THE good news is that now fewer cases of genital ulcer diseases and increase in condom use over time has led to a sharp decline in the HIV incidence among patients attending Sexually Transmitted Infection (STI) clinics in Pune. National AIDS Research Institute (NARI) scientists have for the first time provided direct evidence of how a significant decline in HIV infection rates among prostitutes and men with STIs has been achieved.
National AIDS Research Institute (NARI) scientists have in their study — published in the August issue of the US-based Journal of AIDS — said that this was the first direct evidence of a decline in HIV incidence rates in prostitutes and male patients with STIs over time in the country.
The finding of declining HIV rates among high-risk men and FSWs is not just good news for Pune but important because it indicates that significant decline in infection rates can be achieved in high-risk individuals in the country, said Dr S M Mehendale, deputy director (senior grade) of NARI and principal investigator of the study.
Mehendale told Newsline the aim was to study how many people who were negative at the beginning of the study become HIV positive (this is called ‘seroconversion’ or a new case of HIV infection. Incidence it is calculated by taking the number of people who become positive during the follow-up study).
According to Mehendale, the HIV incidence rates were analysed among men, women and prostitutes attending STI clinics in Pune over 10 years. The relative risk of HIV infection decreased significantly by approximately 80 per cent among male patients with STIs and by 70 per cent among prostitutes during the 10-year study period.
“Interventions like the extensive counselling employed at our site for risk reduction in behaviour, condom promotion and aggressive management of sexually transmitted diseases have led to this decline,” the NARI scientist says.
Between 1993 and 2002, 14,147 patients attending the STI clinics were screened for HIV, of whom 3,185 (22.5 per cent) were HIV-infected. A total of 3,268 HIV-uninfected individuals participated in the study, and the incidence estimations were done in the three study cohorts with different risk behaviors. In all, 274 seroconversions (new HIV infections) were identified over a period of 10 years.
However, an area of concern was the lack of change in the risk of HIV infection among the women. “There is a need for additional targeted HIV prevention interventions,” said Mehendale.
To identify appropriate strategies for prevention and control under the National AIDS Control and Prevention (NACP-III) programme, it was important to confirm whether decline in HIV seroprevalence also reflected actual declines in HIV transmission rates. Till date, there have been no direct estimates of HIV transmission (HIV incidence) over time from any population in India, Mehendale said.
To analyse trends in HIV transmission rates over time, HIV incidence was calculated for the three risk groups by calendar year.