NEW DELHI—India seemed to have all the ingredients for an Africa-like AIDS explosion: relatively low condom use, an uneven public health system and a natural client base for prostitution—a large population of truckers and migrant workers.
But the worst fears of experts never panned out.
What they overlooked was the apparently crucial importance of one factor: Indian women often don't have sex partners outside their marriage.
HIV did sweep through the ranks of sex workers. They passed the virus to their customers, who in turn infected their wives. But then the disease came to a halt.
"That's sort of a dead end, because multi-partner sex among women is not very high," said Dr. Rajesh Kumar, head of the School of Public Health at the Post Graduate Institute of Medical Education and Research in Chandigarh, India.
Only 2 percent of Indian women reported having sex with people other than their husbands in the past year, according to a government survey.
Kumar was the lead author of a study, published last month in The Lancet, that found a significant decline in new infections in four Indian states hit hard by AIDS. Those results suggested new infections might be peaking nationwide.
That's not to say that AIDS is no longer a problem. HIV is still spreading, and in a country as large as India, the estimated 1 percent infection rate translates to 5.2 million people—more than 10 percent of the global total.
The challenge in India, said Dr. Ruben del Prado, deputy country coordinator for the Joint U.N. Program on HIV/AIDS, is to guard against localized outbreaks across such a large and diverse country.
The good news is that the more-than-two-decade-long, multibillion-dollar global prevention effort finally is bearing fruit. Kumar said studies show that increased condom use contributed to the drop in new infections.
"For the first time ever ... I believe that we have a real potential to get ahead of this epidemic," Peter Piot, executive director of the Joint U.N. Program on HIV/AIDS, said in a speech in Washington in March.
"For me," said del Prado, "it means that 21 years of hard work is finally paying off."
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(Moritsugu is a Knight Ridder Newspapers special correspondent.)
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(c) 2006, Knight Ridder/Tribune Information Services.
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