To what extent is the HIV epidemic in southern India driven by commercial sex? A

[Guest guest]

Editors note: Congratulations! Impressive list of authors and an equality

impressive study. However, for the sake of good research governance practice,

the principal investigators should have thought about including the local

researchers and research institutions as co investigators and co-authors of this

study. Perhaps, research ethics also should have promoted the principal

investigators of this project, to explore ways to strengthen the capacity of the

local researchers. Kudos to Vickerman et al..For a review copy of the full

version of this article you may contact the editor of the FORUM ]

To what extent is the HIV epidemic in southern India driven by commercial sex? A

modelling analysis

Vickermana,b, M. Fossa, Picklesa,c,

Kathleen Deeringd, Supriya Vermaf, Demerse,

M. Lowndese,g, Mosesd, Michel Alarye and Marie-Claude Boilyc

aLondon School of Hygiene and Tropical Medicine, London, bUniversity of Bristol,

Bristol, cDepartment of Infectious Diseases Epidemiology, Imperial College,

London, UK, dSchool of Population and Public Health, University of British

Columbia, Vancouver, British Columbia, eCentre Hospitalier Affilie´

Universitaire de Que´bec and Universite´ Laval, Laval, Canada, fKarnataka Health

Promotion Trust, Bangalore, India, and gHealth Protection Agency, London, UK.

Correspondence to Vickerman, London School of Hygiene and Tropical

Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.

Tel: +44 20 7612 7886; fax: +44 20 7637 5391; e-mail:

peter.vickerman@...

Received: 29 March 2010; revised: 12 July 2010; accepted: 20 July 2010.

DOI:10.1097/QAD.0b013e32833e8663

AIDS: 23 October 2010 - Volume 24 - Issue 16 - p 2563–2572

doi: 10.1097/QAD.0b013e32833e8663

Abstract

Background: In south India, general population HIV prevalence estimates range

from 0.5 to 3%. To focus HIV prevention efforts, it is important to understand

whether HIV transmission is driven by commercial sex.

Methods: A dynamic HIV/sexually transmitted infection transmission model was

parameterized using data from Belgaum and Mysore in south India. Fits to

sexually transmitted infection/HIV data from female sex workers (FSWs) and their

clients for each district were obtained.

Model HIV/herpes simplex virus-2 (HSV-2) prevalence projections for the general

population were cross-validated against empirical estimates not used to fit

model. The model estimated the proportion of incident HIV/HSV-2 infections due

to HIV/HSV-2 transmission between FSWs/clients, their noncommercial partners and

other low-risk partnerships. The relative impact of a generic intervention

targeting different partnerships was explored.

Results: The model's general population HIV/HSV-2 prevalence projections agreed

well with empirical estimates. Recent increases in condom use resulted in

decreasing HIV epidemics in both settings. For men, most incident HIV/HSV-2

infections (>90%) directly result from commercial sex, whereas for women most

are due to bridging infections from clients of FSWs (80–90%) with the remainder

mainly due to commercial sex. Less than 1.5% of incident infections are due to

low-risk partnerships. Intervention impact is maximized through targeting

commercial sex but substantial impact could also be achieved through targeting

noncommercial partners of clients.

Discussion: In southern India, HIV transmission could be driven by FSWs and

their clients. While efforts to reduce HIV transmission due to commercial sex

must continue, prevention programmes should also consider strategies to prevent

transmission from clients to their noncommercial partners.

[Guest guest]

Dear All,

Re:

/messages#n=messages & c=message%2F\

12094 & p=0 & v=t%3D0

We would like to comment on a recent article by Vickerman and colleagues (AIDS

2010, vol 24, pp 2563-2572) that was reported and praised in this forum [To what

extent is the HIV epidemic in southern India driven by commercial sex? Thursday,

October 14, 2010].

Vickerman and colleagues (AIDS 2010, vol 24, pp 2564-2572) say that almost all

people in India got HIV from sex work. The basis on which they make such a claim

is a model with a lot of equations and assumptions. It has so many assumptions,

that no one can say with any assurance that the model is true to life.

Maybe they are right, and maybe they are wrong. Why should we care? 

Here's why: Lets look at just one of the the consequences if they are wrong. To

be specific: Lets consider what they are saying about married women with HIV. 

The latest national survey in India found that 2 out of 5 women who are married

and HIV-positive have HIV-negative husbands. So, when Vickerman and colleagues

say that almost all HIV-positive women are either sex-workers or got HIV from

husbands who visit sex-workers  they are saying that most such HIV-positive

married women (thats several hundred thousand women in India) with HIV-negative

husbands are either sex workers or had affairs with men (other than

their husbands) who visited sex workers.

So, lets imagine going to an HIV-negative man with an HIV-positive wife. There

are several hundred thousand such men. Lets imagine telling him that his wife is

very likely either a sex worker or has had another sex partner.

And we can site experts with all sorts of diplomas and foundation money and

complex mathematics showing that they know whats what. So the husband might

believe us“ and then what happens to the wife and children? 

 

In another recent AIDS-India [Tuesday, October 19, 2010: Social Protection for

Children Affected by AIDS “ Experiences] post I read that UNICEF is concerned to

protect children affected by AIDS.

Heres one way to protect the children: Stop saying that their

HIV-positive mothers are sex workers or have had illicit affairs with men who

visit sex workers.

Don't stigmatize and blame HIV-positive mothers or fathers for sexual

misbehavior. Admit and acknowledge that an unknown proportion of people living

with HIV in India got it from health care, tattoos, or some other blood

exposure. That would protect families, and children. 

Why do so many people who live off AIDS project money spend so much effort to

stigmatize people with AIDS?

Why is the AIDS programme reluctant to incorporate the findings of the AIIMS

2005 study on unsafe injections in India in their national strategies?

Why are so many health care professionals so anxious to blame the victim, and

to deny that health care is often unsafe and dangerous? 

Is't it time to be consistent “not only to say that we should not stigmatize

people with HIV, but also to stop stigmatizing them? 

Best regards, 

Gisselquist

Mariette Correa

Gisselquist

e-mail: <david_gisselquist@...>