TY - JOUR
T1 - Trends in HIV-1 in young adults in south India from 2000 to 2004
T2 - a prevalence study
AU - Kumar, Rajesh
AU - Jha, Prabhat
AU - Arora, Paul
AU - Mony, Prem
AU - Bhatia, Prakash
AU - Millson, Peggy
AU - Dhingra, Neeraj
AU - Bhattacharya, Madhulekha
AU - Remis, Robert S.
AU - Nagelkerke, Nico
N1 - Funding Information:
We thank NACO for providing access to the antenatal and STI data. External funding for the ISHA comes from the Canadian Institute of Health Research (grant no 109 828), the National Commission on Macroeconomics and Health, and the Bill and Melinda Gates Foundation (grant no 34145). P Jha is supported by a Canada Research Chair of the Government of Canada. The opinions represented here are only those of the individual authors. They do not represent the official views of the Government of India, University of Toronto, St Michael's Hospital, or the study sponsors.
PY - 2006/4/8
Y1 - 2006/4/8
N2 - Background: Major increases in HIV-1 prevalence in India have been predicted. Incident infections need to be tracked to understand the epidemic's course, especially in some southern states of India where the epidemic is more advanced. To estimate incidence, we investigated the prevalence of HIV-1 in young people attending antenatal and sexually transmitted infection (STI) clinics in India. Methods: We analysed unlinked, anonymous HIV-1 prevalence data from 294 050 women attending 216 antenatal clinics and 58 790 men attending 132 STI clinics in 2000-04. Southern and northern states were analysed separately. Findings: The age-standardised HIV-1 prevalence in women aged 15-24 years in southern states fell from 1·7% to 1·1% in 2000-04 (relative reduction 35%; ptrend<0·0001, yearly reduction 11%), but did not fall significantly in women aged 25-34 years. Reductions in women aged 15-24 years were seen in key demographic groups and were similar in sites tested continuously or in all sites. Prevalence in the north was about a fifth of that in the south, with no significant decreases (or increases) in 2000-04. Prevalence fell in men aged 20-29 years attending STI clinics in the south (ptrend<0·0001), including those with ulcerative STIs (ptrend=0·0008), but reductions were more modest in their northern counterparts. Interpretation: A reduction of more than a third in HIV-1 prevalence in 2000-04 in young women in south India seems realistic, and is not easily attributable to bias or to mortality. This fall is probably due to rising condom use by men and female sex workers in south India, and thus reduced transmission to wives. Expansion of peer-based condom and education programmes for sex workers remains a top priority to control HIV-1 in India.
AB - Background: Major increases in HIV-1 prevalence in India have been predicted. Incident infections need to be tracked to understand the epidemic's course, especially in some southern states of India where the epidemic is more advanced. To estimate incidence, we investigated the prevalence of HIV-1 in young people attending antenatal and sexually transmitted infection (STI) clinics in India. Methods: We analysed unlinked, anonymous HIV-1 prevalence data from 294 050 women attending 216 antenatal clinics and 58 790 men attending 132 STI clinics in 2000-04. Southern and northern states were analysed separately. Findings: The age-standardised HIV-1 prevalence in women aged 15-24 years in southern states fell from 1·7% to 1·1% in 2000-04 (relative reduction 35%; ptrend<0·0001, yearly reduction 11%), but did not fall significantly in women aged 25-34 years. Reductions in women aged 15-24 years were seen in key demographic groups and were similar in sites tested continuously or in all sites. Prevalence in the north was about a fifth of that in the south, with no significant decreases (or increases) in 2000-04. Prevalence fell in men aged 20-29 years attending STI clinics in the south (ptrend<0·0001), including those with ulcerative STIs (ptrend=0·0008), but reductions were more modest in their northern counterparts. Interpretation: A reduction of more than a third in HIV-1 prevalence in 2000-04 in young women in south India seems realistic, and is not easily attributable to bias or to mortality. This fall is probably due to rising condom use by men and female sex workers in south India, and thus reduced transmission to wives. Expansion of peer-based condom and education programmes for sex workers remains a top priority to control HIV-1 in India.
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U2 - 10.1016/S0140-6736(06)68435-3
DO - 10.1016/S0140-6736(06)68435-3
M3 - Article
C2 - 16616559
AN - SCOPUS:33645990313
SN - 0140-6736
VL - 367
SP - 1164
EP - 1172
JO - The Lancet
JF - The Lancet
IS - 9517
ER -