title: Is HIV prevalence declining in southern India? Evidence from two rounds of general population surveys in Bagalkot District, Karnataka.
abstract: OBJECTIVE
  To assess the levels and trends in the prevalence of HIV and sexually transmitted infections in the general population in Bagalkot district using 2 cross-sectional surveys undertaken in 2003 and 2009.
  
  
  METHODS
  In both surveys, a target sample of 6600 adult males and females was selected systematically from a sample of 10 rural villages and 20 urban blocks in 3 of the 6 talukas (subdistrict units) in the district. Urine and blood samples were collected from all consenting participants for HIV and sexually transmitted infection testing. Changes in HIV prevalence in age subgroups were determined by logistic regression, taking into account the survey design.
  
  
  RESULTS
  HIV prevalence fell not significantly from 3.2% to 2.5% during the 6-year study period. It decreased significantly (P = 0.023) among persons aged 15 to 24 years, from 2.4% in 2003 (95% confidence interval [95% CI]: 1.2-3.7) to 1.3% in 2009 (95% CI: 0.6 -2.0). However, among males aged 35 and above, HIV prevalence increased significantly (P = 0.008), from 3.0% (95% CI: 1.1-4.8) to 4.2% (95% CI: 1.8-6.6), a level similar to that found in the younger age-group in 2003.
  
  
  CONCLUSIONS
  We observed a significant decline in HIV prevalence among people aged 15 to 24 years, where HIV prevalence more closely reflects incidence. The increase in HIV prevalence among older males may have been because of the aging of a cohort of men among whom HIV prevalence was highest in the 2003 survey. It may also have in part reflected increased survival, as a result of the scaling up of antiretroviral treatment programs throughout the district and state.
authors.affiliation: CHARME-India Project, Bangalore, India. rajaram@khpt.org
authors.forename: Rajaram S
authors.initials: RS
authors.lastname: Potty
authors.forename: Janet E
authors.initials: JE
authors.lastname: Bradley
authors.forename: Banadakoppa M
authors.initials: BM
authors.lastname: Ramesh
authors.forename: Shajy
authors.initials: S
authors.lastname: Isac
authors.forename: Reynold G
authors.initials: RG
authors.lastname: Washington
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.forename: James F
authors.initials: JF
authors.lastname: Blanchard
authors.forename: Marissa L
authors.initials: ML
authors.lastname: Becker
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D015528:HIV Seroprevalence / Q000639:trends*; D015497:HIV-1; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018571:Sentinel Surveillance; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D055815:Young Adult