India needs to dramatically scale up the battle against AIDS in its impoverished and densely populated north if it is to avoid a disastrous spike in HIV infections, the country’s AIDS control chief said on Thursday.

S.Y. Quraishi, head of the state-run National AIDS Control Organisation (NACO), said the economically backward northern states of Uttar Pradesh and Bihar, together home to 255 million people, were key if India was to win the battle against AIDS.

“Uttar Pradesh and Bihar are highly vulnerable. We are worried,” Quraishi said. “Even if a fraction…of these people have HIV/AIDS, it will spell disaster,” he said.

“There is illiteracy, poor health services, more migrant labour and less empowered women in these states.”

India estimates it has 5.1 million people living with HIV/AIDS, second only to South Africa. The U.S. Central Intelligence Agency has said the number could jump to 20 million by 2010.

Uttar Pradesh in India’s crowded northern plains has a population of close to 170 million, while Bihar - a lawless state and the country’s poorest - has around 85 million.

Both states have thousands of villages with little or no access to basic health care facilities.

Their combined population - 100 million more than Russia - constitutes a quarter of India’s one-billion-plus citizens.

At the moment both states have relatively low infection rates compared with the national average of 0.92 percent of the adult population.

“The sheer numbers worry us in Bihar and Uttar Pradesh. Even if one percent of the population gets HIV infected, we will have 2.5 million cases,” Quraishi said.

Bihar has a literacy rate of 47 percent and Uttar Pradesh 56 percent, both below the national average of 65 percent, making anti-AIDS education more challenging, officials say.

REACHING SEX WORKERS

Quraishi said another challenge in the war against AIDS was reaching the estimated half-million sex workers in India.

NACO says health workers have identified and contacted close to 45 percent of commercial sex workers since it was formed in 1992, but hoped to raise that figure to 80 percent by 2008.

“We now need to saturate high-risk groups like commercial sex workers and intravenous drug users,” Quraishi said.

More than 85 percent of HIV infections in India are the result of unprotected sex among heterosexuals, including many cases of husbands transmitting the virus to their faithful wives after visiting prostitutes.

In May this year, NACO reported that its number of new infections fell from 520,000 in 2003 to 28,000 in 2004, sparking disbelief among some private anti-AIDS groups who said they were seeing more HIV-infected people visiting their clinics.

But Quraishi insisted the figures were genuine.

“The war against AIDS is being won. India has one of the most comprehensive and integrated anti-AIDS programmes,” he said.