Declining HIV incidence among patients attending sexually transmitted infection clinics in Pune, India |
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Authors: | Mehendale Sanjay M Gupte Nikhil Paranjape Ramesh S Brahme Radhika G Kohli Rewa Joglekar Neelam Godbole Sheela V Joshi Smita N Ghate Manisha V Sahay Seema Kumar B Kishore Gangakhedkar Raman R Risbud Arun R Brookmeyer Ron S Bollinger Robert C |
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Affiliation: | National AIDS Research Institute, Pune, India. smehendale@nariindia.org |
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Abstract: | OBJECTIVE: A recent report suggesting declining HIV transmission rates in southern India has been based on HIV seroprevalence data to estimate HIV incidence. We analyzed HIV incidence rates among 3 cohorts (male, female non-sex worker, female sex worker [FSW]) presenting to sexually transmitted infection (STI) clinics in Pune, India over 10 years. METHODS: Between 1993 and 2002, consenting HIV-uninfected individuals were enrolled in a prospective study of the risks for HIV seroconversion. Standardized HIV incidence estimates were calculated separately for the 3 cohorts. RESULTS: HIV acquisition risk declined by more than 70% for FSWs (P = 0.02) and men (P < 0.001) attending the STI clinics. There was no significant reduction in HIV incidence among women attending STI clinics (P = 0.74). The decline in HIVacquisition risk among male patients with STIs was associated with an increase in reported condom use with recent FSW contact and a decrease in genital ulcer disease. CONCLUSIONS: We report the first direct evidence for a decline in HIV incidence rates in FSWs and male patients with STIs over time. The lack of change in HIV infection risk among non-sex worker women highlights the need for additional targeted HIV prevention interventions. |
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