Friend-of-a-friend Jason Taylor had a photo exhibition last year in London on Indian truck drivers and AIDS. Apparently they're a significant factor in the speedy spread -- truck drivers crisscrossing the country carrying the virus from one woman (or boy) to the next.

Terrible pun alert!

Nice to know that Sepia bloggers know so much more about AIDS in India than epidemiologists. See http://www.nacoonline.org/facts_hivestimates04.htm

"The trends across the country show that there is no galloping HIV epidemic in India as a whole, as no evidence of upsurge in HIV prevalence has been observed in the country. However, there are sub-national epidemics in various parts of the country ..."

But doomsaying is always more fun.

around 10 years ago, i spent some time on HIV/AIDS education in the slum areas of Bangalore...that and trying to teach some of the truckers at the truck stops...it is seriously a very scary issue that India has to deal with...otherwise, this in itself will lead to population control of the nation and the continent...

it is a social stigma...condoms are expensive for the prostitutes along the highways..and honestly, most of them don't know, or don't really know the consequences of the entire spectrum of the disease...

it is one of those worries of the world that i keep in my head at all times...

Lack of political will, as was initially the case here in the USA, stems from the elite believing HIV is the best eugenics program out there. As long as poor, illiterate truck drivers and prostitutes are "the" HIV infected, many will gleefully slur "good riddance!" While 5m may have HIV, 1.1billion in India are infected with apathy. The best magic for curing this greater epidemic is a Magic Johnson. Some cricket stars, bollywood stars, and other noteworthy celebs need to come out of the woodworks and be more open about their afflictions. The only reason they won't is because, unlike in the USA, India is "family-oriented", meaning one brave soul explaining his or her problems becomes an embarrassment to the third cousin's uncle's sister-in-law. Once the culture of concealment and secrecy to "protect the family from scandal" is eradicated, so too will apathy and all the ills for which apathy is a fountainhead.

Nice to know that Sepia bloggers know so much more about AIDS in India than epidemiologists. See http://www.nacoonline.org/facts_hivestimates04.htm

Yes, Sepia bloggers, the NEJM, the WHO and various other organizations seem to know more about AIDS in Indian than the quote that you cite. Interesting that NACA seems to be part of the Indian ministry of health- a very good example of the issue Anna herself brought up about people denying that there is a global pandemic.

i think we need to keep the frequency in mind. asia - (mid east + russia) is (last i checked) about ~55% of the world's population. you are going to get enormous absolute numbers no matter what. yesterday i saw a report which offered that we should be concerned that india has as many HIV cases as south africa because the absolute numbers are equivalent. this makes as much sense (to me) as getting freaked out that india has a greater number of absolute deaths per year than bangladesh.

also, look at the impact of circumcision. that is i suspect an important variable will result in the HIV epidemic being worse in india than pakistan and bangladesh (or china vs. south korea).

Actually, I amend my earlier comment about NACO upon further inspection. Vish left out the context of his quote:

India remains a low prevalence country with overall HIV prevalence of 0.91% i.e. less than 1% of the population, however, it masks various sub epidemics in various foci in the country based on high prevalence observed in above-mentioned sentinel sites.

In absolute numbers, India continues to stand second next to South Africa having 5.3 million HIV infections and has not overtaken South Africa. However, in terms of prevalence percentage India has HIV prevalence of 0.91% among adult population as compared to 21.5 % in South Africa.So, razib's point is taken. But the point is, there are still communities in India where this is reaching epidemic proportions. And gone unchecked, it is definitely cause for concern.

1) my impression is that sero-positivity rates are far higher in the relatively developed south of india as opposed to the north.

2) in africa the epidemic has not disproportionately hit the backward or rural, rather, it is concentrated among the elite and educated.

3) circumcision is likely a powerful variable, so muslims will likely be less affected, similar to the data for cervical cancer of muslim tamils vs. hindu tamils (compare the luo in kenya with the dominant circumcised population around them or the cut xhosa vs. the uncut zulu).

also, i predict that: the retrograde patriarchal "cow belt" states will do a bit better than the states where gender relations are more equitable. one complaint in africa is that gender power imbalances result in the spread of the disease, but one might note that muslim areas tend to be relatively light affected, and these areas even have stricter gender relations (+ a higher frequency of polygyny) than other parts of africa (i think circumcision plays a role, but even in nations where the christians are circumcised too the muslims have lower HIV frequency rates), where women have traditionally had a stronger role than in the cultures of south or east asia (african women have economic power and often do most of the farm work, in part because of the hoe-orientation of agriculture vs. plow).

i will post more later when others have offered their comments, i am curious what people think....

NACO numbers are official - the same ones as quoted by Peter Piot also. The point I am making is simply that there is no cause for panic. Lots of NGO's have good reason to hype up the numbers.

There is cause for local concern. But even there, in Tamil Nadu for instance, there is reason to believe that infection rates are stabilizing. By all reports, Jayalalitha's government has been reasonably active (by Indian government standards) on this front.

Regarding Razib's theories, I dont think
that Tamil Nadu is especially progressive towards gender relations. Its definitely not the elite who are affected by aids - it seems to be the lower-middle class. Tamil Nadu is however fairly urbanized (by Indian standards). But the spread of AIDS in Tamil Nadu (and Andhra) remains somewhat of a mystery. I wonder if its simply genetics in this case.

In the nort east, its known that drug needles are a big contributor to the spread of AIDS.

Regarding Razib's theories, I dont think
that Tamil Nadu is especially progressive towards gender relations.

two points

1) i am speaking in relative terms. so, compared to UP...bihar (i think sex ratio over 0-6 is a good gauge of this, check the india census site, also note that in most populations there is a mild male bias at birth).

2) note that in south asia son preference has historically been strongest in elite families (due to hypergamy, you can see this in the genetics as well as textual references and oral history).

i don't know about the numbers, but son preference seems to be everywhere. last week, i had posted about a tam woman who performed her activist mother's last rites. the tam priests threatened to 'excommunicate' her for doing so. ugh. i got hatemail on that one, ranging from 'it doesn't feel right for a daughter to perform the last rites', to mail of the '@#$%^&' variety...

yes, son preference has spread in asia with the rise of media that spreads elite values. but there is a great deal of evidence that historically, among the 'lower orders' in eurasian societies daugther preference has been the norm because of hypergamy (whether you look at matrilineally passed DNA or headstones of infants). note that i am not speaking of platonic ideals. i am simply asserting that uttar pradesh and punjab tend to be more patrilineal than much of the south of india.

look at the impact of circumcision... circumcision is likely a powerful variable, so muslims will likely be less affected...

Most of the stuff I've seen on this say it's correlation, not causation so far. They're having trouble isolating the variables, e.g. Muslims generally have less extramarital sex.

"I hardly think that they managed to count everyone, or that people are happily volunteering such info...and that's assuming they're even AWARE of what they bear."
This is absolutely right. According to a report last week, 150 policemen in Mumbai are infected with HIV, and another 500 have AIDS. Firstly, these figures are the result of routine blood tests. Which means, there are possibly hundreds or thousands more of the 40,000 strong police force who are not aware that they have HIV. Second, these very men, as the in case of Constable Sunil More, are out there molesting and raping women. So for both their sake and of their victims, I think HIV testing must be made mandatory for the force. Actually, I think it makes sense for everyone above a certain age to get tested...

Vish: I agree with you. It's annoying how bloggers feel the need to overblow and hype statistics. Any comparison of HIV infection rates between India and South Africa is ludicrous. There are 1+ billion people living in the subcontinent so ABSOLUTE numbers will always be higher, but that doesn't mean there is a rampant AIDS epidemic sweeping the country. Calm down.

@Razib: I would expect more developed, less conservative states to report higher rates due to better testing facilities, lower social cost associated with diagnoses.

The "truth" is that nobody is really in the know. The WHO, the NGOs, and bloggers will generally lead towards the panic button, as will the Ministry of Health of India and the rest of South Asia lean in the opposite direction, both doing a disservice to the real cause. Talking about absolute numbers in a country like India is a risky proposition. I once made the mistake of saying there are 70 Million people in India who could be considered Rich and Upper-Middle-Class, so it makes sense for any brand to come set up shop here, as sales are guaranteed (sure things need to be studied carefully blah blah) - but I got shouted down, because the doomsayers leant the other way on that one - they said those 70 Million as a percent of 1 billion is nothing (7%). But now that's a negative thing, all of a sudden absolutes do matter. In country where xx million people are dying from diarhhea and starvation aids is obviously going to be low priority on the list. People also take one look at India and decide panic is the way to go, because everything looks so filthy it MUST be a place for every disease known to man

1)But I have a few questions - if the situation is so bleak - how come more contagious diseases have passed us by - like SARS - which managed to make its way to Toronto, bypassed India completely? India-HongKong is a popular route, and as we're all know, health care in India is lacking?

2) The Bubonic Plague outbreak caused ridiculous amounts of panic, but what got lost in the middle was the death toll - "only" 540 people died from it.
While the BJP government was full of conservative idiots like Sushma Swaraj who refused to promote condom usage (as "it promotes promiscuity") - the Congress/Communists have no such qualms - well less so than the BJP. You see ads on TV all the time about using Condoms, and they are doing some stuff. AIDS may very well be kept under the table and under-reported in India - on the other hand, it may actually be just as the health ministry says.

Most of the stuff I've seen on this say it's correlation, not causation so far. They're having trouble isolating the variables, e.g. Muslims generally have less extramarital sex.

which is why the comparison of thailand and the philippines is persuasive to me, both have thriving sex industries, but the latter has nearly universal circumcision (emulation of american norms) while the former does not, and the former has far higher HIV rates. also, the example of the nilotic luo in kenya is also interesting, because most kenyan ethnic groups are christian, as are the luo, but only the luo are are uncircumcised, and they have higher HIV infection rates. similarly, both the xhosa and zulu are christian, but the zulu are uncircumcised and have higher HIV infection rates.

i will grant that the connection is not "proved," but i think that in a non-first world condition where hygiene is suboptimal circumcision probably does have some affect. though judging from europe vs. USA circumcision probably has diminishing returns in first world conditions.

btw, the reason circumcision makes sense to me isn't just the correlations. the same reasons that are used as arguments against circumcision in the context of sexual pleasure, the relative thickness of the glans epidermis of cut men due to perpetual air exposure and the lack of a foreskin which has many nerve endings and blood vessels seem a plausible physiological model as to why circimcusion might be salubrious in the context of HIV.

Completely unrelated comment, but DO check out this HILARIOUS post on Mallus/South Indians:

http://sidin.blogspot.com/2004/05/travails-of-single-south-indian-men-of.html

Payam and Vish- I believe it's you that might need to calm down. ANNA didn't create the hype or the article, but simply offered her (as always) insightful, compassionate commentary about a story that should touch you somehow as a human, and shared something nice with the rest of the class. If you have issues with the statistics or report, take it up with BBC.

Here, here Desi Dancer. Quit killing the messenger. AIDS is and will be a problem in India, whether you like the BBC article or Anna's post or not. The sooner we stop getting mired in semantics, the sooner we can try and, oh, I don't know, actually DO something.

There was a REALLY informative, though also REALLY long article about AIDS in India published in sapna magazine last year: http://sapnamagazine.com/December/articles/lifestyle/d-aids.html

I recommend reading it, it's really comprehensive