Though commercial sex is the major reason behind the prevalence of the pandemic in most parts of the country, injecting drug use (IDUs), especially in north-eastern states, Delhi, Mumbai and Chennai, is fast emerging as a major source of transmission.

"Analysis of surveillance data by place of residence indicates that HIV has been spreading to the rural areas," the report said.

"Of the estimated 5.2 million HIV-infected adults in India, 3.05 million or nearly 60 per cent were residing in rural areas. Of the reported AIDS cases, sexual transmission accounts for 86 per cent in India," the report said.

Apart from several states recording a higher HIV prevalence among rural sentinel surveillance sites than urban sites, the dreaded disease has now started penetrating the low-risk general population, the report pointed out.

"The HIV epidemic of Manipur that was once a concentrated epidemic among IDUs, is now considered a generalised epidemic," the report said.

In 2005, seven of the 10 ante-natal clinic sentinel surveillance sites in Manipur recorded an HIV prevalence of one per cent or above indicating the spread of infection from high-risk to low-risk populations, report said.

The report said HIV among IDUs increased markedly from seven per cent in 2002 to 23 per cent in 2005.

Increasingly, HIV infection rates are being observed among IDUs in not only in northeastern states, but other urban areas like Delhi, Mumbai and Chennai, it said.

The WHO report said that in five of the 35 states and union territories, the median adult prevalence rate is 1 per cent. These states are Andhra Pradesh, Karnataka, Maharashtra, Manipur and Nagaland.

Mumbai continues to remain the city where HIV prevalence among sex workers remained consistently high. The city continues to see 40 to 50 per cent prevalence among the this high-risk group for the past five years.

Though, HIV prevalence rates has begun to decrease in some of the southern states, it is increasing in the

north-eastern states.

"In Maharashtra, where HIV prevalence among sex workers has remained as high as up to 50 per cent for several years, 18 of 30 districts and 16 of 25 districts in Karnataka have HIV prevalence of one per cent or above among ante-natal clinic attendees at government health centres," it said.

Highlighting the need for collecting data on HIV transmission among homosexuals, the report said there was "high HIV transmission among homosexuals".

"In India, HIV prevalence among this population ranged from one per cent to 40 per cent across the 18 targeted intervention sites," the report said.

The report said the early IDU epidemics in India were in the north-eastern states where up to 70 per cent of the IDUs were injected.