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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    • "Studies from some parts of Africa and Asia have demonstrated a link between long-distance truck drivers and the prevalence of HIV/STIs (Manjunath et al., 2002; Mbugua et al., 1995; Mustikawati et al., 2009). Within these regions, there is growing evidence that the high rates of HIV and STIs among truck drivers largely occur by sexual contact with HIV, and STIs-infected women, often commercial sex workers (CSW) along the major transportation routes; the infected men then transmit the virus to wives and other sex partners en route and in their place of origin (Pison et al., 1993; Gangakhedkar et al., 1997; Brockerhoff , M. and Biddlecom,1999; Wolffers et al., 2002; McCree et al., 2010). Consistent with this pattern, there is growing public health concern that long-distance truck drivers and other mobile, individuals may act as bridge populations who spread the infections from high to low-risk populations and regions and urban to rural areas (Decosas et al., 1995; Morris et al., 1996; Entz et al., 2000; Chandrasekaran et al., 2005). "
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    ABSTRACT: Background: Although the high prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis infections among longdistance truck drivers has been well documented globally, such data are sparse from Africa, and there has been no such data from Ghana. This study carried out between the months of January and June 2013 sought to determine the sero-prevalence and risk factors of HIV, HBV and syphilis infections among long distance truck drivers at the Tema sea port, Ghana.Materials and Methods: Of a total of 800 eligible drivers, 106 (13.25%) drivers consented to take part in the study. Subjects voluntarily completed a risk factor questionnaire and provided blood specimen for testing for HIV, syphilis and the surface antigen of HBV (HBsAg).Results: The mean age of the drivers was 40.56 ± 11.56 years. The sero-prevalence of HIV was 0.94%, 14.2% had HBsAg and reactive syphilis serology was 3.8%. On multivariate analysis, the main determinants of HBV infection were; multiple sexual partnership (OR, 6.36; 95% CI: 1.35– 29.79), patronage of commercial sex workers (OR, 6.85; 95% CI: 0.88 – 52.89), cross-border travelers (OR: 6.89-fold, 95% CI: 0.86 - 55.55) and prolonged duration of trips for more than two weeks (OR: 4.76; 95% CI: 0.59 – 38.02). The main determinant of syphilis infection on multivariate analysis was being a Muslim (OR, 2.19; 95% CI: 0.22 – 21.74).Conclusion: The data indicate a lower sero-prevalence of HIV but a higher sero-prevalence of syphilis. However, the sero-prevalence of HBV infection is comparable to that of the general population.
    Preview · Article · Dec 2015 · African Journal of Infectious Diseases
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    • "However, the medical mismanagement respondents faced whereby they were treated for many other conditions before HIV was diagnosed echoes previous research where private practitioners were frequently found not following current HIV guidelines (Chomat et al., 2009;Datye et al., 2006;Kielmann et al., 2005). Social factors: This study supports previous research that marriage is the main risk factor for HIV (Gangakhedkar et al., 1997;Saggurti &amp; Malviya, 2009), and that aside from antenatal HIV screening, married women are usually tested following their husband's HIV diagnosis (Joseph et al., 2010;Malave, Ramakrishna, Heylen, Bharat, &amp; Ekstrand, 2013). Being a migrant's wife influenced both their risk of becoming HIV-infected and subsequent pathways into care. "
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    ABSTRACT: Migrant workers are designated a bridge population in the spread of HIV and therefore if infected, should be diagnosed and treated early. This study examined pathways to HIV diagnosis and access to care for rural-to-urban circular migrant workers and partners of migrants in northern India, identifying structural, social and individual level factors that shaped their journeys into care. We conducted a qualitative study using in-depth interviews with HIV-positive men (n = 20) and women (n = 13) with a history of circular migration, recruited from an antiretroviral therapy centre in one district of Uttar Pradesh, north India. Migrants and partners of migrants faced a complex series of obstacles to accessing HIV testing and care. Employment insecurity, lack of entitlement to sick pay or subsidised healthcare at destination and the household's economic reliance on their migration-based livelihood led many men to continue working until they became incapacitated by HIV-related morbidity. During periods of deteriorating health they often exhausted their savings on private treatments focused on symptom management, and sought HIV testing and treatment at a public hospital only following a medical or financial emergency. Wives of migrants had generally been diagnosed following their husbands' diagnosis or death, with access to testing and treatment mediated via family members. For some, a delay in disclosure of husband's HIV status led to delays in their own testing. Diagnosing and treating HIV infection early is important in slowing down the spread of the epidemic and targeting those at greatest risk should be a priority. However, despite targeted campaigns, circumstances associated with migration may prevent migrant workers and their partners from accessing testing and treatment until they become sick. The insecurity of migrant work, the dominance of private healthcare and gender differences in health-seeking behaviour delay early diagnosis and treatment initiation.
    Preview · Article · Nov 2015 · AIDS Care
    • "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.
    No preview · Article · Jul 2014
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