Kumar Rajesh, Jha Prabhat, Arora Paul, Mony Prem, Bhatia Prakash, Millson Peggy, Dhingra Neeraj, Bhattacharya Madhulekha, Remis Robert S, Nagelkerke Nico
School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Lancet. 2006 Apr 8;367(9517):1164-72. doi: 10.1016/S0140-6736(06)68435-3.
Major increases in HIV-1 prevalence in India have been predicted. Incident infections need to be tracked to understand the epidemic's course, especially in some southern states of India where the epidemic is more advanced. To estimate incidence, we investigated the prevalence of HIV-1 in young people attending antenatal and sexually transmitted infection (STI) clinics in India.
We analysed unlinked, anonymous HIV-1 prevalence data from 294 050 women attending 216 antenatal clinics and 58 790 men attending 132 STI clinics in 2000-04. Southern and northern states were analysed separately.
The age-standardised HIV-1 prevalence in women aged 15-24 years in southern states fell from 1.7% to 1.1% in 2000-04 (relative reduction 35%; p(trend)<0.0001, yearly reduction 11%), but did not fall significantly in women aged 25-34 years. Reductions in women aged 15-24 years were seen in key demographic groups and were similar in sites tested continuously or in all sites. Prevalence in the north was about a fifth of that in the south, with no significant decreases (or increases) in 2000-04. Prevalence fell in men aged 20-29 years attending STI clinics in the south (p(trend)<0.0001), including those with ulcerative STIs (p(trend)=0.0008), but reductions were more modest in their northern counterparts.
A reduction of more than a third in HIV-1 prevalence in 2000-04 in young women in south India seems realistic, and is not easily attributable to bias or to mortality. This fall is probably due to rising condom use by men and female sex workers in south India, and thus reduced transmission to wives. Expansion of peer-based condom and education programmes for sex workers remains a top priority to control HIV-1 in India.
据预测，印度艾滋病毒-1感染率将大幅上升。需要追踪新发感染情况以了解疫情发展趋势，尤其是在印度一些疫情更为严重的南部邦。为了估计发病率，我们调查了在印度产前和性传播感染（STI）诊所就诊的年轻人中艾滋病毒-1的感染率。
我们分析了2000年至2004年期间在216家产前诊所就诊的294050名女性和在132家性传播感染诊所就诊的58790名男性的非关联匿名艾滋病毒-1感染率数据。分别对南部邦和北部邦进行了分析。
2000年至2004年期间，印度南部邦15至24岁女性的年龄标准化艾滋病毒-1感染率从1.7%降至1.1%（相对降幅35%；p趋势<0.0001，年降幅11%），但25至34岁女性的感染率未显著下降。15至24岁女性在关键人口群体中的感染率有所下降，在持续检测的地点或所有地点情况相似。北部邦的感染率约为南部邦的五分之一，2000年至2004年期间没有显著下降（或上升）。印度南部邦20至29岁在性传播感染诊所就诊的男性感染率下降（p趋势<0.0001），包括患有溃疡性性传播感染的男性（p趋势=0.0008），但北部邦的男性感染率降幅较小。
2000年至2004年期间，印度南部年轻女性的艾滋病毒-1感染率下降超过三分之一似乎是真实的，且不太可能归因于偏差或死亡率。这种下降可能是由于印度南部男性和女性性工作者使用避孕套的比例上升，从而减少了向妻子传播。扩大针对性工作者的同伴教育避孕套项目仍然是印度控制艾滋病毒-1的首要任务。
