figures still
point towards a serious epidemic with the potential to trigger
off if the prevention efforts identified in the NACP III (third

National AIDS Control Plan) are not scaled up rapidly and
implemented in the desired manner." In addition, the report
specifically raises concerns about HIV/AIDS trends in East India
and notes that new pockets of high HIV prevalence have emerged
in 29 districts, particularly in the states of West Bengal,
Orissa and Bihar.

-------------- --------------
Alarming HIV/AIDS Infection Rise in Rural Bihar
-------------- --------------

3. (SBU) Bihar State AIDS Control Society (BSACS) Executive
Director K.P. Ramaiah, speaking of his organization's
Surveillance Report for 2006-2007, noted an "alarming" rise in
HIV/AIDS cases in Bihar and added that, "The situation is
turning from bad to worse." Ramaiah highlighted that the
disease was spreading to new areas, with ten districts where
previously no cases of HIV/AIDS had been detected were now
having a high prevalence. (Note: Areas are assessed as "high
prevalence" if the rate of HIV prevalence in ante-natal women is
1% or more. End Note). The "worst-hit" districts Ramaiah
identified included Banka, Lakhisarai, Madhepura and Rohtas, and
East Champaran and West Champaran districts. Other high
prevalence districts included Muzaffarpur, Kishanganj and
Purnia.


4. (SBU) According to the latest report published by Population
Foundation India, BSACS and UNAIDS, the HIV prevalence rate for
Bihar in 2006 was 0.76 percent, up from 0.67 percent in 2005.
The Bihar State AIDS Control Society (BSACS) Voluntary
Counseling and Testing Centers report estimates that the
approximate number of HIV positive persons in the state was
13,500. The BSACS 2006 Sentinel Surveillance report determined
that the HIV prevalence rates in the state of the following
populations were: Injecting Drug Users (IDU) 0.2 percent,
ante-natal care women (ANC) 0.4 percent, persons seeking
treatment for sexually transmitted diseases (STD) 1 percent, men
having sex with men (MSM) 0.3 percent and female sex workers
(FSW) 1.6 percent.


5. (SBU) The average HIV prevalence for the state is below
epidemic levels but as noted by Ramaiah, there are a significant
number of districts in Bihar where increasing HIV positive cases
are being reported. In 2005, BSACS started a Mobile Awareness
and Testing (MAT) Campaign reaching out to all 38 districts in
the state via mobile vans to raise awareness among the largely
rural population, with limited access to health centers and
ignorant about HIV/AIDS and provide testing facilities to those

KOLKATA 00000258 002.2 OF 004


willing to be counseled and tested for HIV. Confirming what
Ramaiah had observed, the MAT campaign has also identified
increased positivity in several districts within the state as:
East Champaran (Motihari),West Champaran (Bettiah),Sitamarhi,
Kishanganj, Khagaria, Purnea, Muzaffarpur and Madhubani.


6. (SBU) According to government and U.N. health officials,
returning migrant workers and poverty are fueling the spread of
HIV in these densely populated districts of Bihar. The number
of migrant workers from Bihar ranges from 2 million to 10
million. Not all migrants are a higher risk and studies have
shown that long-term single migrants are more vulnerable than
others. However, many migrant workers become HIV-positive from
prostitutes in cities such as Mumbai or Bangalore, and then
transmit the virus to their partners and families on returning
home to Bihar.


7. (U) BSACS has also undertaken a mobile awareness campaign
focusing on the problem of parent to child transmission of HIV
through the Prevention of Parent to Child Transmission (PPTCT)
campaign. According to the BSACS website (wwwHYPERLINK
"http://www.bsacs.org" .bsacs.org),in 2006, 20,607 pregnant
women in 38 districts were tested for HIV and 58 positive cases
were recorded. (Comment: This highlights the importance of
raising awareness among expectant mothers about HIV/AIDS.
However, low literacy (which is as low as 31 percent in
Kishanganj district, with the state average being 47 percent),
poverty and poor health infrastructure make spreading awareness
about HIV/AIDS very challenging in Bihar. End Comment.).


-------------- -
Drug Use Fuels Infections in Orissa
-------------- -


8. (SBU) The state of Orissa on India's East coast attracts
both national and international tourists with its "golden
triangle" of historic temple sites in Puri, Konark and
Bhubaneswar. Due to the influx of visitors and other factors,
drug use is reported to be increasing and consequently, there is
a high prevalence of HIV among injecting drug users (IDUs) in
the state. According to the Orissa State AIDS Control Society
(OSACS),prevalence among IDUs is 10.4 percent. However, OSACS
officials did not comment on the relative trend among IDUs since
they say that the surveillance site for IDUs only started in
2006, so previous years' figures are not available. For Orissa,
the ANC prevalence rate is 0.55 percent, in STI patients is 2.34
percent, and in FSW is 1.00 percent.


9. (SBU) While the general prevalence rate for Orissa is 0.22
percent, there are three high prevalence districts within the
state: Ganjam, Balasore and Khurda. The situation in Ganjam
district appears the most serious. ANC prevalence rate for this
district is 3.25 percent and in 2006, there were 2446 reported
HIV positive cases and 234 reported deaths. According to news
reports, one of the reasons for high prevalence of HIV/AIDS in
this district is, as in Bihar, a large migrant laborer
population. Unsafe sex with prostitutes especially in
Maharashtra and Gujarat exposes the laborers to infection which
they then pass on to their sexual partners once they return home.

-------------- --------------
--------------
West Bengal Sees Sharp Rise IDUs and FSWs with Doubling of
Infections among Prenatal Women
-------------- --------------
--------------


10. (SBU) The ninth round of HYPERLINK
"javascript:show_window('wbsapcs.ppt')" HIV Sentinel
Surveillance in West Bengal (conducted in August-October 2005)
revealed an average HIV prevalence of 0.90% among ANC attendees
or pregnant women at nine designated sites. This is double the
2004 figure, which was just 0.43 percent, indicating a rapidly
increasing trend in reported HIV positive cases in the state.
As of March 31, 2007 the State AIDS Prevention and Control
Society (SACS) reports that the total number of cumulative
registered AIDS cases in WB was 3,888.


11. (U) While WB is not considered a "high prevalence" state,
the ANC sites for Kolkata city and Burdwan district show
HIV/AIDS prevalence rates of 2.25 percent and 1.25 percent

KOLKATA 00000258 003.2 OF 004


respectively. In addition, 2005 HIV/AIDS prevalence among IDU
populations was 7.41 percent, up sharply, almost a three-fold
increase, from just 2.22 percent in 2004, with the Darjeeling
district being the worst affected.


12. (U) The striking upward trend was also evident among FSWs
as the prevalence reached 6.80 percent in 2005, up from 4.11
percent the previous year. It was the highest among FSW
populations in Kolkata city, South 24 Parganas and East Midnapur
districts. The corresponding figures for the MSM population
were 0.54 percent in 2005, down from 1.33 percent in 2004.


13. (U) Comment: WB shares international borders with
Bangladesh, Bhutan and Nepal, and the northern areas of the
state are the conduit for the flow of people and goods from the
Northeast states and from Southeast Asian countries such as
Burma. Human and narcotics trafficking across these borders is
a perpetual problem. Trafficking and sexual exploitation and a
lagging awareness of high-risk behavior constitute a potent
combination that facilitates the spread of HIV/AIDS.


14. (U) Comment Continued: WB also witnesses large-scale
migration, both into and out of the state. Separation from
families, lack of access to information, health services and
social support systems can lead to social and sexual practices
that make migrants more susceptible to HIV/AIDS exposure. This
also translates into an increased vulnerability for married
women. Most married women have only their husbands as sexual
partners, but lack the awareness and power to negotiate safer
sex. End Comment.

-------------- --------------
--------------
In High Prevalence NE States HIV/AIDS Spreads from IDUs to
General Populace
-------------- --------------
--------------


15. (U) Manipur is a high prevalence HIV/AIDS state in
Northeast India. Manipur's proximity to Burma, the world's
second largest producer of illicit opium, has made this state a
major transit route for drug smuggling. As a result of the
availability of illicit drugs, HIV prevalence among IDUs is a
serious concern and while HIV prevalence rate among this group
has come down from a shockingly high rate of 72.78 percent in
1998, it was a still dismal 19.8 percent in 2006. Local health
officials attribute the reduction to the deaths of many IDUs
over the past ten years from various medical complications.
However, the failure to stem infections among IDUs has meant
HIV/AIDS is no longer confined to the IDU group, but has spread
further to the sexual partners of drug users and their children.



16. (U) According to the Manipur State AIDS Control Society,
until March 2007 a total of 191,793 blood samples were screened.
Of these samples, 25,905 were HIV positive, with 6,110 positive
women. Since 1986, 4,030 AIDS cases have been reported and 589
have died of AIDS. HIV prevalence among pregnant women is 1.3
percent, STDs 4.8 percent, among male sex workers 12.4 percent
and among FSW 11.6 percent.


17. (U) Nagaland is the other high prevalence state in
Northeast India but it has some positive trends among IDUs and
ANC. The current HIV prevalence rate for the state is 1.22
percent. According to the Nagaland State AIDS Control Society,
since the year 1999, 4,788 HIV positive cases have been
reported. HIV prevalence rate among IDUs is 2.4 percent in
2006, down from 4.51 percent reported in 2002. Prevalence among
pregnant women decreased to 1.2 percent in 2006 from 1.63
percent in 2005. However, the prevalence among FSWs has shown
a persistently increasing trend from 2003 onwards, when it was
4.40 percent to 10.80 percent in 2005, and the recent 2006
figure at 16.4 percent.

--------------
COMMENT
--------------


18. (SBU) The 2006 NACO report showing a significant reduction
in India's overall estimated HIV/AIDS infections, while
positive, does not appear to change the reality in Eastern India
of rapidly growing pockets of infection. In addressing

KOLKATA 00000258 004.2 OF 004


HIV/AIDS, the GOI and international health community have
primarily focused their attention and efforts on high prevalence
states in the India's South and West, where the overall numbers
are high, but also where the health facilities and resources are
generally better than in the poorer states of the East and
Northeast. As a result, the Eastern and Northeastern states
struggle with limited awareness among the general populace about
HIV/AIDS and lack adequate healthcare infrastructure with which
to combat the problem. The results of the 2006 NACO report
ultimately risks fostering a sense of complacency, which will
exacerbate the already weak response to the HIV/AIDS crisis in
India's East. Given the prevailing infection trends, India's
Eastern states will likely move from the "highly vulnerable
category" to the "high prevalence category" in the next few
years unless increased efforts are made by the GOI and the
international community to combat HIV/AIDS in the region. Any
serious effort to control HIV/AIDS infections in India
ultimately will have to include directing greater attention and
resources to the Eastern and Northeastern states.
JARDINE