Background: While increasing attention is being focused on prevention of HIV infection in high risk groups, little is known about the sex-related factors within marriage that increase women’s risk for HIV and the similarities and differences between Indian women who are HIV⁺ and HIV^-. The purpose of this study was to examine psychological and sexual risk factors among HIV⁺ and HIV^- married women in North and South India.

Methods: The study was conducted at 4 centres in southern (Chennai) and northern (New Delhi) India. Four hundred and fifty-nine (459) women sought medical services at any of the participating health clinics and were tested for HIV participated. Women were interviewed about their sexual practices and risk taking behaviours, relationship satisfaction, psychological well being, HIV-related knowledge, etc.

Results: Of the 459 women, 216 were HIV⁺ and 243 HIV^-. There were no significant differences in the demographic characteristics of women in Chennai and New Delhi. For HIV⁺ women, the most common source of infection was their husbands. Coercion in sexual relations with the husband was reported by 44% of HIV⁺ and 41% of HIV^- women. However, 83% of women said they would adjust if the marriage became bad. Twelve percent (12%) of HIV⁺ women reported having a sexual partner outside the marriage compared to 4% of HIV^- women (p < 0.01). More HIV⁺ women (34%) suspected that their husbands had sex outside the marriage than HIV^- women (14%), p < 0.0001. Condom use was low in both groups, but increased marginally after the diagnosis of HIV had been made. The performance on the AIDS Risk Behaviour Questionnaire was poor in both groups, especially so for HIV negatives. HIV⁺ women were more likely than their HIV- peers to report depressive symptoms and somatic complaints (23% vs 7%, p < 0.01)

Conclusions: This formative research has identified socio-cultural, gender-related, and relationship-based factors that increase risks for HIV among married Indian women. Given that coercion and force in marriage was common and HIV knowledge was low, these findings highlight the importance of developing HIV prevention programs for the general population, as well as interventions for HIV⁺ women. Our findings suggest that a multifaceted HIV prevention program that addresses sexual relationship and violence within marriage, in addition to providing information on preventive measures to women, is required in India.