India houses the world’s third largest population of people living with Human
Immunodeficiency Virus (HIV) who constitute about 6% of the global HIV burden. In about
2008-9, an estimated 1.9 million [95%CI: 1.5 to 2.5] adults were living with HIV in India.
The four southern Indian states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu
account for about 60% of estimated HIV infections, although they house only 30% of the
adult population.
I report that most HIV infections in infected couples in the general population of India
(85.4% (95%CI: 80.0, 90.7)) were introduced by the male partner. The per-partnership
transmission probability of HIV in the general population was low 29.1% (95%CI: 22.5,
35.7) compared to what has been reported for other STIs.
Important theoretical facilitating factors for HIV transmission were associated with HIV
infection with nearly equal effect sizes in both genders and across HIV–risk settings
(multiple partnerships (OR: 2.46 (95%CI: 1.98, 3.06) and STIs (ORHSV-2: 5.60 (95%CI: 3.37,
9.33); ORSyphilis: 4.12 (95%CI: 2.35, 7.25)). The strength of association of STIs with HIV was
consistent.
Intervention spending on, or coverage of, STI treatment-focused sex work interventions (per
1000 total district population) was associated with a reduced annual risk of either HIV (-
1.7%, 95%CI: -3.3, -0.10) or syphilis (-10.9%, 95%CI: -15.9, -5.8) infection in young
pregnant women in the high-burden southern states. A decreased annual risk of syphilis
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among young pregnant women attending public prenatal clinics in the high-burden southern
states was associated with a unit increase (per 1000 total district population) of intervention
spending (-0.009%, 95%CI: -0.014, -0.004), number of STIs treated (-10.9%, 95%CI: -15.9,
-5.8), FSWs reached (-3.0%, 95%CI: -5.2, -0.7) and condoms distributed (-0.034%, 95%CI: -
0.053, -0.015).
Male sexual behaviour (non-regular partnerships and use of female sex work) is the dominant
driver of HIV transmission in the general population of south India. Ulcerative STIs were
strongly associated with HIV infection in south India and interventions aimed at treating
STIs and promoting safer sex practices for FSWs and their clients have resulted in reductions
in HIV and syphilis incidence and prevalence in the general population of south India.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/43521 |
| Date | 08 January 2014 |
| Creators | Arora, Paul |
| Contributors | Jha, Prabhat |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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