HIV infection dynamics in rural Andhra Pradesh south India

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HIV infection dynamics in rural Andhra Pradesh south India: A sexual-

network analysis exploratory study

Authors: Schneider, J. A.1; Saluja, G. S.2; Oruganti, G.3; Dass, S.4;

Tolentino, J.5; Laumann, E. O.6; Yeldandi, V.7; Pitrak, D.5

AIDS Care, Volume 19, Number 9, October 2007 , pp. 1171-1176(6)

Abstract:

The southern state of Andhra Pradesh (AP) has one of the highest

rates of HIV-1 infection in India. Estimates of HIV infection in

rural areas have begun to approximate the urban. Methods of HIV

transmission in rural India are poorly understood. We examined risk

factors for HIV transmission in a group of rural villages in AP

through the use of a sexual-network analysis survey - the Indian

Health and Family Life Survey (IHFLS). The study sample included 20

HIV-positive and 40 HIV-negative matched controls randomly selected

from a population-based, voluntary counselling and testing program in

rural AP. HIV-1 status was confirmed by Western Blot. The 405-item

IHFLS is based upon the National Health and Life Survey which has

been validated in the US and China. The sample mean age was 37 years

and 22% were of a tribal caste.

Among female respondents, none were commercial sex workers (CSWs) and

there were no significant social or behavioral associations with HIV

infection. Among male respondents, ever having bought sex and having

more than one lifetime partner were found to be significantly

associated with HIV infection (p=0.002 and p=0.017). Amongst sub-

populations, all men who had sex with men (MSM) were married. Tribals

were more likely to report a concurrent sexual relationship (p=0.04).

All high-risk men, including MSM, men who buy sex and men with

multiple lifetime female partners did not use condoms.

Public health interventions aimed at reducing HIV transmission in

rural AP should consider targeting sub-populations of men who engage

in covert MSM or CSW, high-risk tribal caste members and at-risk

wives.

DOI: 10.1080/09540120701336392

Affiliations: 1: Center for AIOS Research, Lifespan/Tufts/Brown,

Boston, US,SHARE, MediCiti Department of Microbiology, Hyderabad,

India 2: MediCiti, Immunology and Infectious Diseases Research

Institute, Ghanpur Village, India 3: SHARE, MediCiti Department of

Microbiology, Hyderabad, India 4: SHARE, Mediciti Department of

Pathology, Ghanpur Village, India 5: Section of Infectious Diseases,

University of Chicago, Chicago, US 6: Section of Sociology,

University of Chicago, Chicago, US 7: Medicine, Resurrection Westlake

Hospital, Melrose Park, US,SHARE, MediCiti Immunology and Infectious

Disesaes Research Institute, Ghanpur Village, India