title: Geographic prevalence and multilevel determination of community-level factors associated with herpes simplex virus type 2 infection in Chennai, India.
abstract: Herpes simplex virus type 2 (HSV-2) is one of the most prevalent sexually transmitted infections, and it increases the risk of transmission of human immunodeficiency virus type 1 at least twofold. Individual-level factors are insufficient to explain geographic and population variation in HSV-2, suggesting the need to identify ecologic factors. The authors sought to determine the geographic prevalence and community-level factors associated with HSV-2 after controlling for individual-level factors among slums in Chennai, India. From March to June 2001, participants aged 18-40 years voluntarily completed a survey and were tested for HSV-2. Community characteristics were assessed through interviews with key informants and other secondary data sources. Multilevel nonlinear analysis was conducted. Eighty-five percent of eligible persons completed the survey; of these, 98% underwent HSV-2 testing, producing a final sample of 1,275. Participants were of Tamil ethnicity, were predominantly female and married, and were on average 30 years old. Fifteen percent were infected with HSV-2, and there was significant variation in HSV-2 prevalence among communities. After controlling for individual-level factors, the authors identified community-level factors, including socioeconomic status and the presence of injection drug users, that were independently associated with HSV-2 and explained 11% of the variance in prevalence. Future studies are needed to test mechanisms through which these community-level factors may be operating.
authors.affiliation: Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA. jjennin1@jhmi.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Jennings
authors.forename: T A
authors.initials: TA
authors.lastname: Louis
authors.forename: J M
authors.initials: JM
authors.lastname: Ellen
authors.forename: A K
authors.initials: AK
authors.lastname: Srikrishnan
authors.forename: S
authors.initials: S
authors.lastname: Sivaram
authors.forename: K
authors.initials: K
authors.lastname: Mayer
authors.forename: S
authors.initials: S
authors.lastname: Solomon
authors.forename: R
authors.initials: R
authors.lastname: Kelly
authors.forename: D D
authors.initials: DD
authors.lastname: Celentano
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000209:etiology* / Q000635:transmission / Q000821:virology; D018258:Herpesvirus 2, Human; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D010865:Pilot Projects; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors; D012725:Sexual Behavior; D012923:Social Class; D011795:Surveys and Questionnaires