Topping the Aids table

Heallth -

When the latest official HIV figures for India appeared they were described as "miraculous", because they suggested that the number of new infections had fallen by roughly 95 per cent in a single year. But while a delighted government hailed the drop in new cases from 500,000 to 28,000 as a vindication of its policies, independent experts greeted the news with alarmed scepticism.

Peter Piot, executive director of Unaids, dismissed the statistics as "plainly impossible", and Anjali Gopalan of the Naz Foundation, an HIV/Aids prevention group, was dismayed. "There were self-aggrandising officials who truly believed they had done something so wonderful that had made this drop happen," she said.

It soon emerged that there had been a serious miscount, and the head of the state-run National Aids Control Organisation was despatched to another job. The figures have still not been rectified, and the affair underlines the uncertainties about India's Aids crisis.

Officially there are 5.13 million Indians living with HIV, putting India second in the world league table, but that is an estimate, and the margin of error is enormous, ranging from 2.5 million to 8.5 million. Last year, Richard Feachem, executive director of the Global Fund to Fight Aids, Tuberculosis and Malaria, said he believed India was at the high end of the range and had probably surpassed South Africa as the nation with the largest number of HIV/Aids sufferers.

Whatever the numbers - and counting in this huge country is difficult - no one doubts the seriousness of the problem. The prime minister, Manmohan Singh, has admitted that Aids is "no longer just a public health issue" and that it could "severely hurt" the country's development. The CIA has predicted that India could have 20 to 25 million HIV/Aids cases by 2010 and a senior US diplomat warned that there was "perhaps no greater threat to India's ambition to become a world power than the country's rapidly growing HIV infection rates".

Understanding remains low. Recent surveys in some states showed that most sex workers didn't know that condoms prevented HIV, and 42 per cent of sex workers nationwide thought that they could tell whether a client was infected from his physical appearance. Alarmingly, the government believes that up to 95 per cent of the

5.13 million estimated to be infected do not know they are HIV-positive.

Experts try to be optimistic. Ruben del Prado, deputy Unaids country co-ordinator, said: "In some countries - including western Europe and the US - things are regressing. But in India things are improving. There has been a greater engagement with society. I'm not saying that there has been any quantum leap or that things are suddenly hunky-dory, but the country is going in the right direction."

Gopalan said a fresh approach was needed. "The face of the epidemic is changing - we are seeing more and more women and children infected - but the government is continuing with the same old policies," she said. "The precise numbers don't really matter; if we could deal with five million people affected that would be a start. At the moment we're not managing to do that."