1. National Family Health Survey (NFHS-3), 2005-06 HIV Measurement Process and Prevalence

2. Contents HIV measurement process HIV measurement process Coverage of HIV testing in NFHS-3 Coverage of HIV testing in NFHS-3 HIV prevalence HIV prevalence

3. Goals for HIV Prevalence Estimates GOALS: To Estimate HIV prevalence At all India level by rural urban residence and by background characteristics of the respondents and At all India level by rural urban residence and by background characteristics of the respondents and Separately at state level by sex for six high prevalence states (Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, and Tamil Nadu), and Uttar Pradesh Separately at state level by sex for six high prevalence states (Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, and Tamil Nadu), and Uttar Pradesh However, in Nagaland blood could not be collected because of the strong local opposition However, in Nagaland blood could not be collected because of the strong local opposition

4. Ethical Considerations and HIV/AIDS Sample All national and International guidelines and protocols required for blood collection and testing were followed An informed consent statement was read to each respondent for voluntary HIV testing Complete anonymity and confidentiality is maintained

5. Collection of Samples in the field for HIV Testing  Blood spots from a finger prick were collected on a special filter paper card  No names or personal identifiers were placed on the filter paper sample  Self-adhesive barcode labels bearing same numbers were affixed to filter paper card and questionnaire for each individual respondent

6. Storage and shipment of samples  Samples collected were allowed to dry overnight in a drying box with desiccants and a humidity indicator card  By morning, the blood spot samples were completely dry and were called Dried Blood Spots (DBS)  Appropriately packaged DBS samples were transported to the Ranbaxy sample collec- tion centres

7. Transportation  Transported from SRL Ranbaxy Collection Centres to SRL- Mumbai as ambient shipment in SRL packing materials along with transmittal sheets  Blood samples were tested for sero-positivity at Ranbaxy  A subsample of more than 5,000 samples, including all positive samples were sent to NARI by Ranbaxy for external quality control

8. Contents HIV measurement process HIV measurement process Coverage of HIV testing in NFHS-3 Coverage of HIV testing in NFHS-3 HIV prevalence HIV prevalence

9. Coverage of HIV Testing Percent of eligible women age 15-49 and men age 15-54 whose blood was tested for HIV Percent of eligible women age 15-49 and men age 15-54 whose blood was tested for HIV Women: 85 percent Women: 85 percent Men: 78 percent Men: 78 percent Response rates are comparable to HIV test response rates on national household surveys worldwide Response rates are comparable to HIV test response rates on national household surveys worldwide

10. Reason Women (%) Men (%) Not interviewed Refused to give blood Absent at time of blood collection collectionOther661114522 Non-Response Rates by Reason Persons who were not interviewed were not eligible for blood collection

11. State Women (%) Men (%) Tamil Nadu Manipur Andhra Pradesh Uttar Pradesh KarnatakaMaharashtra939185838278908281797268 Response Rates in 6 States Response rates are higher than the national average in Tamil Nadu and Manipur, about the same as the national average in UP and Andhra Pradesh, and lower than the national average in Maharashtra and Karnataka

12. Contents HIV measurement process HIV measurement process Coverage of HIV testing in NFHS-3 Coverage of HIV testing in NFHS-3 HIV prevalence HIV prevalence

13. HIV Prevalence  HIV prevalence estimates are based on HIV tests of 102,946 blood samples  52,853 from de facto women age 15-49  50,093 from de facto men age 15-54

14. Sex Women (%) Men (%) Total (%) UrbanRural0.290.180.410.320.350.25 India0.220.360.28 HIV Prevalence by Residence and Sex, India

15. State Total (%) Women (%) Men (%) Manipur Andhra Pradesh KarnatakaMaharashtra Tamil Nadu Uttar Pradesh Non-high prevalence states 1.130.970.690.620.340.070.120.760.760.540.480.400.050.081.591.220.860.780.270.100.16 India0.280.220.36 HIV Prevalence by State

16. State HIV Prevalence (%) Confidence Interval Manipur Andhra Pradesh KarnatakaMaharashtra Tamil Nadu Uttar Pradesh Non-high prevalence states 1.130.970.690.620.340.070.120.82-1.440.70-1.250.44-0.930.43-0.810.18-0.500.03-0.110.07-0.19 India0.280.23-0.33 Confidence Intervals

17. StateFemale:MaleRural:Urban Manipur Andhra Pradesh KarnatakaMaharashtra Tamil Nadu Uttar Pradesh Non-high prevalence states 1:2.11:1.61:1.61:1.61:0.71:2.11:2.1NANANANANANANA India1:1.61:1.4 Ratios of HIV Prevalence Rates by Residence and Sex

18. Age Total (%) Women (%) Men (%) 15-1920-2425-2930-3435-3940-4445-4950-540.040.180.350.540.370.300.33NA0.070.170.280.450.230.190.17NA0.010.190.430.640.530.410.480.34 HIV Prevalence in India by Age

19. HIV Prevalence by Prior HIV Testing NFHS-3, 2005-06

20. HIV Prevalence by Background Characteristics HIV Prevalence rates are low for all groups so the differentials in HIV prevalence by socio- economic and background characteristics and individual’s sexual behaviour are generally small And these results need to be interpreted with caution because of the small number of the cases by many of these characteristics

21. HIV Status among Married Couples NFHS-3 data on women and men can be linked to identify married couples Married couples in which both the wife and the husband were tested for HIV in NFHS-3 can be studied to examine HIV discordance The study of HIV discordance is important for designing effective HIV/AIDS interventions

22. HIV Discordance among Couples Among the 27,771 married couples who were tested for HIV in NFHS-3, there were 138 couples in which the wife or the husband or both were HIV positive Among these 138 couples For 22%, both the husband and wife were HIV positive For 64%, only the husband was HIV positive For 14%, only the wife was HIV positive

23. HIV Prevalence Summary HIV prevalence among the household population in the 15-49 age group in India is low (0.28%) HIV prevalence exceeds 0.5% in Manipur, Andhra Pradesh, Karnataka, and Maharashtra Tamil Nadu does not appear to be a high HIV prevalence state

24. HIV Prevalence Summary HIV prevalence is 64% higher among males than among females –48% higher in high HIV prevalence states and 106% higher in other states HIV prevalence is 40% higher in urban areas than in rural areas

25. HIV Prevalence Summary cont… NFHS-3 provides an accurate and robust estimate of HIV prevalence in the general household population age 15-49 (0.28%) Analysis of non-response and missed populations provides evidence that HIV prevalence in the general population age 15-49 is approximately 0.3%, and could not be higher than 0.4% under any reasonable assumptions

26. Summary Based on the NFHS-3 estimate of HIV and other data, the Government of India has reduced its official HIV estimate for the adult population. However, strong programmes are still required to prevent the further spread of HIV.

27. Summary and Highlights (contd.) HIV prevalence among the NFHS-3 household population of men and women age 15-49 is 0.28 percent. Based on this estimate and other data, the Government of India has reduced its official HIV estimate for the adult population. However, strong programmes are still required to prevent the further spread of HIV.