Declining HIV incidence among patients attending sexually transmitted infection clinics in Pune, India.
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.
Mehendale
Sanjay M
SM
National AIDS Research Institute, Pune, India. smehendale@nariindia.org
Gupte
Nikhil
N
Paranjape
Ramesh S
RS
Brahme
Radhika G
RG
Kohli
Rewa
R
Joglekar
Neelam
N
Godbole
Sheela V
SV
Joshi
Smita N
SN
Ghate
Manisha V
MV
Sahay
Seema
S
Kumar
B Kishore
BK
Gangakhedkar
Raman R
RR
Risbud
Arun R
AR
Brookmeyer
Ron S
RS
Bollinger
Robert C
RC
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