The human immunodeficiency virus (HIV) burden among adults in India is estimated officially by direct extrapolation of annual sentinel surveillance data from public-sector antenatal and sexually transmitted infection (STI) clinics and some high-risk groups. The validity of these extrapolations has not been systematically examined with a large sample population-based study.The official method in India leads to a gross overestimation of the HIV burden in this district due to addition of substantial extra HIV estimates from STI clinics, the common practice of referral of HIV-positive/suspected people to public hospitals, and a preferential use of public hospitals by people in lower socioeconomic strata. India may be overestimating its HIV burden with the currently used official estimation method.

Background..

It has been suggested recently that India now has the highest number of people living with human immunodeficiency virus (HIV) in the world [1]. India's national organisation for control of acquired immunodeficiency disease syndrome (AIDS), the National AIDS Control Organization (NACO), uses public-sector sentinel surveillance data to estimate the HIV burden annually [2,3]. However, the validity of arriving at population estimates from direct extrapolation of the sentinel surveillance HIV data, as is currently done in India, has not yet been systematically examined [3,4]. A reliable estimate of HIV burden is critical, as it is the first step towards informed planning of HIV control including treatment requirements. The importance of HIV estimates is highlighted by the marked attention received by the Joint United Nations programme on AIDS (UNAIDS) estimates for countries around the world released every 2 years, and the extensive work carried out on HIV estimation by the UNAIDS reference group on estimates, modelling and projections [1,5]. However, research to improve HIV estimates has so far been carried out predominantly in sub-Saharan Africa. Primary research to inform accurate HIV estimation in India has been sorely missing [4]. Consequently, UNAIDS estimates the plausibility range of the HIV burden for India to be very wide: 3.49.4 million for 2005 [1]. Clearly, a three-fold plausibility range is not optimum for informed planning of HIV control in India.

A large annual sentinel surveillance is carried out in India in the third quarter of each year, which includes data predominantly from public-sector antenatal clinics and sexually transmitted

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