Evolutionary and Ecological Drivers Shape the Emergence and Extinction of Foot-and-Mouth Disease Virus Lineages.

Livestock farming across the world is constantly threatened by the evolutionary turnover of foot-and-mouth disease virus (FMDV) strains in endemic systems, the underlying dynamics of which remain to be elucidated. Here, we map the eco-evolutionary landscape of cocirculating FMDV lineages within an important endemic virus pool encompassing Western, Central, and parts of Southern Asia, reconstructing the evolutionary history and spatial dynamics over the last 20 years that shape the current epidemiological situation. We demonstrate that new FMDV variants periodically emerge from Southern Asia, precipitating waves of virus incursions that systematically travel in a westerly direction. We evidence how metapopulation dynamics drive the emergence and extinction of spatially structured virus populations, and how transmission in different host species regulates the evolutionary space of virus serotypes. Our work provides the first integrative framework that defines coevolutionary signatures of FMDV in regional contexts to help understand the complex interplay between virus phenotypes, host characteristics, and key epidemiological determinants of transmission that drive FMDV evolution in endemic settings.

Non-malarial febrile illness: a systematic review of published aetiological studies and case reports from Southern Asia and South-eastern Asia, 1980-2015.

BACKGROUND: In the absence of definitive diagnosis, healthcare providers are likely to prescribe empirical antibacterials to those who test negative for malaria. This problem is of critical importance in Southern Asia (SA) and South-eastern Asia (SEA) where high levels of antimicrobial consumption and high prevalence of antimicrobial resistance have been reported. To improve management and guide further diagnostic test development, better understanding is needed of the true causative agents of fever and their geographical variability. METHODS: We conducted a systematic review of published literature (1980-2015) to characterise the spectrum of pathogens causing non-malarial febrile illness in SA and SEA. We searched six databases in English and French languages: MEDLINE, EMBASE, Global Health (CABI) database, WHO Global Health Library, PASCAL, and Bulletin de la Société Française de Parasitologie (BDSP). Selection criteria included reporting on an infection or infections with a confirmed diagnosis, defined as pathogens detected in or cultured from samples from normally sterile sites, or serological evidence of current or past infection. RESULTS: A total of 29,558 records from 19 countries in SA and SEA were screened, of which 2410 (8.1%) met the selection criteria. Bacterial aetiologies were reported in 1235 (51.2%) articles, viral in 846 (35.1%), parasitic in 132 (5.5%), and fungal in 54 (2.2%), and 143 (6.0%) articles reported more than one pathogen group. In descending order of frequency, Salmonella Typhi, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and coagulase negative Staphylococcus were the commonly reported bacteria, while dengue virus, chikungunya virus, Japanese encephalitis virus, hepatitis B virus, and hepatitis C virus were common viral pathogens reported. Reports of rarely reported or emerging pathogens included a case report of Borrelia burgdorferi (Lyme disease) in India in 2010 and reports of Nipah virus in Singapore and India. CONCLUSIONS: This review summarises the reported non-malaria pathogens that may cause febrile illness in SA and SEA. The findings emphasise the need of standardising the reporting of aetiological studies to develop effective, evidence-based fever management and improved surveillance. Research and development of diagnostic tools would benefit from up-to-date epidemiological reporting of the regional diversities of non-malaria fever aetiologies. TRIAL REGISTRATION: PROSPERO registration, CRD42016049281.

Spectrum of biopsy proven renal disease in South Asian children: Two decades at a tropical tertiary care centre.

AIM: We report findings from a large single centre paediatric renal biopsy cohort in South Asia. METHODS: We analyzed all renal biopsies performed on children aged ≤18 years between 1996 and 2015 at our centre. The clinical characteristics and histological diagnosis pertaining to each case, distribution of renal diseases in children with various clinical presentations, and changes in the pattern of kidney disease during the study period were analyzed. RESULTS: A total of 1740 paediatric kidney biopsies were performed during the study period. The mean age was 12.8 ± 4.9 years (8 months to 18 years) and the male: female ratio was 1.5:1. The most common indication for renal biopsy was nephrotic syndrome (63.2%) followed by acute nephritic syndrome (13%). Minimal change disease was the most common cause of nephrotic syndrome while endocapillary proliferative glomerulonephritis (65.7% infection related), remained the commonest cause of acute nephritic syndrome. IgA nephropathy was the commonest cause of chronic kidney disease. Contrary to trends in European paediatric cohorts, the frequency of lupus nephritis increased over the two decades of the study, while that of endocapillary proliferative glomerulonephritis did not show any appreciable decline. CONCLUSION: This study provides the largest data on biopsy proven renal disease in children from South Asia published till date and highlights important differences in the spectrum and trends of kidney disease compared to data from other regions.

Government helper and citizen advocate? A case study of the multiple roles and pressures facing a nongovernmental organization contracted by government to strengthen community health in northern India.

While nongovernmental organizations (NGOs) can potentially strengthen valuable citizen political engagement, NGOs that are increasingly oriented towards donor and government contracts may instead contribute to depoliticizing development. Amidst competing pressures, NGO experiences and agency in managing multiple roles require examination. We present a qualitative case study of an NGO implementing a government-designed intervention to strengthen Village Health, Sanitation, and Nutrition Committees (VHSNCs) in rural north India. Despite a challenging context of community scepticism and poor government services, the NGO did successfully form VHSNCs by harnessing its respected interlocutor status, preexisting relationships, and ability to "sell" the VHSNC as a mechanism for improving local well-being. While the VHSNC enabled community members to voice concerns to government officials, improvements often failed to meet community expectations. NGO staff endured community frustration on one hand and rebuffs from lower-level officials on the other, while feeling undersupported by the government contract. Consequently, although contracted to strengthen a community institution, the NGO increasingly worked alongside VHSNC members to try to strengthen the public sector. Contrary to assumptions that NGOs become "tamed" through taking government contracts, being contracted to deliver inputs for community participation was intertwined with microlevel political action, though this came at a cost to the NGO.

Adipose tissue distribution in relation to insulin sensitivity and inflammation in Pakistani and Norwegian subjects with type 2 diabetes.

Immigrants from South Asia to Western countries have a high prevalence of type 2 diabetes mellitus (T2DM) associated with obesity. We investigated the relationship between diabetes and adipose tissue distribution in a group of younger T2DM subjects from Norway and Pakistan. Eighteen immigrant Pakistani and 21 Norwegian T2DM subjects (age 29-45, 49% men) were included. They underwent anthropometrical measurements including bioelectrical impedance analysis, CT scans measuring fatty infiltration in liver and adipose and muscle tissue compartments in mid-abdomen and thigh, a euglycemic clamp, and blood samples for serum insulin and plasma glucose, adipokines and inflammation markers. Adipose tissue distribution was similar in Norwegians and Pakistanis. Pakistanis, but not Norwegians, showed a negative correlation between insulin sensitivity and visceral adipose tissue (VAT, rs = - 0.704, p = 0.003). Subcutaneous adipose tissue (SAT) correlated to leptin in both Pakistanis and Norwegians (rs = 0.88, p < 0.001 and 0.67, p = 0.001). SAT also correlated to C-reactive protein (CRP) in the Pakistanis only (rs = 0.55, p = 0.03), and superficial SAT to Interleukin-1 receptor antagonist (IL-1RA) in Norwegians only (rs = 0.47, p = 0.04). In conclusion, despite similar adipose tissue distribution in the two groups Pakistanis were more insulin resistant, with a negative correlation of VAT to insulin sensitivity, not present in Norwegians. The correlation of adipose tissue to Leptin, CRP and IL-1RA showed ethnic differences.

Terminology and methods used to differentiate injury intent of hospital burn patients in South Asia: Results from a systematic scoping review.

INTRODUCTION: A key component in the classification of all injury types is to differentiate whether the injury was deliberately inflicted and by whom, commonly known as "intent" in the surveillance literature. These data guide patient care and inform surveillance strategies. South Asia is believed to have the greatest number of intentional burn injuries, but national surveillance data is not disaggregated by injury intent. Scientific literature can be used for injury surveillance where national data collection does not exist. In order to synthesise research findings, it is essential to assess the potential impact of misclassification bias. We therefore conducted a systematic scoping review to understand terminology and methods used to differentiate injury intent of hospital burn patients in South Asia. METHODS: We followed the methods in our registered protocol (https://doi.org/10.17605/OSF.IO/DCYNQ). Studies met defined population, concept, context, and study design criteria. The databases Embase, MEDLINE, CINAHL, PsycInfo, and PakMediNet were searched. Two reviewers independently screened results. Data were extracted in a standardised manner and verified. The rigour of the method used to differentiate injury intent was appraised. RESULTS: 1435 articles were screened. Of these, 89 met our inclusion criteria. Most articles were from India and Pakistan, and used an observational study design. There were 14 stem terms used in the articles. The most common was "cause". There were 40 classifier terms. The most common were "accident", "suicide", and "homicide". Few articles defined these terms. The method used to differentiate injury intent was only described explicitly in 17% of articles and the rigour of the methods used were low. Where methods of differentiation were described, they appear to be based on patient or family report rather than multidisciplinary assessment. CONCLUSION: The heterogeneity in terms, lack of definitions, and limited investigation of injury intent means this variable is likely to be prone to misclassification bias. We strongly recommend that the global burn community unites to develop a common data element, including definitions and methods of assessment, for the concept of burn injury intent to enable more reliable data collection practices and interstudy comparisons.

Perceived barriers to peritoneal dialysis utilization amongst South Asian nephrologists.

Peritoneal dialysis (PD) is a well-established modality for kidney replacement therapy (KRT) globally, offering benefits such as better preservation of residual kidney function, improved quality of life, and reduced resource requirements. Despite these advantages, the global utilization of PD remains suboptimal, particularly in South Asia (SA), where a significant gap in PD delivery exists. This study aims to uncover the perceived barriers hindering PD utilization among nephrologists in SA. This is a cross-sectional survey involving 732 nephrologists from SA region. . The majority of respondents (44.7%) reported initiating less than six PD cases annually, reflecting low PD utilization. Cost and financial reimbursement policies emerged as major barriers, with 44.3% considering PD more expensive than haemodialysis (HD). Accessibility, negative attitudes toward PD, and fear of complications were identified as critical factors influencing PD adoption. The study also highlighted variations in PD costs among SA countries, emphasizing the need for tailored health economic strategies. This analysis provides insights into the multifaceted challenges faced by SA nephrologists in promoting PD and underscores the importance of targeted interventions.

Does provision of antenatal care in Southern Asia improve neonatal survival? A systematic review and meta-analysis.

BACKGROUND: Southern Asia has one of the highest burdens of neonatal mortality worldwide (26/1000 live births). Ensuring that women receive antenatal care from a skilled provider may play an important role in reducing this burden. OBJECTIVE: This study aimed to determine whether antenatal care received from a skilled provider could reduce neonatal mortality in Southern Asia by systematically reviewing existing evidence. STUDY DESIGN: Seven databases were searched (MEDLINE, Embase, Cochrane Library, CINAHL, PubMed, PsycINFO, and International Bibliography of the Social Sciences [IBSS]). The key words included: "neonatal mortality," "antenatal care," and "Southern Asia." Nonrandomized comparative studies conducted in Southern Asia reporting on neonatal mortality in women who received antenatal care compared with those who did not were included. Two authors carried out the screening and data extraction. The Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) was used to assess quality of studies. Results were reported using a random-effects model based on odds ratios with 95% confidence intervals. RESULTS: Four studies were included in a meta-analysis of adjusted results. The pooled odds ratio was 0.46 (95% confidence interval, 0.24 to 0.86) for neonatal deaths among women having at least 1 antenatal care visit during pregnancy compared with women having none. In the final meta-analysis, 16 studies could not be included because of lack of adjustment for confounders, highlighting the need for further higher-quality studies to evaluate the true impact. CONCLUSION: This review suggests that in Southern Asia, neonates born to women who received antenatal care have a lower risk of death in the neonatal period compared with neonates born to women who did not receive antenatal care. This should encourage health policy to strengthen antenatal care programs in Southern Asia.

AIDS in position to ravage India.

PIP: The Joint UN Program on AIDS reports that India has more than 3 million adults infected with HIV, more HIV-infected adults than any other country in the world. By the year 2005, India will have more people infected with HIV than does Africa. Having sex with a Bombay housewife today is at least twice as risky as it was to have sex with a prostitute in the city's red light district in 1988. 2-3% of all women in the city are infected with HIV. There is ignorance, apathy, corruption, and lack of commitment at all levels with regard to HIV/AIDS. Accordingly, India's lackluster campaign against AIDS launched 10 years ago has lost momentum just as the epidemic is exploding and at a time when traditional beliefs about cultural barriers and the sexual behavior of Indian males are being called into question. Considerable homosexual behavior occurs in India. However, the most important factor contributing to the spread of HIV throughout India is the virus' spread from urban areas into small villages, often through migrant laborers. Ignorance, illiteracy, and poverty in villages will make AIDS prevention especially difficult. Indian government policy forbidding the distribution of condoms in prisons, needles to injectable-drug users, and free drugs to AIDS patients further contributes to the spread of HIV.^ieng

India to develop its own AIDS vaccine.

PIP: UNAIDS believes that more than 3 million Indians are infected with HIV, approximately 200,000 of which have AIDS. Failing in its attempt to check the spread of HIV/AIDS through disease prevention messages and the promotion of condom use, the government of India has launched a program to develop a vaccine against HIV/AIDS. Some see the development of a vaccine as the only viable course of action against HIV/AIDS in India, for educational campaigns have failed and AIDS drugs are unaffordable even for wealthy Indians. Interest in producing an indigenous vaccine stems from concern that vaccines being developed in the West may not be effective in India due to differences in HIV subtypes. A 5-year extension of an existing Indo-US program started in 1987 to develop vaccines against a range of infectious diseases was signed in December 1997, with AIDS added to the list of original program diseases. This revised agreement includes collaboration with US vaccine research groups and possible US funding, but details of the terms have yet to be disclosed. The following Indian teams are working on the project: the government Department of Biotechnology (DBT), the All India Institute of Medical Sciences, the National Institute of Communicable Diseases (New Delhi), Christian Medical College (Vellore), and the National AIDS Research Institute (Pune). The DBT argues that there will be enough funding even without a US contribution. Indian scientists plan to develop a DNA vaccine mixture containing the desired gene sequences of the HIV subtypes which are prevalent in India.^ieng

Indian state plans compulsory HIV testing, segregation and branding.

PIP: Health officials in the Indian state of Maharashtra have ordered the compulsory testing of all girls 12 years and older who live in designated "destitute homes." The officials also plan to tattoo a symbol on the thighs of all HIV-positive prostitutes. By April 1998, this December 1997 order had resulted in the compulsory testing of women living in 50 boarding houses and the transfer of several found to be HIV-positive to a separate institution 200 miles from the state capital. Nongovernment organizations (NGOs) have mounted a protest over this statute, but state governments in India are free to enact their own health laws. The Maharashtran government is also seeking to legalize prostitution and to force prostitutes to register with a Board that will be able to order compulsory HIV tests and tattooing. Women with HIV who continue to engage in prostitution will be quarantined, and their clients will be jailed. In response, prostitutes in the capital city of Mumbai have threatened to release a list of their client's names to the press. The only recourse available to NGOs who oppose this action is to generate a large enough public outcry to stop it. A Mumbai-based attorney noted that many private companies are also requiring HIV testing and dismissing those who test positive.^ieng

World Bank will lend more money to India for AIDS.

PIP: This article discusses the World Bank's plans to lend India money that will be used in part to fund HIV/AIDS prevention and control. The loan amounts to about US$200 million, of which 25% would be directed to research and development for HIV/AIDS. The loan is a 5-year extension of support that ended March 1999. The loan will cover the cost of blood safety programs, hospital and community care plans, and medical drugs for treating opportunistic infections. According to the Department of Biotechnology and the Indian Council of Medical Research, research and development money will be split between indigenous AIDS vaccine programs and assessment of local production of HIV diagnostic kits and development of vaginal microbicides. The government will support clinical trials of more than herbal medicines for treating tuberculosis. Funding will also support evaluation research on cost of patient care and the HIV/AIDS impact on the work force. A major focus will be on the high risk population of women and children. The World Bank requires that 50% of the loans go to nongovernmental organizations (NGOs). However, the National AIDS Control Organization (NACO) of India lost government financial funding and will not be able to fund NGO efforts directly. NACO must channel funding through state governments. There is fear that the AIDS control program will suffer due to the restructuring of operations and shortages of manpower. The AIDS program funding could be halted by the Bank due to India's nuclear testing.^ieng

Possible obliquity-forced warmth in southern Asia during the last glacial stage.

Orbital-scale global climatic changes during the late Quaternary are dominated by high-latitude influenced ~100,000-year global ice-age cycles and monsoon influenced ~23,000-year low-latitude hydroclimate variations. However, the shortage of highly-resolved land temperature records remains a limiting factor for achieving a comprehensive understanding of long-term low-latitude terrestrial climatic changes. Here, we report paired mean annual air temperature (MAAT) and monsoon intensity proxy records over the past 88,000 years from Lake Tengchongqinghai in southwestern China. While summer monsoon intensity follows the ~23,000-year precession beat found also in previous studies, we identify previously unrecognized warm periods at 88,000-71,000 and 45,000-22,000 years ago, with 2-3 °C amplitudes that are close to our recorded full glacial-interglacial range. Using advanced transient climate simulations and comparing with forcing factors, we find that these warm periods in our MAAT record probably depends on local annual mean insolation, which is controlled by Earth's ~41,000-year obliquity cycles and is anti-phased to annual mean insolation at high latitudes. The coincidence of our identified warm periods and intervals of high-frequent dated archaeological evidence highlights the importance of temperature on anatomically modern humans in Asia during the last glacial stage.

Prevention and improvement of clinical management of snakebite in Southern Asian countries: A proposed road map.

In the Southern Asian countries, snakebite takes a substantial toll in terms of human life, inflicts acute morbidity and long term disability both physical and psychological, and therefore represents a neglected socio-economic problem and severe health issue that requires immediate medical attention. The 'Big Four' venomous snakes, viz. Daboia russelii, Naja naja, Bungarus caeruleus and Echis carinatus, are prominent, medically important species and are the most dangerous snakes of this region; therefore, the commercial polyvalent antivenom (PAV) contains antibodies against the venoms of these snakes. However, envenomations by species other than the 'Big Four' snakes are grossly neglected, and PAV is only partially effective in neutralizing the venom of these snakes. Many issues confounding effective treatment of snakebite are discussed in this review, and these hurdles preventing successful treatment of snakebite must be addressed. However, in South Asian countries, the pre-hospital treatment and appropriate first aid are equally important to mitigate the problem of snakebite and therefore, these issues are also highlighted here. Further, this review suggests a roadmap and guidelines for the prevention of snakebite and improvement of hospital management of snakebite in these Southern Asian countries.

New species of Pseudosperma (Agaricales, Inocybaceae) from Pakistan revealed by morphology and multi-locus phylogenetic reconstruction.

During fungal surveys between 2012 and 2014 in pine-dominated forests of the western Himalayas in Pakistan, several collections of Pseudosperma (Agaricales, Inocybaceae) were made. These were documented, based on morphological and molecular data. During this work, three new species came to light, which are here formally described as Pseudosperma brunneoumbonatum, P. pinophilum and P. triacicularis. These species belong in the genus Pseudosperma fideMatheny et al. (2019) = Pseudosperma clade fideMatheny (2005) = Inocybe sect. Rimosae s.s. fideLarsson et al. (2009). Macro- and micro-morphological descriptions, illustrations and molecular phylogenetic reconstructions of the studied taxa are provided. The new species are differentiated from their close relatives by basidiospore size and colouration of basidiomata. Molecular phylogenetic relationships are inferred using ITS (ITS1-5.8S-ITS2), nrLSU and mtSSU sequence data. All three newly-described taxa likely share an ectomycorrhizal association with trees in the genus Pinus. In addition, five names are recombined in Inosperma, Mallocybe and Pseudosperma. These are Inosperma vinaceobrunneum, Mallocybe erratum, Pseudosperma alboflavellum, Pseudosperma friabile and Pseudosperma neglectum.

Vaccines against fertility.

The first evidence for the efficacy of a birth control vaccine in humans is now available from the Phase II trials on the human chorionic gonadotrophin vaccine in India. Several sperm antigens have been identified as potential contraceptive immunogens and zona pellucida antigens have been reported that reversibly control fertility.

PIP: Birth control vaccines, once proven to be safe, effective, and reversible, may be superior to available methods in terms of the reduced number of doses required, the lack of administration of pharmacological agents, and the absence of risk due to improper use. The reproductive process can be interrupted by immune effectors at several points, making several potential birth control vaccines possible. For example, pregnancy can be blocked by immune effectors which can either inactivate an hormone which is indispensable to reproduction or counteract a gamete antigen crucial for gamete development and/or fertilization. First evidence of a birth control vaccine in humans has emerged from Phase II trials on the human chorionic gonadotrophin vaccine in India. Several sperm antigens have been identified as potential contraceptive immunogens and zona pellucida antigens have been reported which reversibly control fertility. Several problems still have to be resolved before fertility control vaccines become available for routine use, but research is nonetheless yielding encouraging results. Sections discuss human chorionic gonadotrophin vaccines, gonadotropin releasing hormone vaccine, carrier-induced suppression, sperm antigen vaccines, egg antigens, other candidate immunogens, and future perspectives.

A new species of psallopinous plant bug from the Malay Peninsula (Heteroptera, Miridae, Psallopinae).

The paper presents description and illustrations of a new peculiar species from the genus Psallops, P. coloratussp. n. from Southeast Asia (Singapore). Photographs, line drawings of the general habitus and a short comparison with a species from Thailand are provided.

Carcinoma of hard palate in India in relation to reverse smoking of chuttas.

PIP: An investigation of the incidence of carcinoma of the palate, its relation to reverse smoking, and the age and sex prevalence of these patients (with carcinoma of the hard palate in particular) as compared to patients with other oral carcinomas was undertaken from September 1970 to October 1973. Records of 600 consecutive patients with cancer of the oral cavity and oropharynx at the King George Hospital in Visakhaptnam were compared with controls matched in age, sex, economic status, education, occupation, religion, and origin. The incidence of cancer of the hard palate was 54.8% overall and 73.8% among females (soft-palate carcinomas were rare with only 8 in males and 4 in females). The mean age of males with hard palate carcinoma 50.4 + or - 11.23) was significantly different from that of females (45.4 + or - 10.37). Reverse smoking predominated in cancer patients, but other habits were prevalent in controls. The risk of developing hard palate carcinoma increased for females 132 times with reverse smoking of chuttas. Reverse smoking allows particulate material (including carcinogens) from the smoke to enter glad openings of the hard palate which do not empty as effectively as do those of the soft palate.^ieng

The epidemiology of HIV in India.

India is the first country outside Africa where an HIV-2 epidemic is running in parallel to an HIV-1 epidemic, resulting in a significant proportion of double infections. HIV is spreading rapidly, mainly by heterosexual contact, but also among intravenous drug users. Genetic analyses of the HIV variants circulating in India point towards HIV-1 and HIV-2 having been introduced into the country recently.

PIP: The genetic strains of HIV which have been uncovered in India have a different origin from those present in Thailand. Also, both HIV-1 and HIV-2 have been detected in India. In a 1991-93 study of clients of a sexually transmitted disease clinic in Bombay, it was found that seroprevalence of HIV in 241 clients was 39%, the 78.5% positive for HIV-1, 6.5% for HIV-2, and 15% for both. Distribution was even for males and females, reflecting heterosexual transmission. HIV-2 has also been detected in other parts of India, and HIV-1 is spreading throughout the country. HIV in children is a sequelae to blood transfusion. The prevalence of HIV in areas where IV drug use is rampant is increasing rapidly and is spreading to the general population. Genetic analysis revealed that the most closely related genetic sequence to the Indian HIV-1 from Bombay occurs in a strain of the virus from South Africa. One subtype of HIV-2 and several subtypes of HIV-1 have been found, with HIV-1 subtype C and HIV-2 subtype A the most frequently encountered. An examination of phylogenetic trees shows the relationships among these different strains. The close genetic relationship between isolates of HIV-1 and HIV-2 from patients in different parts of the country reflects the recent introduction of these strains. Thus, India is an ideal site for studying the efficacy of a vaccine designed specifically for a population of highly similar strains (the high similarity among HIV-2 isolates is unique in India). Since HIV-2 strains are diverging at a rate of 1% per year, any such research would have to occur soon.

Epidemiology of HIV and AIDS in India.

PIP: India is the second most populous country in the world, with more than 880 million people in 1993. With less than 1% of the global land mass, India has more than 16% of the world's population, more than that of South America, Africa, and Australia combined. The population will exceed one billion by 2000, surpassing even China. By then, India will have more new cases of HIV infection per year than any single country, and probably the largest number of HIV-infected people as well. Whatever happens in India will therefore have a major impact upon the global pandemic of HIV and AIDS. The paper considers the history of the HIV epidemic in India, the probable routes of entry of HIV into India, trends in prevalence in population samples, the geographic distribution of HIV in India, AIDS in India, clinical problems in India, projections of HIV/AIDS cases, and how to control HIV/AIDS. The HIV epidemic has grown silently in India over the past decade, with the virus spread mainly through heterosexual intercourse. All known routes of transmission are, however, known in India, and increasing seroprevalence has been noted among prostitutes, STD clinic patients, blood donors, and IV drug users. The population has been largely ignorant of the advance of HIV, with public officials and the media at a loss to adequately inform the public about what is taking place. Greater energy and resources are now being devoted to the problem, but it may be too late to stop a major epidemic. The authors reviewed all available published and unpublished data to present an overview of the epidemiology of HIV and AIDS in India.^ieng