India flawed by focus on sex in campaign against AIDS


PARIS (AFP) - India is making perilous mistakes in its fight against AIDS by assuming the human immunodeficiency virus (HIV) is being spread overwhelmingly by sex and especially by prostitutes, a study warns.

India is considered by many specialists to be an easy target for AIDS, despite the health authorities' insistence that they are making headway against the disease.

In May, the Geneva-based agency UNAIDS said India had 5.7 million people living with HIV/AIDS -- the highest figure in the world, ahead of South Africa where the figure stands at 5.5 million. The government says the tally is 5.2 million.

The new study, published by Britain's prestigious Royal Society of Medicine, does not wade into the row over these figures, but instead lashes India's assumption that sex, especially with prostitutes, is the main driver for new infections.

"It is inconsistent with evidence and very likely wrong," is the blunt verdict delivered by US researchers David Gisselquist and Mariette Corea in the society's International Journal of STD and AIDS.

According to India's National AIDS Control Organisation (NACO), 86 percent of HIV infections are from sexual transmission, and according to three studies that have helped underpin the country's AIDS strategies, prostitutes account for 27 percent of the total.

But Gisselquist and Corea -- who did extensive field research in India -- say these calculations are terribly wide of the mark.

The total estimate of infections comes from hospital staff, who assess and report routes of transmission for patients admitted with AIDS.

But many personnel routinely assign cases to the category of sexual acquisition without asking if the patient may have been exposed to infection through blood, the authors say.

And they argue the official tally of prostitutes in India, their number of clients and the frequency of clients' visits are probably huge overestimates.

In addition, there is evidence that commercial sex workers are far likelier to use condoms and less likely to have HIV than health officials believe, the study says.

Its best estimate is that prostitutes account for just two percent of HIV infections -- and a high estimate would be 13 percent, less than half that of NACO's figure.

This means that India is ignoring threats from other sources, in particular the re-use of unsterile instruments in hospitals, cosmetic services, dental surgeries and tattoo parlours.

In one incident, commercial sex workers reported they had stood in line for tattoos that were administered without changing needles or inkpot between customers.

And the researchers found a common mistaken belief among the general public as well as the medical profession that HIV survives no more than seconds or a few minutes outside the body.

"The official sexualisation of the HIV epidemic has blinded just about everybody to considering (and protecting against) non-sexual routes of transmission," the journal said in an editorial.