VZCZCXRO9247
PP RUEHAST RUEHBI RUEHDBU RUEHHM RUEHLH RUEHLN RUEHMA RUEHPB RUEHPOD
RUEHPW
DE RUEHCI #0258/01 2361253
ZNR UUUUU ZZH
P 241253Z AUG 07
FM AMCONSUL KOLKATA
TO RUEHC/SECSTATE WASHDC PRIORITY 1652
INFO RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHC/DEPT OF LABOR WASHINGTON DC
RUEHC/USAID WASHDC
RUEHPH/CDC CDC ATLANTA GA PRIORITY
RHEHAAA/NSC WASHINGTON DC
RUEAIIA/CIA WASHINGTON DC
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHCI/AMCONSUL KOLKATA 2032

UNCLAS SECTION 01 OF 04 KOLKATA 000258 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
HHS FOR STEIGER AND HICKEY 
NEW DELHI FOR USAID 
 
E.O. 12958: N/A 
TAGS: PGOV KHIV TBIO KWMN SENV ELAB IN
SUBJECT: THE HIV/AIDS SCENARIO IN INDIA'S EAST AND NORTHEAST 
 
REF: KOLKATA 250 
 
KOLKATA 00000258  001.2 OF 004 
 
 
¶1.   (SBU) Summary:   In July, India's National AIDS Control 
Organization (NACO) released the results of an analytical 
exercise  supported by UNAIDS and the World Health Organization 
(WHO) that provided new, lower estimates of HIV prevalence in 
India.  The exercise, conducted in 2006, found that 
approximately 0.36 percent of India's population (an estimated 2 
million to 3.1 million people), was infected with HIV/AIDS.  The 
analysis, reportedly based on better methodologies, 
significantly reduces the number of infections from earlier 
estimates of 5.2 to 5.7 million.  However, the report does not 
diminish concern over increased HIV/AIDS infections in districts 
of the "highly vulnerable" Eastern states of Bihar, Orissa and 
West Bengal and over a generally worsening situation in the 
"high prevalence" Northeastern states of Manipur and Nagaland. 
GOI health officials and international partners need to focus on 
these growing pockets of infections in Eastern India and the 
Northeastern states to effectively combat HIV/AIDS in India. 
End Summary. 
 
¶2.   (SBU) On July 6, NACO released the results of its 2006 
estimates on HIV/AIDS infections in India.  This latest report 
found an HIV/AIDS prevalence of approximately 0.36 percent, 
which corresponds to an estimated 2 million to 3.1 million 
people living with HIV in the country.   This number is down 
significantly from early estimates of 5.2 to 5.7 million.  Union 
Minister for Health and Family Welfare Dr. Anbumani Ramadoss, 
commenting on the significant drop in estimated infections, said 
that "Revision of estimates based on more data and improved 
methodology marks a significant improvement in systems and 
capabilities to monitor the spread of HIV, a sign of the 
progress we have made in understanding the epidemic better. 
This is welcome progress.  Unfortunately, the new figures still 
point towards a serious epidemic with the potential to trigger 
off if the prevention efforts identified in the NACP III (third 
National AIDS Control Plan) are not scaled up rapidly and 
implemented in the desired manner."  In addition, the report 
specifically raises concerns about HIV/AIDS trends in East India 
and notes that new pockets of high HIV prevalence have emerged 
in 29 districts, particularly in the states of West Bengal, 
Orissa and Bihar. 
 
--------------------------------------------- ----------------- 
Alarming HIV/AIDS Infection Rise in Rural Bihar 
--------------------------------------------- ----------------- 
¶3.  (SBU) Bihar State AIDS Control Society (BSACS) Executive 
Director K.P. Ramaiah, speaking of his organization's 
Surveillance Report for 2006-2007, noted an "alarming" rise in 
HIV/AIDS cases in Bihar and added that, "The situation is 
turning from bad to worse."  Ramaiah highlighted that the 
disease was spreading to new areas, with ten districts where 
previously no cases of HIV/AIDS had been detected were now 
having a high prevalence.  (Note:  Areas are assessed as "high 
prevalence" if the rate of HIV prevalence in ante-natal women is 
1% or more.  End Note).  The "worst-hit" districts Ramaiah 
identified included Banka, Lakhisarai, Madhepura and Rohtas, and 
East Champaran and West Champaran districts.  Other high 
prevalence districts included Muzaffarpur, Kishanganj and 
Purnia. 
 
¶4.  (SBU) According to the latest report published by Population 
Foundation India, BSACS and UNAIDS, the HIV prevalence rate for 
Bihar in 2006 was 0.76 percent, up from 0.67 percent in 2005. 
The Bihar State AIDS Control Society (BSACS) Voluntary 
Counseling and Testing Centers report estimates that the 
approximate number of HIV positive persons in the state was 
13,500.  The BSACS 2006 Sentinel Surveillance report determined 
that the HIV prevalence rates in the state of the following 
populations were:  Injecting Drug Users (IDU) 0.2 percent, 
ante-natal care women (ANC) 0.4 percent, persons seeking 
treatment for sexually transmitted diseases (STD) 1 percent, men 
having sex with men (MSM) 0.3 percent and female sex workers 
(FSW) 1.6 percent. 
 
¶5.  (SBU) The average HIV prevalence for the state is below 
epidemic levels but as noted by Ramaiah, there are a significant 
number of districts in Bihar where increasing HIV positive cases 
are being reported.  In 2005, BSACS started a Mobile Awareness 
and Testing (MAT) Campaign reaching out to all 38 districts in 
the state via mobile vans to raise awareness among the largely 
rural population, with limited access to health centers and 
ignorant about HIV/AIDS and provide testing facilities to those 
 
KOLKATA 00000258  002.2 OF 004 
 
 
willing to be counseled and tested for HIV.   Confirming what 
Ramaiah had observed, the MAT campaign has also identified 
increased positivity in several districts within the state as: 
East Champaran (Motihari), West Champaran (Bettiah), Sitamarhi, 
Kishanganj, Khagaria, Purnea, Muzaffarpur and Madhubani. 
 
¶6.  (SBU) According to government and U.N. health officials, 
returning migrant workers and poverty are fueling the spread of 
HIV in these densely populated districts of Bihar.  The number 
of migrant workers from Bihar ranges from 2 million to 10 
million.  Not all migrants are a higher risk and studies have 
shown that long-term single migrants are more vulnerable than 
others.  However, many migrant workers become HIV-positive from 
prostitutes in cities such as Mumbai or Bangalore, and then 
transmit the virus to their partners and families on returning 
home to Bihar. 
 
¶7.   (U) BSACS has also undertaken a mobile awareness campaign 
focusing on the problem of parent to child transmission of HIV 
through the Prevention of Parent to Child Transmission (PPTCT) 
campaign.  According to the BSACS website (wwwHYPERLINK 
"http://www.bsacs.org" .bsacs.org), in 2006, 20,607 pregnant 
women in 38 districts were tested for HIV and 58 positive cases 
were recorded.  (Comment:  This highlights the importance of 
raising awareness among expectant mothers about HIV/AIDS. 
However, low literacy (which is as low as 31 percent in 
Kishanganj district, with the state average being 47 percent), 
poverty and poor health infrastructure make spreading awareness 
about HIV/AIDS very challenging in Bihar.  End Comment.). 
 
 
--------------------------------------------- - 
Drug Use Fuels Infections in Orissa 
--------------------------------------------- - 
 
¶8.  (SBU) The state of Orissa on India's East coast attracts 
both national and international tourists with its "golden 
triangle" of historic temple sites in Puri, Konark and 
Bhubaneswar.  Due to the influx of visitors and other factors, 
drug use is reported to be increasing and consequently, there is 
a high prevalence of HIV among injecting drug users (IDUs) in 
the state.  According to the Orissa State AIDS Control Society 
(OSACS), prevalence among IDUs is 10.4 percent.  However, OSACS 
officials did not comment on the relative trend among IDUs since 
they say that the surveillance site for IDUs only started in 
2006, so previous years' figures are not available.  For Orissa, 
the ANC prevalence rate is 0.55 percent, in STI patients is 2.34 
percent, and in FSW is 1.00 percent. 
 
¶9.  (SBU) While the general prevalence rate for Orissa is 0.22 
percent, there are three high prevalence districts within the 
state:  Ganjam, Balasore and Khurda.  The situation in Ganjam 
district appears the most serious.  ANC prevalence rate for this 
district is 3.25 percent and in 2006, there were 2446 reported 
HIV positive cases and 234 reported deaths.  According to news 
reports, one of the reasons for high prevalence of HIV/AIDS in 
this district is, as in Bihar, a large migrant laborer 
population.  Unsafe sex with prostitutes especially in 
Maharashtra and Gujarat exposes the laborers to infection which 
they then pass on to their sexual partners once they return home. 
 
--------------------------------------------- -------------- 
------------------------------- 
West Bengal Sees Sharp Rise IDUs and FSWs with Doubling of 
Infections among Prenatal Women 
--------------------------------------------- -------------- 
------------------------------- 
 
¶10.  (SBU) The ninth round of HYPERLINK 
"javascript:show_window('wbsapcs.ppt')" HIV Sentinel 
Surveillance in West Bengal (conducted in August-October 2005) 
revealed an average HIV prevalence of 0.90% among ANC attendees 
or pregnant women at nine designated sites.  This is double the 
2004 figure, which was just 0.43 percent, indicating a rapidly 
increasing trend in reported HIV positive cases in the state. 
As of March 31, 2007 the State AIDS Prevention and Control 
Society (SACS) reports that the total number of cumulative 
registered AIDS cases in WB was 3,888. 
 
¶11.   (U) While WB is not considered a "high prevalence" state, 
the ANC sites for Kolkata city and Burdwan district show 
HIV/AIDS prevalence rates of 2.25 percent and 1.25 percent 
 
KOLKATA 00000258  003.2 OF 004 
 
 
respectively.  In addition, 2005 HIV/AIDS prevalence among IDU 
populations was 7.41 percent, up sharply, almost a three-fold 
increase, from just 2.22 percent in 2004, with the Darjeeling 
district being the worst affected. 
 
¶12.  (U) The striking upward trend was also evident among FSWs 
as the prevalence reached 6.80 percent in 2005, up from 4.11 
percent the previous year.  It was the highest among FSW 
populations in Kolkata city, South 24 Parganas and East Midnapur 
districts.  The corresponding figures for the MSM population 
were 0.54 percent in 2005, down from 1.33 percent in 2004. 
 
¶13.  (U) Comment:   WB shares international borders with 
Bangladesh, Bhutan and Nepal, and the northern areas of the 
state are the conduit for the flow of people and goods from the 
Northeast states and from Southeast Asian countries such as 
Burma.  Human and narcotics trafficking across these borders is 
a perpetual problem.  Trafficking and sexual exploitation and a 
lagging awareness of high-risk behavior constitute a potent 
combination that facilitates the spread of HIV/AIDS. 
 
¶14.  (U) Comment Continued:  WB also witnesses large-scale 
migration, both into and out of the state.  Separation from 
families, lack of access to information, health services and 
social support systems can lead to social and sexual practices 
that make migrants more susceptible to HIV/AIDS exposure.  This 
also translates into an increased vulnerability for married 
women.  Most married women have only their husbands as sexual 
partners, but lack the awareness and power to negotiate safer 
sex.  End Comment. 
 
--------------------------------------------- -------------- 
---------------------------- 
In High Prevalence NE States HIV/AIDS Spreads from IDUs to 
General Populace 
--------------------------------------------- -------------- 
--------------------------- 
 
¶15.   (U) Manipur is a high prevalence HIV/AIDS state in 
Northeast India.  Manipur's proximity to Burma, the world's 
second largest producer of illicit opium, has made this state a 
major transit route for drug smuggling.  As a result of the 
availability of illicit drugs, HIV prevalence among IDUs is a 
serious concern and while HIV prevalence rate among this group 
has come down from a shockingly high rate of 72.78 percent in 
1998, it was a still dismal 19.8 percent in 2006.  Local health 
officials attribute the reduction to the deaths of many IDUs 
over the past ten years from various medical complications. 
However, the failure to stem infections among IDUs has meant 
HIV/AIDS is no longer confined to the IDU group, but has spread 
further to the sexual partners of drug users and their children. 
 
 
¶16.   (U) According to the Manipur State AIDS Control Society, 
until March 2007 a total of 191,793 blood samples were screened. 
 Of these samples, 25,905 were HIV positive, with 6,110 positive 
women.  Since 1986, 4,030 AIDS cases have been reported and 589 
have died of AIDS.  HIV prevalence among pregnant women is 1.3 
percent, STDs 4.8 percent, among male sex workers 12.4 percent 
and among FSW 11.6 percent. 
 
¶17.  (U) Nagaland is the other high prevalence state in 
Northeast India but it has some positive trends among IDUs and 
ANC.  The current HIV prevalence rate for the state is 1.22 
percent.  According to the Nagaland State AIDS Control Society, 
since the year 1999, 4,788 HIV positive cases have been 
reported.   HIV prevalence rate among IDUs is 2.4 percent in 
2006, down from 4.51 percent reported in 2002.  Prevalence among 
pregnant women decreased to 1.2 percent in 2006 from 1.63 
percent in 2005.   However, the prevalence among FSWs has shown 
a persistently increasing trend from 2003 onwards, when it was 
4.40 percent to 10.80 percent in 2005, and the recent 2006 
figure at 16.4 percent. 
 
---------------- 
COMMENT 
---------------- 
 
¶18.   (SBU) The 2006 NACO report showing a significant reduction 
in India's overall estimated HIV/AIDS infections, while 
positive, does not appear to change the reality in Eastern India 
of rapidly growing pockets of infection.  In addressing 
 
KOLKATA 00000258  004.2 OF 004 
 
 
HIV/AIDS, the GOI and international health community have 
primarily focused their attention and efforts on high prevalence 
states in the India's South and West, where the overall numbers 
are high, but also where the health facilities and resources are 
generally better than in the poorer states of the East and 
Northeast.   As a result, the Eastern and Northeastern states 
struggle with limited awareness among the general populace about 
HIV/AIDS and lack adequate healthcare infrastructure with which 
to combat the problem.   The results of the 2006 NACO report 
ultimately risks fostering a sense of complacency, which will 
exacerbate the already weak response to the HIV/AIDS crisis in 
India's East.  Given the prevailing infection trends, India's 
Eastern states will likely move from the "highly vulnerable 
category" to the "high prevalence category" in the next few 
years unless increased efforts are made by the GOI and the 
international community to combat HIV/AIDS in the region.  Any 
serious effort to control HIV/AIDS infections in India 
ultimately will have to include directing greater attention and 
resources to the Eastern and Northeastern states. 
JARDINE