Urban and Rural HIV Estimates among Adult Population (15 - 49 Years) in Selected States of India Using Spectrum Data

HIV estimation has become a standard tool for understanding the epidemic. Although the majority of India’s population lives in rural areas, to date, an exploration of the urban and rural HIV epidemic has not been undertaken. The objective of this study is to develop HIV estimation based on urban and rural adult populations in selected states of India to understand the difference in HIV related indices geographically. Ten states were selected based on HIV prevalence levels-Andhra Pradesh, Tamil Nadu, Karnataka, Maharashtra, Manipur, and Nagaland, Mizoram, Punjab, Odisha and Jharkhand. Spectrum, version 4.53 beta 19, was used. Data files of Indian national estimation, 2010-11 which included population, HIV Sentinel Surveillance, Integrated Bio Behavioral Assessment and program coverage data, were used and alterations made wherever necessary. The urban and rural sub epidemic structures and their subpopulations were separately configured in the Estimation projection package and curve fitting done. Outputs for each state were separately analyzed. Findings show that HIV prevalence is lower in urban than rural areas in Tamil Nadu and Maharashtra; in Karnataka there is no difference in HIV prevalence in the urban and rural populations; and in the remaining seven states urban HIV prevalence is higher as compared to rural HIV prevalence. In the states of Andhra Pradesh, Tamil Nadu, Maharashtra, Odisha and Punjab, the number of people living with HIV, new HIV infections and deaths among people living with HIV is higher in the rural than in the urban population. An early and lower peak in HIV prevalence and incidence in the urban population was seen in Andhra Pradesh, Tamil Nadu, Karnataka and Naga-land, while in Maharashtra the rural peak was earlier and higher. Mizoram shows an earlier and lower peak in the rural population while Manipur shows an earlier and higher urban peak. In Odisha, the epidemic peaked earlier and was lower in the rural than the urban population. HIV prevalence in the urban population in Punjab was still peaking while HIV incidence was earlier and lower in the rural population. In Jharkhand, both urban and rural HIV prevalence and incidence are still increasing. Our findings indicate lower levels of HIV prevalence and incidence in the urban population as compared to the rural populations in Maharashtra and Tamil Nadu. In the remaining eight states, urban prevalence and incidence are higher than their rural counterparts. Future estimations of the HIV epidemic in the country need to adopt a similar approach to inform the design of appropriate state-level strategies for HIV prevention in urban and rural areas.