national family health survey (nfhs-3), 2005-06

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




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 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


KarnatakaKarnataka




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


KarnatakaKarnataka





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


KarnatakaKarnataka





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.

national family health survey (nfhs-3), 2005-06

Documents

hiv prevalence estimatesgoals

hiv prevalencegoals

hiv tests

hiv testingblood spots

hiv test response rates

prior hiv testingnfhs

sexhiv prevalence

agehiv prevalence