United States Mission to India : five-year strategic plan for the President"s emergency plan for AIDS relief 2006-2010

Since then, the number of HIV-infected persons has increased to an estimated 5.134 million, second only to South Africa. The overall adult prevalence rate is estimated at 0.9%. However, 111 of the 600 districts in India have prevalence rates greater than 1% in antenatal clinics, up from 49 in 2003. Most of these districts are concentrated in the states of Tamil Nadu, Maharashtra, Karnataka, Andhra Pradesh, Manipur, Nagaland, and Mizoram -- with a combined population of approximately 300 million. The epidemic in India is considered to be a concentrated epidemic and the GOI estimated in 2003 that there are 1.63 million infections among high-risk groups, including 1.5 million in persons with sexually transmitted infections (STI); 71,000 in female prostitutes, and 10,300 in injecting drug users (IDUs). Sexual transmission accounts for over 85% of HIV infections in India, especially in the south and west. Sex with prostitutes is an important driver of the epidemic, and in the North East, the epidemic is fueled by intravenous drug use. The extent to which the behavior of men who have sex with men (MSM) contributes to the epidemic is not known. An increasing number of individuals who are perceived as low risk are becoming infected, especially women and youth. The ratio of infected women to infected men is increasing: the National AIDS Control Organization (NACO) estimates that 40% of new infections in 2004 were in women. (excerpt, modified)