PROCAARE: HIV in monogamous women in India

[procaare@usa.healthnet.org]

Reference: Gangakhedkar, R.R., Bentley, M.E., Divekar, A.D., Gadkari, D.,
Mehendale, S.M., Shepherd, M.E., Bollinger, R.C., Quinn, T.C. (1997).
Spread of HIV infection in married monogamous women in India.  JAMA 278:
2090-2.

This report describes a prospective study enrolling 916 women who
presented to 2 STD clinics in Pune, India.  All were HIV-negative at
enrollment; 525 were female sex workers (FSWs).  92% of the 391women who
were not FSWs reported one lifetime sex partner, while 77% of the FSWs
reported >1000 lifetime sex partners and 94% had >2 within the past three
months.  91.5% of the "non-FSWs" never used condoms within the past three
months, compared to 17% of the FSWs.

Though FSWs reported prior STDs significantly more frequently than did
non-FSWs (60% vs. 35.6%), genital ulcer, cervicitis, or vaginitis were
more commonly diagnosed in follow-up in non-FSWs (65% vs. 43%, p<0.001).
Pelvic inflammatory disease was more common in FSWs (14% vs. 5.1%,
p<0.001).

The prevalence of HIV infection during follow-up was 49.9% among FSWs and
13.6% in non-FSWs.  In multivariate analysis, inconsistent condom use,
genital ulcer, genital molluscum contagiosum, tinea cruris and genital
warts were significantly associated with HIV disease in FSWs.  Among
non-FSWs, only a history of a partner with an STD was significantly
associated with HIV infection.

The increased incidence of STDs among non-FSWs may be a consequence of
referral to clinic after a partner was similarly diagnosed.  The
significant HIV infection rate among monogamous women previously
considered to be at low risk emphasizes the crucial importance of STD and
HIV prevention, counseling, and partner-notification in stemming further
extension of the HIV epidemic in India.

From: Albert Shaw <ashaw@usa.healthnet.org>

KEYWORDS: CLINICAL SCIENCE, EPIDEMIOLOGY, STD, SEX WORKERS, GENITAL ULCER,
MOLLUSCUM CONTAGIOSUM, TINEA CRURIS, GENITAL WARTS, INDIA 
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