According to the 2005 figures available in early 2007, there were about 5.2 million "people living with HIV/AIDS" in India.

This is 0.88 per cent of the population, which is also the second largest in the world after South Africa.

But there is reason to feel relieved, albeit just a little bit, for all those who are working to fight HIV/AIDS.

The latest report released by National AIDS Control Organization based on the revised 2006 estimates says there are only 2.5 million people living with HIV in the country and HIV prevalence among adults is around 0.36 per cent.

NACO is supported by UNAIDS and the World Health Organisation.

If you look at the data previously available for India, you will see that the range was quite broad (3.4 to 9.4 million).

This is due to the high level of uncertainty about the number of people living with HIV in India.

The UNAIDS report says, "India's epidemic is complex due to the vastness of the country, the large number of people living in India (over 1 billion) and the difference in HIV prevalence in different states and in urban and rural areas."

Because of this uncertainty about previous estimates, the Indian government, together with national and international partners, invested a lot of effort in obtaining more accurate information about it. The survey then included the population in large numbers.

The report says the revised estimate made available in the latter part of 2007 is more accurate than the estimates of the previous years largely due to three main factors.

It is a new population-based survey, which includes the HIV component; it also expands sentinel surveillance which includes groups at higher risk of HIV infection; and it uses revised methodology to make the best use of the new data sources.

In India, the HIV epidemic is very different in different regions of the country. HIV prevalence is higher in some southern and north-eastern states of India than it is in other areas, including large parts of northern India.

Also, the main modes of transmission vary from one region to another.

The new data says that India's epidemic, although still large in numbers, is smaller than the previous estimates indicated.

Success in the Tamil Nadu and other southern states

Though the HIV epidemic shows a stable trend in recent years, there is variation between states and population groups.

There is a slow decrease in HIV prevalence among the general population in the southern states.

The good news is that in Tamil Nadu, where effective interventions have been in place for several years, HIV prevalence has begun to decline or stabilise.

New pockets of high HIV prevalence identified

But the alarming fact is that the survey finds HIV emerging in new areas. The surveillance data has identified selected pockets of high prevalence in the northern states.

There are 29 districts with high prevalence, particularly in the states of West Bengal, Orissa, Rajasthan and Bihar. That is not good news.

Decline in HIV prevalence among sex workers

There are some signs of a decline in HIV prevalence among sex workers in areas where focused interventions have been implemented, particularly in the southern states.

The overall prevalence level among this group still continues to be high.

A J Hariharan [Images], secretary, Indian Community Welfare Organisation, an NGO that has been working with sex workers since 1994, says, "When we first started working with sex workers in Chennai, their attitude was that we were interfering in their affairs and it was not for them that we were working. Though extremely challenging, we could slowly win their confidence. It required a lot of patience. What we did was to work through the peer education programme. These peer workers could manage to enter their private territory. Then, it started showing results. Now, they know that they are at risk and the intervention programme is for them and their own benefit."

However, Hariharan warns that the positive results should not make anybody complacent. "We should not slow down. If we relax, it will bounce back. Sustained effort is what we need," he says.

HIV prevalence continues to be high among vulnerable groups

If it has come down in the case of female sex workers, there is an increase in HIV infection among several groups who are at higher risk such as the injecting drug users and men who have sex with men.

The HIV positivity among IDU has been found to be significantly high in the metro cities of Chennai, Delhi, Mumbai and Chandigarh.

The states of Orissa, Punjab, West Bengal, Uttar Pradesh and Kerala [Images] also show high prevalence among IDUs.

Hariharan, who also works with MSM says, "85 per cent of those who have HIV/AIDS get it through unprotected sex. Among them, MSM is at the highest risk, much more than female sex workers. We have to deal with this group very carefully and seriously. Otherwise the matter will go out of control."