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Low Rates of HIV Incidence in Core Populations at High Risk of HIV Infection and Bridge Populations in 6 High HIV Prevalence States in India
Ramesh Paranjape*1, S Kulkarni1, B Ramesh2, G Brahmam3, J Mahanta4, J Dale1, B Kishore kumar1, A Risbud1, R Gangakhedkar1, and M Gupte5
1National AIDS Research Institute,Pune, India; 2Karnataka Hlth Promotion Trust, Bangalore, India; 3Natl Inst of Nutrition, Hyderabad, India; 4Regional Med Res Ctr, Dibrugurh, India; and 5Natl Inst of Epi, Chennai, India
Background: The National
AIDS Control Organization of India recently announced that 2.5 million persons
are estimated to be infected with HIV in India. Some of the recent reports have
suggested that the HIV epidemic has slowed down in some states in India. In a cohort of sexually transmitted diseases clinic attendees in Pune, decline in
HIV incidence was reported over 10 years. Integrated behavioral and biological
assessment survey in selected high risk populations was carried out in six high
prevalent states. This provided opportunity to study the incidence of HIV
infection in these populations using BED-capture enzyme immunoassay (BED-CEIA)
assay.
Methods: After mapping of target populations’ probability based sampling
was done in each selected district. The groups included female sex workers
(FSW), clients of FSW, men having sex with men (MSM), and injecting drug users
(IDU). Survey was carried out only if adequate size of target population for
particular group was present. All samples were tested for anti-HIV antibody.
Those found positive among them were tested by BED-CEIA (Calypte Biomedical
Corporation, USA). The assay was earlier validated on HIV seroconverter panel
from India.
Results: Incidence among FSW in Maharashtra varied between 0.43 and 5.09
in 6 districts, 0.61 to 1.3 in 5 districts in Tamil Nadu, 0.47 to 2.77 in 8
districts in Andhra Pradesh, and 4.31 in 1 district tested in Karnataka.
Incidence figures were by and large lower in the clients of commercial sex
workers (bridge population) compared to the FSW in all districts tested.
Incidence of 0.97 was reported among MSM in Mumbai and 4.0 in Bangalore,
between 0.15 and 1.07 in 4 districts of Tamil Nadu, between 0.99 and 2.77 in 4
districts in Andhra Pradesh. IDU in Mumbai-Thane reported incidence of 2.92.
Conclusions: This is first large-scale population-based incidence estimate
among high-risk groups in India using cross-sectional survey by detuned assay.
The overall HIV incidence was reported lower in the Tamil Nadu state in
comparison with other states. This is consistent with report of declining
prevalence in Tamil Nadu. The lower incidence indicates a window of opportunity
to contain the epidemic in India.
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