Spread of HIV Infection in Married Monogamous Women in India

Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 12/1997; 278(23):2090-2. DOI: 10.1001/jama.278.23.2090
Source: PubMed


A high prevalence of human immunodeficiency virus (HIV) infection in female sex workers (FSWs) and men who attend sexually transmitted disease (STD) clinics poses a risk for spread of infection to other populations.
To examine spread of HIV to a low-risk population by comparing prevalence of, and risk factors for, HIV and STDs in FSWs and non-FSWs.
Women attending STD clinics in Pune, India, were assessed for STDs and HIV from May 13, 1993, to July 11, 1996. Demographic and behavioral information was collected, and clinical and laboratory assessment was performed.
Prevalence and risk determinants of HIV infection.
Of 916 women enrolled, 525 were FSWs and 391 were non-FSWs. Prevalence of HIV in FSWs and non-FSWs was 49.9% and 13.6%, respectively (P<.001). In multivariate analysis, inconsistent condom use and genital ulcer disease or genital warts were associated with prevalent HIV in FSWs. History of sexual contact with a partner with an STD was associated with HIV in non-FSWs.
Infection with HIV is increasing in non-FSWs, previously thought to be at low risk in India. Since history of sexual contact with their only sex partner was the only risk factor significantly associated with HIV infection, it is likely that these women are being infected by their spouses. This underscores the need for strengthening partner-notification strategies and counseling facilities in India.

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Available from: Sanjay M Mehendale, Aug 07, 2014
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    • "All the female patients in our study group were married monogamous. This observation explains the shift of the epidemic from high risk groups like sexually transmitted diseases and injectable drug users, to low risk groups like married monogamous women.[21] This finding is based on the interview with the study group female patients, but polygamous relation cannot be ruled out. "
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    ABSTRACT: Background: Opportunistic infections (OI) are the major cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals. The pattern of OIs differs widely, hence it is necessary to correlate spectrum of OIs and CD4 counts among HIV infected individuals in specific localities. Materials and Methods: The present study describes the clinical and laboratory profiles of different OIs among 55 HIV seropositive patients. CD4 count was estimated and antiretroviral therapy (ART) was started in 27 patients as per National Acquired Immunodeficiency Syndrome Control Organization guidelines. These 27 patients were classified into stage 1, stage 2 and stage 3 based on CD4 counts of >500 cells/μl, 200-499 cells/μl and <200 cells/μl respectively. The OIs presented by respective groups were documented. Results: Pulmonary tuberculosis was found to be the most common OI constituting 43.6% of all cases followed by candidiasis (30.9%), cryptosporidial diarrhea (21.8%), herpes zoster (16.3%), cryptococcal meningitis (3.63%), Pneumocystis jirovecii pneumonia (1.81%), and other miscellaneous infections (23.6%). Only 1 patient was found in stage I while 13 patients each were grouped in stage II or stage III. The mean CD4 count in our study population who were on ART was 230 ± 150 cells/µl. Conclusion: The pattern of OIs among our study group did not differ significantly from patients not receiving ART. The effect of ART on CD4 count differs from patient to patient based on the degree of depletion of CD4 count before the initiation of ART, drug adherence, concomitant OIs and their treatment.
    07/2014; 5(2):392-6. DOI:10.4103/0976-9668.136200
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    • "The vast majority of HIV infections in India spread through sexual transmission (85.6%) [1]. The shift of the epidemic from high risk groups like sexually active and injectable drug users, to low risk groups like married monogamous women, led to increasing HIV infection among children [2]. Nearly five per cent of infections are attributable to parent-to-child transmission. "
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    ABSTRACT: Background: Karnataka, being "High Prevalent State" of southern India, the HIV infection among antenatal women has crossed 1%. There are very few reports available with CD4 count and stage wise clinical spectrum among children. The clinical spectrum among HIV infected infants and children vary in different areas of the world. Hence it is important to know the spectrum of opportunistic infections and their respective CD4 count among HIV infected children of our locality. Materials and methods: The opportunistic infections among 31 paediatric seropositive patients were evaluated. These all patients were classified as per CDC guide lines into stage I, stage II, and stage III based on CD4 counts of > 1000cells/μl, 500-999 cells/μl,<500cells/μl respectively. The opportunistic infections were diagnosed by standard laboratory investigations. Clinical spectrum presented by each stage children was documented. Results: Children in stage I were 5(16.1%),stage II 14(45.1%) and stage III 12(38.7%). Oral candidiasis (29%) was the commonest, followed by recurrent respiratory tract infection (25.8%), tubercular lymphadenitis (16.1%) and chronic diarrhoea (12.9%). Conclusion: The present study showed the children with higher CD4 count had few infections and children with lower CD4 count presented with multiple opportunistic infections. This study also showed vertical transmission as the sole mode of transmission.
    06/2014; 8(6). DOI:10.7860/JCDR/2014/7419.4443
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    • "Recent studies have shown that the face of the HIV epidemic in India is changing; while new infections in the adult population have reduced dramatically, HIV infection rates among women have increased over the past decades, mainly as a result of male-to-female transmission within marriage and intimate partnerships [1-4]. According to current estimates, women account for 39% of India's HIV-positive population [3], of whom the majority have acquired HIV due to their husband's or regular sexual partner's high-risk behaviors [4-7]. "
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    ABSTRACT: In the context of increasing HIV prevalence among women in regular sexual partnerships, this paper examines the relationship between male injecting drug users' (IDUs) risky injecting practices and sexual risk behaviors with casual partners and inconsistent condom use with regular partners. Data were drawn from the behavioral tracking survey, conducted in 2009 with 1,712 male IDUs in two districts each of Manipur and Nagaland states, in north-east India. IDUs' risky behaviors were determined using two measures: ever shared needles/syringes and engaged in unprotected sex with casual paid/unpaid female partners in the past 12 months. Inconsistent condom use with regular sexual partners (wife/girlfriend) in the past 12 months was assessed in terms of non-condom use in any sexual encounter. More than one-quarter of IDUs had shared needles/syringes, and 40% had a casual sexual partner. Among those who had casual sexual partners, 65% reported inconsistent condom use with such partners. IDUs who shared needles/syringes were more likely to engage in unprotected sex with their regular partners (95% vs 87%; adjusted OR = 2.31, 95% CI = 1.30-4.09). Similarly, IDUs who reported inconsistent condom use with casual partners were more likely to report unprotected sex with their regular partners (97% vs 66%; adjusted OR = 18.14, 95% CI = 6.82-48.21). IDUs who engage in risky injecting and/or sexual behaviors with casual partners also report non-condom use with their regular sex partners, suggesting the high likelihood of HIV transmission from IDUs to their regular sexual partners. Risk reduction programs for IDUs need to include communication about condom use in all relationships in an effort to achieve the goal of zero new infections.
    Harm Reduction Journal 02/2014; 11(1):5. DOI:10.1186/1477-7517-11-5 · 1.26 Impact Factor
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