title: Ecological analysis of the association between high-risk population parameters and HIV prevalence among pregnant women enrolled in sentinel surveillance in four Southern India states.
abstract: BACKGROUND
  The HIV epidemic is very heterogeneous at the district level in the four Southern states of India most affected by the epidemic and where transmission is mainly heterosexual. The authors carried out an ecological study of the relationship between high-risk population parameters and HIV prevalence among pregnant women (ANC HIV prevalence).
  
  
  METHODS
  The data used in this study included: ANC HIV prevalence available from the National AIDS Control Organization (dependent variable); data on prevalence of HIV and other sexually transmitted infections among female sex workers (FSWs), their clients and high-risk men who have sex with men (HR-MSM) from studies carried out in 24 districts under Avahan; data on clients' volume reported by FSWs and on the size estimates of FSWs and HR-MSM in each district; and census data. The latter two sets of data were used to estimate the percentage of female (male) adults who are FSWs (HR-MSM). The latter was also multiplied by HIV prevalence in FSWs (HR-MSM) to obtain the percentage of HIV-positive FSWs (HR-MSM) in the adult female (male) population. Linear regression was used for statistical analyses.
  
  
  RESULTS
  In univariate analyses, HIV (r=0.59, p=0.002) and HSV-2 (r=0.49, p=0.014) prevalence among FSWs and mean number of clients in the last week reported by FSWs (r=0.43, p=0.036) were significant predictors of ANC HIV prevalence. In multivariate analysis, only FSW HIV prevalence remained significant.
  
  
  CONCLUSIONS
  This ecological study suggests that there is a link between HIV prevalence among FSWs and the spread of HIV to the general population in Southern India. Such an observation supports the rationale of interventions targeted at the sex industry.
authors.affiliation: URESP, Centre de recherche FRSQ du Centre de recherche du CHA universitaire de Québec, Québec, Canada. malary@uresp.ulaval.ca
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
authors.forename: A A
authors.initials: AA
authors.lastname: Jayachandran
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Lowndes
authors.forename: Jan
authors.initials: J
authors.lastname: Bradley
authors.forename: Eric
authors.initials: E
authors.lastname: Demers
authors.forename: Rajatashuvra
authors.initials: R
authors.lastname: Adhikary
authors.forename: Mandar K
authors.initials: MK
authors.lastname: Mainkar
mesh_terms: D000328:Adult; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011477:Sex Work / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000635:transmission