title: Declining HIV incidence among patients attending sexually transmitted infection clinics in Pune, India.
abstract: OBJECTIVE
  A recent report suggesting declining HIV transmission rates in southern India has been based on HIV seroprevalence data to estimate HIV incidence. We analyzed HIV incidence rates among 3 cohorts (male, female non-sex worker, female sex worker [FSW]) presenting to sexually transmitted infection (STI) clinics in Pune, India over 10 years.
  
  
  METHODS
  Between 1993 and 2002, consenting HIV-uninfected individuals were enrolled in a prospective study of the risks for HIV seroconversion. Standardized HIV incidence estimates were calculated separately for the 3 cohorts.
  
  
  RESULTS
  HIV acquisition risk declined by more than 70% for FSWs (P = 0.02) and men (P < 0.001) attending the STI clinics. There was no significant reduction in HIV incidence among women attending STI clinics (P = 0.74). The decline in HIVacquisition risk among male patients with STIs was associated with an increase in reported condom use with recent FSW contact and a decrease in genital ulcer disease.
  
  
  CONCLUSIONS
  We report the first direct evidence for a decline in HIV incidence rates in FSWs and male patients with STIs over time. The lack of change in HIV infection risk among non-sex worker women highlights the need for additional targeted HIV prevention interventions.
authors.affiliation: National AIDS Research Institute, Pune, India. smehendale@nariindia.org
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Mehendale
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupte
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Paranjape
authors.forename: Radhika G
authors.initials: RG
authors.lastname: Brahme
authors.forename: Rewa
authors.initials: R
authors.lastname: Kohli
authors.forename: Neelam
authors.initials: N
authors.lastname: Joglekar
authors.forename: Sheela V
authors.initials: SV
authors.lastname: Godbole
authors.forename: Smita N
authors.initials: SN
authors.lastname: Joshi
authors.forename: Manisha V
authors.initials: MV
authors.lastname: Ghate
authors.forename: Seema
authors.initials: S
authors.lastname: Sahay
authors.forename: B Kishore
authors.initials: BK
authors.lastname: Kumar
authors.forename: Raman R
authors.initials: RR
authors.lastname: Gangakhedkar
authors.forename: Arun R
authors.initials: AR
authors.lastname: Risbud
authors.forename: Ron S
authors.initials: RS
authors.lastname: Brookmeyer
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017280:Condoms / Q000639:trends; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D021841:Safe Sex; D011477:Sex Work