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Declining HIV prevalence among women attending antenatal care in Pune, India
Abstract
A declining prevalence of HIV among young women has been reported by the public sector implementing prevention of mother-to-child
transmission (PMTCT) programmes, sentinel surveillance sites and research institutions in India. However, there are no reports
evaluating such trends from the private healthcare sector. This study is a retrospective analysis of data collected by PRAYAS
as a part of the PMTCT programme at Sane Guruji Hospital (SGH), a secondary care hospital in Pune, India. Women attending
the antenatal clinic at SGH were screened for HIV following a group counselling session, with an option to opt out. Between
January 2003 and March 2008, the overall HIV prevalence was 111/17 578 (0.6%, 95% CI 0.5–0.7%). The HIV prevalence among antenatal
women was 1.1% in 2003 and 0.2% in 2008 (i.e. 82% decline in HIV prevalence over the 5-year period) and the odds ratio (OR)
of HIV prevalence declined by 0.24 per year from 2003 to March 2008 (OR ;= ;0.76, 95% CI 0.69–0.87; P ;< ;0.001). The risk of having HIV infection was significantly higher in women aged ≥24 ;years and those who were uneducated.
To our knowledge, this is the first report from any private sector health system in India documenting a declining HIV prevalence
among antenatal women. Characterising the risk profile of this small percentage of at-risk women will help in planning prevention
strategies.
... The mean prevalence of HIV in our study over nine years was 0.22 %, as compared to the regional Gujarat state's prevalence of HIV in antenatal patients, which was 0.27 %, and a national seroprevalence of 0.22% [9]. The seroprevalence of 0.22% in our study is lower compared to similar studies done in Pune and Andhra Pradesh where the overall prevalence was higher being 0.6% and 0.30%, respectively [10,11]. Since 2002 till 2021, there has been a declining trend of HIV prevalence in the antenatal women in India and Gujarat state. ...
Background
The severity of AIDS and the social and personal implications of HIV makes the epidemiological study of HIV more difficult. Surveillance studies remain the mainstay of understanding the trends of HIV infection. In this study, we aimed to determine the trend in the prevalence of HIV in the antenatal women attending our hospital situated in the western region of India over the period of the last nine years and the ART adherence and the viral loads of the cluster of positive patients identified from this antenatal HIV testing.
Methodology
A retrospective study was conducted by collecting data for nine years from January 2015 to December 2023 from the PPTCT (Prevention of Parent to Child Transmission) Centre and ART (Anti-Retroviral Treatment) Centre of the hospital. All pregnant women attending antenatal clinics and being admitted to the labor room are counseled for HIV testing as per the National AIDS Control Organisation (NACO) guidelines of India. The data of the total antenatal women counseled for HIV testing and who tested HIV positive were collected. The HIV prevalence rate was derived and the trend of HIV prevalence in antenatal women attending the hospital was determined over the study period. The data on ART adherence and the viral load of these HIV-positive women detected antenatally and their seropositive spouse and children were collected and analyzed.
Results
A total of 22,584 antenatal women were counseled for HIV testing during the study period. No women opted out and there was 100% testing of these 22,584 antenatal women for HIV. Fifty antenatal women tested positive for HIV, resulting in an overall HIV prevalence of 0.22% (50/22,584) during the study period. There was a declining trend of HIV prevalence among antenatal women from 2020 to 2023 (from 0.37% to 0.19%). Of the 50 seropositive antenatal women, 42 remained booked at our ART Centre for treatment. Thirty (71%) women are still adhered to taking ART. Of their 20 seropositive spouses, 14 (70%) have remained adhered to ART. Twenty-eight (93%) female patients on ART and 13 (93%) spouses on ART have suppressed viral loads. Two children of these seropositive mothers had tested HIV positive. ART adherence and suppressed viral load were seen in both seropositive children.
Conclusion
The study reflects a decline in antenatal seroprevalence in recent years in our region. The antenatal HIV prevalence trends have major implications on mother-to-child transmission and these positive antenatal cases serve as index cases bringing the testing opportunity for the so-called identified as the non-high-risk population. ART adherence of positive female patients, after the completion of the antenatal period, remains the challenge in our region, which requires improvement in the outreach activities and increased motivation and awareness of these patients regarding the importance of taking lifelong ART.
... Usually, 20% to 45% of infants of HIV-positive mothers may become infected, with an estimated risk of 5%-10% during pregnancy, 10%-20% during labour and delivery, and 5%-20% through breastfeeding [4,5]. This risk of mother-to-child infection can be reduced substantially through prevention of mother-to-child transmission (PMTCT) (which is referred to as prevention of parent-to-child transmission (PPTCT) in India to emphasize the role of the father in both the transmission of infection and the management of the infected mother and child) [2,[6][7][8][9][10][11]. In India, the PPTCT programme was started in the year 2002, and these services were integrated with the existing reproductive and child health (RCH) services [12]. ...
... 23 We have previously reported 82% decline in HIV prevalence in pregnant women from 2003 to 2008 in the same region. 24 In our study, HIV incidence was 0.12 per100 PWY and this also supports decline in new HIV infections among young pregnant women. ...
Objective: To evaluate cost-effectiveness of second HIV test in pregnancy.
Background: Current strategy of single HIV test during pregnancy in India can miss new HIV infections acquired after the first test or those HIV infections that were missed in the first test due to a false-negative HIV test.
Methods: Between August 2011 and April 2013, 9097 pregnant HIV uninfected women were offered a second HIV test near term (34weeks or beyond) or within 4 weeks of postpartum period. A decision analysis model was used to evaluate cost-effectiveness of a second HIV test in pregnant women near term.
Primary and secondary outcome: Our key outcome measures include programme cost with addition of second HIV test in pregnant women and quality-adjusted life years (QALYs) gained. Results: We detected 4 new HIV infections in the second test. Thus HIV incidence among pregnant women was 0.12 (95% 0.032 to 0.297) per 100 person women years (PWY). Current strategy of a single HIV test is 8.2 times costlier for less QALYs gained as compared to proposed repeat HIV testing of pregnant women who test negative during the first test.
Conclusions: Our results warrant consideration at the national level for including a second HIV test of all pregnant women in the national programme. However prior to allocation of resources for a second HIV test in pregnancy, appropriate strategies will have to be planned for improving compliance for prevention of mother-to-child transmission of HIV and reducing loss- to-follow-up of those women detected with HIV.
... Usually, 20% to 45% of infants of HIV-positive mothers may become infected, with an estimated risk of 5%-10% during pregnancy, 10%-20% during labour and delivery, and 5%-20% through breastfeeding [4,5]. This risk of mother-to-child infection can be reduced substantially through prevention of mother-to-child transmission (PMTCT) (which is referred to as prevention of parent-to-child transmission (PPTCT) in India to emphasize the role of the father in both the transmission of infection and the management of the infected mother and child) [2,[6][7][8][9][10][11]. In India, the PPTCT programme was started in the year 2002, and these services were integrated with the existing reproductive and child health (RCH) services [12]. ...
The study aims to assess the counselling services provided to prevent mother to child transmission of HIV (PMTCT) under the Indian programme of prevention of parent-to-child transmission of HIV (PPTCT). Five hospitals in Delhi providing PMTCT services were randomly selected. A total of 201 post-test counselled women were interviewed using a modified version of the UNICEF-PPTCT evaluation tool. Knowledge about HIV transmission from mother-to-child was low. Post-test counselling mainly helped in increasing the knowledge of HIV transmission; yet 20%-30% of the clients missed this opportunity. Discussion on window period, other sexually transmitted diseases and danger signs of pregnancy were grossly neglected. The PMTCT services during the antenatal period are feasible and agreeable to be provided; however, certain aspects, like lack of privacy, confidentiality of HIV status of the client, counsellor's 'hurried' attitude, communication skills and discriminant behaviour towards HIV-positive clients, and disinterest of clients in the counselling, remain as gaps. These issues may be addressed through refresher training to counsellors with an emphasis on social and behaviour change communication strategies. Addressing attitudinal aspects of the counsellors towards HIV positives is crucial to improve the quality of the services to prevent mother-to-child transmission of HIV.
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Limited evidence is available on the vulnerability of Adolescent Girls and Young Women (AGYW) to sexual risk behaviour and STI/HIV. Though there are almost no statistics available on vulnerability, related literature suggests that AGYW have low awareness about sexual risk behaviour/ transmission and the prevalence of STI/HIV, making them vulnerable. We conducted a rapid review of peer-reviewed studies addressing transmission network, prevalence, incidence awareness, common determinants of sexual risk behaviour/STI/HIV, health-seeking behaviour and existing interventions addressing the situation among AGYW (age 15–24) to inform the evidence gap in this crucial area of research. We registered the study in PROSPERO (CRD42023403713). We developed detailed inclusion/exclusion criteria, searched JSTOR, PubMed, Google Scholar, Science Direct and Population Council Knowledge Commons databases and followed the guidance from Cochrane Rapid Review to develop the rapid review. We also searched the bibliography of the included studies. We included the English language peer-reviewed quantitative, qualitative, mixed method studies published from Jan 1 2000 to Mar 31 2023. Six reviewers extracted data, and the seventh reviewer independently assessed the quality. Ninety-six studies met the inclusion criteria. We used descriptive statistics and narrative synthesis methods for data analysis. We also conducted a Risk of Bias Assessment (RoB) to check the quality of the included studies. Inadequate literature was found on the transmission network. Prevalence and awareness of STI/HIV are low among AGYW. However, Female Sex Workers, sex-trafficked women or drug users in this age group suffer more. Age, education, income, relationship dynamics with spouses/partners, multiple partners, and substance use are crucial in determining STI/HIV. Traditional sources of health seeking are more popular than formal sources because of social stigma. Mass media campaigns, community mobilization programs, and life skills training programs increase awareness about HIV, condom use and self-efficacy. The inclusion of only English language studies and not conducting meta-analysis because of high heterogeneity are some of the limitations of the study.
Human Immunodeficiency Virus (HIV) in East Java was not only occurred in urban areas. This is due to the population mobility and sexual lifestyles. This study aimed to classify districts/cities in East Java used Cluster K-Means analysis based on the number of high risk population that living with HIV. This study was an observational study with an analytical method. The secondary data was taken from HIV and PIMS Situation Report of the East Java Provincial Health in 2017. This study obtained 3 optimal clusters, which were 4 districts/cities in cluster 1 named alert category, 24 districts/cities in cluster 2 named standby category and 10 districts/cities in cluster 3 named alert category. Proposed suggestions based on this study were prioritized early HIV test and counseling, provided adequate care, support and treatment for people living with HIV.
Aim
The aim of this three-year retrospective study (2010–2012) is to determine the prevalence, trend and factors associated with HIV infections among pregnant women presenting to Olabisi Onabanjo University Teaching Hospital (OOUTH) and Redeemed Camp Maternity Centre (RCMC) both in Ogun state, south-west, Nigeria.
Background
HIV in pregnant women has become an important focus of HIV research because of its role in the spread of HIV infection, particularly, among children.
Materials and methods
A total of 4140 case records comprising 2272 at OOUTH and 1868 at the RCMC were reviewed. Of these, 3486 (84.2%) had records on HIV status. Test of association was carried out to determine factors associated with HIV infection in the two hospitals.
Results
Of 3486 ante-natal clinic attendees during the study period, 272 were confirmed HIV positive resulting in an overall prevalence rate of 7.7%. Analysis of records at the RCMC showed a prevalence of 0.41% (5/1212) while 11.5% (262/2272) was observed at the OOUTH. The prevalence was higher among older women than the younger ones. In RCMC, test of independence showed that HIV prevalence was dependent on parity and religion (p < 0.05) while in OOUTH, it was dependent on gravidity and parity (p < 0.05).
Conclusions
The overall HIV prevalence rate of 7.7% observed among pregnant women in this study was higher than the national average of 4.1%. Furthermore, HIV prevention campaigns need to be tailored towards older women as done for the younger ones in Nigeria, since prevalence was higher in the former than the latter.
Indias HIV epidemic is of global interest. 2 years ago we showed that HIV prevalence in young women declined by about a third between 2000 and 2004 in the southern states of Andhra Pradesh Karnataka Maharashtra and Tamil Nadu. HIV prevalence at young ages (15-24 years) is a useful proxy for trends in HIV incidence. We now present trends up to 2007. Among 423842 women aged 15-24 years tested nationally at antenatal clinics prevalence declined by 54% (95% CI -45 to -63; p<0.0001) between 2000 and 2007 in south India and there was no significant change in north India (3% -47 to 53; p=0.73) where HIV is less prevalent. Declines in south India were similar if we analysed individual age-groups if we excluded Tamil Nadu or restricted the analyses to each individual state or to the sites tested continuously for at least 4 years. Women who use antenatal clinics differ from those who do not in education residence and migration but these demographic factors remained similar from year to year. More research is needed to understand why incidence has fallen in south India. The most probable reason is reduced contacts with female sex work by the husbands of tested women or increased condom use in sex work. Although useful for estimating trends in HIV incidence data from antenatal clinics cannot estimate community prevalence reliably. The National Family Health Survey of 2005-06 (NFHS-3) yielded lower HIV prevalence nationally in adults (0.28% 95% CI 0.25-0.31 at ages 15-49 years) than seen among women at antenatal clinics in our study (0.60% 0.57-0.63 at ages 15-49 years). A study in one district suggested that women with HIV were over-represented in public antenatal clinics but we found that HIV infection was associated with lower use of public antenatal clinics within the NHFS-3. Among 8743 eligible women survival analyses with Coxs regression of time since last antenatal clinic use yielded a hazard ratio for HIV of 0.44 (0.22-0.90; p=0.02) after adjustment for age and sampling unit. The halving of new infections in south India and the lack of demonstrable increases in the north would at first glance seem to be consistent with Indias downward revision of HIV prevalence in 2006 from 5.1 million to 2.5 million (range 2.0-3.1 million). However the revised prevalence estimates are based largely on "hybrid" analyses that combine antenatal clinic and NFHS-3 data whereas earlier estimates were based on antenatal clinic data. The NFHS-3 has biases also including the under-representation of high-risk groups. In conclusion although the estimation of HIV trends is reasonably robust we caution that prevalence estimates remain uncertain. Reliable estimation of prevalence requires combining various sources of data including information on AIDS mortality. (full-text)
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.
These recommendations for human immunodeficiency virus (HIV) testing are intended for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings. The recommendations address HIV testing in health-care settings only. They do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans). The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States. These revised recommendations update previous recommendations for HIV testing in health-care settings and for screening of pregnant women (CDC. Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR 1993;42[No. RR-2]:1-10; CDC. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50[No. RR-19]:1-62; and CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50[No. RR-19]:63-85). Major revisions from previously published guidelines are as follows: For patients in all health-care settings HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Persons at high risk for HIV infection should be screened for HIV at least annually. Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings. For pregnant women HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women. HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.
A recent report suggesting declining HIV transmission rates in southern India has been based on HIV seroprevalence data to estimate HIV incidence. We analyzed HIV incidence rates among 3 cohorts (male, female non-sex worker, female sex worker [FSW]) presenting to sexually transmitted infection (STI) clinics in Pune, India over 10 years.
Between 1993 and 2002, consenting HIV-uninfected individuals were enrolled in a prospective study of the risks for HIV seroconversion. Standardized HIV incidence estimates were calculated separately for the 3 cohorts.
HIV acquisition risk declined by more than 70% for FSWs (P = 0.02) and men (P < 0.001) attending the STI clinics. There was no significant reduction in HIV incidence among women attending STI clinics (P = 0.74). The decline in HIVacquisition risk among male patients with STIs was associated with an increase in reported condom use with recent FSW contact and a decrease in genital ulcer disease.
We report the first direct evidence for a decline in HIV incidence rates in FSWs and male patients with STIs over time. The lack of change in HIV infection risk among non-sex worker women highlights the need for additional targeted HIV prevention interventions.
Estimating the seroprevalence of HIV in a low risk population such as pregnant women provides essential information for an effective implementation of AIDS control programmes, and also for the monitoring of HIV spread within a country. Very few studies are available from north India showing the current trend in HIV prevalence in the antenatal population;which led us to carry outthis study at a tertiary care hospital in north India
Blood samples from pregnant women attending antenatal clinics at the All India Institute of Medical Sciences, New Delhi were collected after informed consent and pre-test counseling. The samples were tested for HIV antibodies as per the WHO guidelines, over a period of four years from January 2003 to December 2006.
Of the 3529 pregnant women tested in four years, 0.88% (CI 0.5 - 1.24) women were found to be HIV seroreactive. Majority of the seroreactive pregnant women (41.9%) were in the age group of 20-24 years followed by the 30-34 yrs (25.8%) and 25-29 years (22.6%) age group. The mean age of the HIV positive women was 24.9 years (SD +/- 1.49 yrs). The HIV seroprevalence rates showed an increasing trend from 0.7% (CI 0.14 - 2.04) in 2003-2004 to 0.9% (CI 0.49 - 1.5) in 2005-2006. This prevalence rate indicates concern, as Delhi and its adjoining states are otherwise considered as 'low prevalence states'.
Seroprevalence of HIV infection was found to be increasing in the last four years amongst pregnant women of North India. These findings are in contrast to the national projections.
These recommendations for human immunodeficiency virus (HIV) testing are intended for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings. The recommendations address HIV testing in health-care settings only. They do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans). The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States. These revised recommendations update previous recommendations for HIV testing in health-care settings and for screening of pregnant women (CDC. Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR 1993;42[No. RR-2]:1-10; CDC. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50[No. RR-19]:1-62; and CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50[No. RR-19]:63-85). Major revisions from previously published guidelines are as follows: For patients in all health-care settings HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Persons at high risk for HIV infection should be screened for HIV at least annually. Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings. For pregnant women HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women. HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.
In September 1999, the Elizabeth Glaser Pediatric AIDS Foundation initiated a multicountry, service-based programmatic effort in the developing world to reduce perinatally acquired HIV infection. We review 6(1/2) years of one of the world's largest programs for the prevention of mother-to-child transmission (PMTCT) of HIV.
Each PMTCT facility records patient data in antenatal clinics and labor and delivery settings about counseling, testing, HIV status, and antiretroviral prophylaxis and submits the data to foundation staff.
More than 2.6 million women have accessed foundation-affiliated services through June 2006. Overall, 92.9% of women who received antenatal care or were eligible for PMTCT services in labor and delivery have been counseled, and 82.8% of those counseled accepted testing. Among women identified as HIV positive, 75.0% received antiretroviral prophylaxis (most a single dose of nevirapine), as did 45.6% of their infants.
The foundation's experience has demonstrated that opt-out testing, supplying mothers with medication at time of diagnosis, and providing the infant dose early have measurably improved program efficiency. PMTCT should be viewed as an achievable paradigm and an essential part of the continuum of care.
AIDS was diagnosed in 187 men and 24 women (M:F = 8:1) from April 1987 till December 1994 at the Christian Medical College Hospital, Vellore. The doubling time of the occurrence of AIDS cases was 14 months; during 1987-90 there were an average of 5.7 cases per year; in 1991-93 there were 28 per year; in 1994 there were 104 cases. The mean age of patients was 33 yr for men and 31 for women. Among men, the primary mode of infection was heterosexual contact with female commercial sex workers. Among women, the most common source of infection was their husbands. There were 4 bisexuals and one homosexual subject who might have acquired infection by having sex with other men. There were 135 subjects from urban and 76 from rural communities. Most subjects belonged to the lower socio-economic classes. These data show that HIV infection had been very widespread in this region, both urban and rural.
To assess the potential of antenatal surveillance data on HIV prevalence in young women as an indicator of trends in HIV incidence.
Review of empirical data and discussion of problems encountered with surveillance systems, illustrated using cohort-component projection models.
Simple descriptive analyses are presented of prevalence and incidence data, with projection models used to explore aspects of the dynamic relationships between changes in HIV incidence and prevalence in young pregnant women for which empirical data are not yet available. Incidence changes due to change in risk among sexually active, and change in pattern of sexual debut are explored separately, and the resulting prevalence trends in pregnant women under age 25 years, and those expecting their first two births are described.
HIV prevalence levels in young pregnant women categorized by age and by parity have different relationships to recent incidence levels. Age categorized prevalence data provide a reasonable indication of incidence under stable conditions, but may be very misleading if the age pattern of sexual debut changes. Prevalence levels categorized by parity are a reliable guide to incidence in the sexually active, but not necessarily to incidence in the population as a whole.
Ante-natal surveillance systems should categorize prevalence data by both age and parity to aid in the interpretation of underlying incidence levels.
Richard Feachem Executive Director of the Geneva-based Global Fund to Fight AIDS Tuberculosis and Malaria recently stated that India now has the world’s largest number of HIV-infected people surpassing South Africa and that India is “on an African trajectory”. He has characterised the Indian Government’s response to the HIV epidemic as “way short of what is necessary to turn around the epidemic”. Recent estimates showing an increasing burden of HIV-infected citizens necessitates that India sustain and intensify its commitment to HIV prevention and treatment. However it is equally important to recognise that the HIV epidemic in India is not “on an African trajectory” and that the response of the Indian Government reflects a commitment to addressing this critical public-health priority. (excerpt)
A single recent study has suggested a decrease in HIV risk for women attending antenatal clinics (ANCs) in southern India. Yet, some have questioned the validity of the Indian national surveillance data and analyses. Previous studies suggest that the only major HIV risk factor for married Indian women is the risk behavior of their husbands. Therefore, to address concerns about potential selection bias in the analysis of sentinel surveillance data from multiple sites, we estimated the trajectory of HIV transmission rates among recently married, monogamous, primigravid women attending a single large ANC in Pune, India.
Participants were self-referred, young, primigravid women from 18 to 27 years of age consenting to HIV screening. Time trends in HIV prevalence over 3.5 years were evaluated by logistic regression adjusted for age. HIV incidence was estimated by dividing the number of HIV-infected mothers by an estimate of exposure person-time, which was an estimate of the average age-specific duration of marriage.
Between August 16, 2002 and February 28, 2006, 30,085 (79.5%) of 37,858 pregnant women consented to HIV screening; 10,982 (36.5%) were primigravid and their age range was from 18 to 27 years. HIV infection risk declined over 3.5 years among primigravid women. An estimated 19,739 person-years (PYs) of exposure yielded an overall HIV incidence rate 1.25/100 PYs (95% confidence interval [CI]: 1.10 to 1.42). Estimated HIV incidence decreased from 2.2/100 PYs (95% CI: 1.6 to 3.0) in 2002 to 2003 to 0.73/100 PYs (95% CI: 0.5 to 1.0) in 2006.
HIV infection risk among young primigravid women in Pune seems to have decreased over the past 3.5 years. A decreasing HIV risk among pregnant women in Pune would also decrease the number of HIV-exposed infants. We hypothesize that decreased high-risk sexual behavior among young recently married men is most likely contributing to a decreasing risk to their wives and children in Pune.
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