India has largest no. of HIV infected outside South Africa

Something to boast about from the just released UN Report on the global AIDS epidemic. The short summary about the situation in India is below with some surprising (if not shocking) facts:

Some general notes before the extract from the report:

1. To give you a qualitative sense of 4.6 million (the total number of known cases in 2002) - it is roughly the population of Bangalore city, about 1/3 of Mumbai's population, and 1.5 times the population of Greater Boston (if you have a better intuition for US cities).
   
2. It's not in this report but the estimate is that Mumbai accounts for about 4.7% of AIDS cases in all of India

"...The region includes the world’s most populous countries—China and India—with 2.25 billion people between them. National HIV prevalence in both countries is very low: 0.1% (range:0.1–0.2%) in China and between 0.4% and 1.3% in India. But a closer focus reveals that both have extremely serious epidemics in a number of provinces, territories and states...

India has the largest number of people living with HIV outside South Africa—estimated at 4.6 million in 2002. Most infections are acquired sexually, but a small proportion is acquired through injecting drug use. Injecting drug use dominates in Manipur and Nagaland in the north-east of the country, bordering Myanmar and close to the Golden Triangle. In this area, HIV infection levels of 60–75% have been found among injecting drug users using non-sterile injecting equipment.

In the southern states of Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu, HIV is transmitted mainly through heterosexual sex, and is largely linked to sex work. Indeed, according to selected surveys, more than half of sex workers have become infected with HIV. In all four states, infection levels among pregnant women in sentinel antenatal clinics have remained roughly stable at over 1%, suggesting that a significant number of sex workers’ clients may have passed on HIV to their wives.

In India, knowledge about HIV is still scant and incomplete. In a 2001 national behavioural study of nearly 85000 people, only 75% of respondents had heard of AIDS and awareness was particularly low among rural women in Bihar, Gujarat and West Bengal. Less than 33% of all respondents had heard of sexually transmitted infections and only 21% were aware of the links between sexually transmitted infections and HIV.

HIV transmission through sex between men is also a major cause for concern in many areas of
India. Recent research shows that many men who have sex with men also have sex with women. In 2002, behavioural surveillance in five cities among men who have sex with men found that 27% reported being married, or living with a female sexual partner. In a study conducted in a poor area of Chennai in 2001, 7% of men who have sex with men were HIV-positive. Attention currently focuses on areas with high recorded prevalence, but there is concern about what might be happening in the vast areas of India for which there are little data...."