Risk factors associated with HIV in a population-based study in Andhra Pradesh

August 18, 2008

Risk factors associated with HIV in a population-based study in

Andhra Pradesh state of India

[A copy of this article is available from the editor of the FORUM]

Lalit Dandona, Rakhi Dandona, G Anil Kumar,G

Brahmananda Reddy, M Abdul Ameer, G Mushtaq Ahmed, S P Ramgopal, Mohammed Akbar,

Talasila Sudha and Vemu Lakshmi

International Journal of Epidemiology 2008;1–13.

doi:10.1093/ije/dyn161

Background Population-based data on risk factors associated with HIV

are not readily available from India. This understanding, and an

estimate of the impact of addressing behavioural factors on reducing

HIV, would be useful.

Methods We interviewed a population-based sample of 12 617 persons 15–

49 years old from 66 rural and urban clusters in Guntur district in

the south Indian state of Andhra Pradesh and tested their dried blood

spots for HIV. We used multiple logistic regression to assess the

association of risk factors with HIV, and calculated population

impact numbers for HIV reduction if behavioural factors were

addressed.

Results Among men, there was significant association between HIV and

history of sex with men, blood transfusion, having ever visited sex

worker or multiple lifetime women sex partners, consuming alcohol

before sex, recreational drug use, male non-circumcision and

tattooing (odds ratios 5.74–1.97, P<0.03, R2¼0.11).

Among women, the only identified behavioural factor associated with

HIV was multiple lifetime men sex partners (P¼0.001, R2¼0.10). Taking

into account the relative risk and prevalence of risk factors, the

highest impact on reducing the HIV number per unit population was for

male circumcision.

Conclusions Among the identified factors, male circumcision was

estimated to have the highest relative impact on reducing HIV per

unit population, but the feasibility of this intervention in India

needs further investigation. The low explanatory power in the

regression models of the usually considered risk factors for HIV

suggests that better understanding of HIV dynamics at the population level in

India is needed.

Keywords HIV, India, male circumcision, population impact number,

risk factors

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