title: Sero-Epidemiological and Behavioural Survey of HIV, HBV and HCV amongst Indian Armed Forces Trainees.
abstract: BACKGROUND
  Information on the emerging epidemics of Human immunodeficiency virus (HIV), Hepatitis B (HBV) and C (HCV) viruses in younger age groups in India is scanty due to paucity of representative, population based surveys and varied estimation methodology. This study was done to assess the point prevalence of HIV, HBV and HCV infections alongwith the epidemiological factors associated with these infections. Attitudes, beliefs and behaviour related to sexual and injecting drug practices, with a view to assess the need for introduction of screening program for the new entrants of the armed forces was also studied.
  
  
  METHODS
  A multi-centric cross sectional serological and behavioural survey was carried out amongst newly enrolled trainees of the Armed Forces in 2004. The group was selected by multistage random sampling giving equal representation to all regions of India. Study subjects were interviewed using a pretested, validated questionnaire and screened for HIV, HBV and HCV infections by rapid tests. Standard confirmatory tests were carried out for trainees testing positive. Quality assurance measures were integral part of each activity. A database was created in MS Access and SPSS ver 11.0.1 was used for analysis.
  
  
  RESULTS
  Out of the 23,000 trainees included in the study, 22666 (98.55%) were included in the analysis. The age, formal education and age at first sexual intercourse of participants ranged from 16-25 years (median 20), 8-17 years (median 10) and 12-25 years, respectively. Partial knowledge about routes of spread of HIV was highly prevalent but complete knowledge was extremely low. Per thousand point prevalence of HIV, HBV and HCV was 0.61 (95% CI, 0.34-10.3, poisson), 9.31 (8.1-10.65) and 4.44 (3.61-5.39), respectively. Clustering of HIV (4.56 per 1000, 2.19-8.38) and HCV (30.54 per 1000, 23.67-38.78) and a higher number of HCV as compared to HBV was found amongst trainees from northeast. A statistically significant association was found between history of injecting drug use (other than medical) and HCV (p<0.05).
  
  
  CONCLUSIONS
  Self-exclusion for recruitment as military trainees might have resulted in underestimation of general population figures but results provide region wise estimates unavailable till now. Concerted efforts are required in the current HIV/AIDS program activities to bring about knowledge and behaviour change amongst teenagers and young adults.
authors.affiliation: Addl DGAFMS (MR), O/o DGAFMS, 'M' Block, Ministry of Defence, New Delhi.
authors.forename: M
authors.initials: M
authors.lastname: Singh
authors.affiliation: Associate Professor, AFMC, Pune-40.
authors.forename: A
authors.initials: A
authors.lastname: Kotwal
authors.affiliation: Associate Professor (Department of Microbiology), AFMC, Pune-40.
authors.forename: R M
authors.initials: RM
authors.lastname: Gupta
authors.affiliation: DADH, HQ 25 Inf Div, C/o 56 APO.
authors.forename: S
authors.initials: S
authors.lastname: Adhya
authors.affiliation: Reader (Department of Community Medicine), AFMC, Pune-40.
authors.forename: K
authors.initials: K
authors.lastname: Chatterjee
authors.affiliation: Ex DGHS (AF), O/o DGAFMS, 'M' Block, Ministry of Defence, New Delhi.
authors.forename: J
authors.initials: J
authors.lastname: Jayaram
keywords: Behavioural and sero-surveillance; Epidemiology; Hepatitis B virus; Hepatitis C virus; Human immunodeficiency virus