RISK-FACTORS FOR HIV-INFECTION IN PEOPLE ATTENDING CLINICS FOR SEXUALLY-TRANSMITTED DISEASES IN INDIA

Objective-To investigate the risk factors for HIV infection in patient s attending clinics for sexually transmitted diseases in India. Design -Descriptive study of HN serology, risk behaviour, and findings on phy sical examination. Subjects-2800 patients presenting to outpatient cli nics between 13 May 1993 and 15 July 1994. Setting-Two clinics and the National AIDS Research Institute, in Pune, Maharashtra State, India. Main outcome measure-HIV status, presence of sexually transmitted dise ases, and sexual behaviour. Results-The overall proportion of patients infected with HIV was 23.4% (655/2800); 34% (184) of the women and 21 % (459) of the men were positive for HN infection. Of the 560 women sc reened, 338 (60%) had a reported history of sex working, of whom 153 ( 45%) were infected with HIV-1. The prevalence of HIV-1 infection in th e 222 women who were not sex workers was 14%. The significant independ ent characteristics associated with HIV infection based on a logistic regression analysis included being a female sex worker, sexual contact with a sex worker, lack of formal education, receptive anal sex in th e previous three months, lack of condom use in the previous three mont hs, current or previous genital ulcer or genital discharge, and a posi tive result of a Venereal Disease Research Laboratory test. Conclusion s-In India the prevalence of HIV infection is alarmingly high among fe male sex workers and men attending clinics for sexually transmitted di seases, particularly in those who had recently had contact with sex wo rkers. A high prevalence of HIV infection was also found in monogamous , married women presenting to the clinics who denied any history of se x working. The HIV epidemic in India is primarily due to heterosexual transmission of HIV-1 and, as in other countries, HIV infection is ass ociated with ulcerative and non-ulcerative sexually transmitted diseas es.