National Family Health Survey (NFHS-3), 2005-06
HIV Measurement Process HIV Measurement Process and Prevalence and Prevalence
ContentsContents
• HIV measurement processHIV measurement process
• Coverage of HIV testing in NFHS-3Coverage of HIV testing in NFHS-3
• HIV prevalenceHIV prevalence
Goals for HIV Prevalence EstimatesGoals for HIV Prevalence Estimates
GOALS: GOALS: To Estimate HIV prevalenceTo Estimate HIV prevalence
At all India level by rural urban residence and by background At all India level by rural urban residence and by background characteristics of the respondents andcharacteristics of the respondents and
Separately at state level by sex for six high prevalence states Separately at state level by sex for six high prevalence states (Andhra Pradesh, Karnataka, Maharashtra, Manipur, (Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, and Tamil Nadu), and Uttar PradeshNagaland, and Tamil Nadu), and Uttar Pradesh
However, in Nagaland blood could not be collected However, in Nagaland blood could not be collected because of the strong local oppositionbecause of the strong local opposition
Ethical Considerations and HIV/AIDS Sample Ethical Considerations and HIV/AIDS Sample
All national and International guidelines and All national and International guidelines and protocols required for blood collection and protocols required for blood collection and testing were followedtesting were followed
An informed consent statement was read to each An informed consent statement was read to each respondent for voluntary HIV testingrespondent for voluntary HIV testing
Complete anonymity and confidentiality is Complete anonymity and confidentiality is maintained maintained
Collection of Samples in the field for Collection of Samples in the field for HIV TestingHIV Testing
Blood spots from a finger Blood spots from a finger prick were collected on a prick were collected on a special filter paper cardspecial filter paper card
No names or personal No names or personal identifiers were placed on identifiers were placed on the filter paper samplethe filter paper sample
Self-adhesive barcode Self-adhesive barcode
labels bearing same labels bearing same numbers were affixed to numbers were affixed to filter paper card and filter paper card and questionnaire for each questionnaire for each individual respondentindividual respondent
Storage and shipment of samplesStorage and shipment of samples
Samples collected were Samples collected were allowed to dry overnight in a allowed to dry overnight in a drying box with desiccants drying box with desiccants and a humidity indicator cardand a humidity indicator card
By morning, the blood spot By morning, the blood spot
samples were completely dry samples were completely dry and were called Dried Blood and were called Dried Blood Spots (DBS)Spots (DBS)
Appropriately packaged DBS Appropriately packaged DBS samples were transported to samples were transported to the Ranbaxy sample collec-the Ranbaxy sample collec-tion centrestion centres
TransportationTransportation
Transported from SRL Ranbaxy Collection Centres to SRL-Transported from SRL Ranbaxy Collection Centres to SRL-Mumbai as ambient shipment in SRL packing materials Mumbai as ambient shipment in SRL packing materials along with transmittal sheetsalong with transmittal sheets
Blood samples were tested for sero-positivity at RanbaxyBlood samples were tested for sero-positivity at Ranbaxy
A subsample of more than 5,000 samples, including all A subsample of more than 5,000 samples, including all positive samples were sent to NARI by Ranbaxy for external positive samples were sent to NARI by Ranbaxy for external quality controlquality control
ContentsContents
• HIV measurement processHIV measurement process
• Coverage of HIV testing in NFHS-3Coverage of HIV testing in NFHS-3
• HIV prevalenceHIV prevalence
Coverage of HIV TestingCoverage of HIV Testing
• Percent of eligible women age 15-49 Percent of eligible women age 15-49 and men age 15-54 whose blood was and men age 15-54 whose blood was tested for HIVtested for HIV• Women: 85 percentWomen: 85 percent• Men: 78 percentMen: 78 percent
• Response rates are comparable to Response rates are comparable to HIV test response rates on national HIV test response rates on national household surveys worldwidehousehold surveys worldwide
ReasonReason Women (%)Women (%) Men (%)Men (%)Not interviewedNot interviewed
Refused to give bloodRefused to give blood
Absent at time of blood Absent at time of blood
collectioncollection
OtherOther
66
66
11
11
1414
55
22
22
Non-Response Rates by ReasonNon-Response Rates by Reason
Persons who were not interviewed were not eligible for blood collection
StateState Women (%)Women (%) Men (%)Men (%)
Tamil NaduTamil Nadu
ManipurManipur
Andhra PradeshAndhra Pradesh
Uttar PradeshUttar Pradesh
KarnatakaKarnataka
MaharashtraMaharashtra
9393
9191
8585
8383
8282
7878
9090
8282
8181
7979
7272
6868
Response Rates in 6 StatesResponse 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
ContentsContents
• HIV measurement processHIV measurement process
• Coverage of HIV testing in NFHS-3Coverage of HIV testing in NFHS-3
• HIV prevalenceHIV prevalence
HIV Prevalence
HIV prevalence estimates are based on HIV HIV prevalence estimates are based on HIV tests of 102,946 blood samplestests of 102,946 blood samples
52,853 from de facto women age 15-4952,853 from de facto women age 15-49
50,093 from de facto men age 15-5450,093 from de facto men age 15-54
SexSex
Women Women (%)(%)
Men Men (%)(%)
Total Total (%)(%)
UrbanUrban
RuralRural
0.290.29
0.180.18
0.410.41
0.320.32
0.350.35
0.250.25
IndiaIndia 0.220.22 0.360.36 0.280.28
HIV Prevalence by Residence HIV Prevalence by Residence and Sex, Indiaand Sex, India
StateState Total (%)Total (%) Women (%)Women (%) Men (%)Men (%)
ManipurManipur
Andhra PradeshAndhra Pradesh
KarnatakaKarnataka
MaharashtraMaharashtra
Tamil NaduTamil Nadu
Uttar PradeshUttar Pradesh
Non-high Non-high prevalence statesprevalence states
1.131.13
0.970.97
0.690.69
0.620.62
0.340.34
0.070.07
0.120.12
0.760.76
0.760.76
0.540.54
0.480.48
0.400.40
0.050.05
0.080.08
1.591.59
1.221.22
0.860.86
0.780.78
0.270.27
0.100.10
0.160.16
IndiaIndia 0.280.28 0.220.22 0.360.36
HIV Prevalence by StateHIV Prevalence by State
StateState
HIV Prevalence HIV Prevalence (%)(%)
Confidence Confidence IntervalInterval
ManipurManipur
Andhra PradeshAndhra Pradesh
KarnatakaKarnataka
MaharashtraMaharashtra
Tamil NaduTamil Nadu
Uttar PradeshUttar Pradesh
Non-high Non-high prevalence statesprevalence states
1.131.13
0.970.97
0.690.69
0.620.62
0.340.34
0.070.07
0.120.12
0.82-1.440.82-1.44
0.70-1.250.70-1.25
0.44-0.930.44-0.93
0.43-0.810.43-0.81
0.18-0.500.18-0.50
0.03-0.110.03-0.11
0.07-0.190.07-0.19
IndiaIndia 0.280.28 0.23-0.330.23-0.33
Confidence IntervalsConfidence Intervals
StateState Female:MaleFemale:Male Rural:UrbanRural:Urban
ManipurManipur
Andhra PradeshAndhra Pradesh
KarnatakaKarnataka
MaharashtraMaharashtra
Tamil NaduTamil Nadu
Uttar PradeshUttar Pradesh
Non-high Non-high prevalence statesprevalence states
1:2.11:2.1
1:1.61:1.6
1:1.61:1.6
1:1.61:1.6
1:0.71:0.7
1:2.11:2.1
1:2.11:2.1
NANA
NANA
NANA
NANA
NANA
NANA
NANA
IndiaIndia 1:1.61:1.6 1:1.41:1.4
Ratios of HIV Prevalence Rates by Ratios of HIV Prevalence Rates by Residence and SexResidence and Sex
AgeAge Total (%)Total (%) Women (%)Women (%) Men (%)Men (%)
15-1915-19
20-2420-24
25-2925-29
30-3430-34
35-3935-39
40-4440-44
45-4945-49
50-5450-54
0.040.04
0.180.18
0.350.35
0.540.54
0.370.37
0.300.30
0.330.33
NANA
0.070.07
0.170.17
0.280.28
0.450.45
0.230.23
0.190.19
0.170.17
NANA
0.010.01
0.190.19
0.430.43
0.640.64
0.530.53
0.410.41
0.480.48
0.340.34
HIV Prevalence in India by AgeHIV Prevalence in India by Age
HIV Prevalence by Prior HIV TestingHIV Prevalence by Prior HIV Testing
0.49
1.71
0.52
1.63
0.04
2.24
0.25
0.40
0.00
0.50
1.00
1.50
2.00
2.50
Ever tested Received results Did not receive results Never tested
Women Men
Sexually transmitted infection in past 12 months
Prior HIV testing
NFHS-3, 2005-06
HIV Prevalence by Background HIV Prevalence by Background Characteristics Characteristics
HIV Prevalence rates are low for all groups so HIV Prevalence rates are low for all groups so the differentials in HIV prevalence by socio- the differentials in HIV prevalence by socio- economic and background characteristics and economic and background characteristics and individual’s sexual behaviour are generally smallindividual’s sexual behaviour are generally small
And these results need to be interpreted with And these results need to be interpreted with caution because of the small number of the caution because of the small number of the cases by many of these characteristics cases by many of these characteristics
HIV Status among Married CouplesHIV Status among Married Couples
NFHS-3 data on women and men can be NFHS-3 data on women and men can be linked to identify married coupleslinked to identify married couples
Married couples in which both the wife and Married couples in which both the wife and the husband were tested for HIV in NFHS-3 the husband were tested for HIV in NFHS-3 can be studied to examine HIV discordancecan be studied to examine HIV discordance
The study of HIV discordance is important for The study of HIV discordance is important for designing effective HIV/AIDS interventionsdesigning effective HIV/AIDS interventions
HIV Discordance among CouplesHIV 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 couplesFor 22%, both the husband and wife were
HIV positiveFor 64%, only the husband was HIV positiveFor 14%, only the wife was HIV positive
HIV Prevalence SummaryHIV Prevalence SummaryHIV prevalence among the household HIV prevalence among the household population in the 15-49 age group in population in the 15-49 age group in India is low (0.28%)India is low (0.28%)
HIV prevalence exceeds 0.5% in HIV prevalence exceeds 0.5% in Manipur, Andhra Pradesh, Karnataka, Manipur, Andhra Pradesh, Karnataka, and Maharashtraand Maharashtra
Tamil Nadu does not appear to be a Tamil Nadu does not appear to be a high HIV prevalence statehigh HIV prevalence state
HIV Prevalence SummaryHIV Prevalence SummaryHIV prevalence is 64% higher HIV prevalence is 64% higher among males than among among males than among females females
– 48% higher in high HIV prevalence 48% higher in high HIV prevalence states and 106% higher in other states and 106% higher in other statesstates
HIV prevalence is 40% higher in HIV prevalence is 40% higher in urban areas than in rural areasurban areas than in rural areas
HIV Prevalence Summary cont…HIV Prevalence Summary cont…
NFHS-3 provides an accurate and robust NFHS-3 provides an accurate and robust estimate of HIV prevalence in the general estimate of HIV prevalence in the general household population age 15-49 (0.28%)household population age 15-49 (0.28%)
Analysis of non-response and missed Analysis of non-response and missed populations provides evidence that HIV populations provides evidence that HIV prevalence in the general population age prevalence in the general population age 15-49 is approximately 0.3%, and could 15-49 is approximately 0.3%, and could not be higher than 0.4% under any not be higher than 0.4% under any reasonable assumptionsreasonable assumptions
SummarySummary
Based on the NFHS-3 estimate of HIV Based on the NFHS-3 estimate of HIV and other data, the Government of and other data, the Government of India has reduced its official HIV India has reduced its official HIV estimate for the adult population. estimate for the adult population. However, strong programmes are still However, strong programmes are still required to prevent the further spread required to prevent the further spread of HIV.of HIV.
Summary and Highlights (contd.)Summary and Highlights (contd.)
HIV prevalence among the NFHS-3 HIV prevalence among the NFHS-3 household population of men and household population of men and women age 15-49 is 0.28 percent. women age 15-49 is 0.28 percent. Based on this estimate and other Based on this estimate and other data, the Government of India has data, the Government of India has reduced its official HIV estimate for reduced its official HIV estimate for the adult population. However, strong the adult population. However, strong programmes are still required to programmes are still required to prevent the further spread of HIV.prevent the further spread of HIV.