Medical transmission of HIV in India

[Guest guest]

[Editors note: The subject tag has been changed from Doctor at  J.J.HOSPITAL

needs counseling about talking with PLHA to Medical transmission of HIV in

India]

Dr Gopal and colleagues,

 

One question I have about this epidemic is why experts who focus on sexual

risks so often want to deny the importance of medical transmission of HIV.

Like many things in life, there can be more than one risk. Those of us who ask

for effective steps to stop nosocomial transmission (ie: investigate unexplained

infections, warn the public) agree that sexual transmission is important. We are

not denying one risk to emphasize another.

About blood risks: Several studies in India found tattoos associated with HIV

infection. As for shaving, it is a small risk, but it is avoidable. We

should tell the public that other peoples' blood is very dangerous -- because it

is -- and that HIV and other pathogens can live on skin-piercing instruments for

hours (dry) or weeks (wet).

Then let people figure out how to be safe. Barbers in India have generally

shifted to disposable razors, which is excellent. Let's appreciate that. But

that is only a beginning. People face many other blood risks.

 

Please note: No government agency in India inspects and enforces infection

control(sterilizing reused instruments) in private formal or informal health

care or in cosmetic services. People who go for services may be at risk. No one

protects them from careless, ignorant, or unscrupulous providers. It is

important to warn people to be aware. 

Now to studies and data. Four recent studies in India show lots of infections

not explained by sexual risks:

(a) A study in Bagalkot District, Karnataka found that HIV prevalence was

significantly greater in men who reported more than one lifetime partner, but

because only 14% of men did so, having more than one partner " explained "

only 20% of men's infections (crude population attributable fraction). Men's HIV

prevalence was not significantly associated with commercial sex or having more

than one sex partner in the past year. HIV prevalence in women was

not associated with reporting more than one sex partner in the past year or

lifetime, or with commercial sex. (Becker et al. AIDS 2007; 21: 737ff.)

( In a study in Mysore District, Karnataka, in 2005-06, having more than two

lifetime partners and having commercial sex were both significantly associated

with HIV prevalence in men, " explaining "  39% and 14% of HIV in men (crude

population attributable fractions). In women, having more than 1 lifetime sex

partner " explained " 16% of HIV in women. (Munro et al. AIDS 2008; 22: S117ff.)

© In a study in Andhra Pradesh, after adjusting for age and other factors, HIV

prevalence was lower in men who reported more than 0 lifetime women sex

partners. Among women, HIV prevalence increased with more than 1 lifetime

partner, but only 9% of women reported more than one lifetime sex

partner, which  " explained " only about 15% of HIV among women (crude population

attributable fraction). (Dandona et al. Int J Epidemiol 2008; 37: 1274ff.)

(d) India's NFHS3 reports 0.9% HIV prevalence in virgin men and women vs 0.28%

in all adults. Because virgins are on average younger than those who had

sexual experience, sex is likely not the only factor that explains higher HIV

prevalence in sexually experienced adults. They are older and have had other

risks as well.

Best regards,

Gisselquist

e-mail: <david_gisselquist@...>