Routes of HIV transmission in India: assessing the reliability of information from AIDS case surveillance.

India's AIDS case surveillance system attributes 86% of HIV infections to sexual risks, 2.4% to injection drug use, 2.0% to blood transfusions, 3.6% to perinatal transmission, and 6.0% to others or not specified. To assess the reliability of this information, we examined the process of AIDS case surveillance in four high HIV-prevalence districts in southern India. We reviewed forms and interviewed doctors, counsellors, officials of State AIDS Control Societies, and a convenience sample of people living with HIV/AIDS. Current surveillance practices are not sensitive to parenteral exposures; forms have no space to report blood exposures other than transfusions and injections, and counsellors often ignore parenteral risks. The system does not distinguish high from lower risk sexual behaviours; all cases with sexual risks are reported in one category. We propose changes in forms and practices to improve the reliability and usefulness of information on risks from AIDS case reporting.