Declining HIV incidence among patients attending sexually transmitted infection clinics in Pune, India

J Acquir Immune Defic Syndr. 2007 Aug 15;45(5):564-9. doi: 10.1097/QAI.0b013e3180d0a6ba.


Objective: A recent report suggesting declining HIV transmission rates in southern India has been based on HIV seroprevalence data to estimate HIV incidence. We analyzed HIV incidence rates among 3 cohorts (male, female non-sex worker, female sex worker [FSW]) presenting to sexually transmitted infection (STI) clinics in Pune, India over 10 years.

Methods: Between 1993 and 2002, consenting HIV-uninfected individuals were enrolled in a prospective study of the risks for HIV seroconversion. Standardized HIV incidence estimates were calculated separately for the 3 cohorts.

Results: HIV acquisition risk declined by more than 70% for FSWs (P = 0.02) and men (P < 0.001) attending the STI clinics. There was no significant reduction in HIV incidence among women attending STI clinics (P = 0.74). The decline in HIVacquisition risk among male patients with STIs was associated with an increase in reported condom use with recent FSW contact and a decrease in genital ulcer disease.

Conclusions: We report the first direct evidence for a decline in HIV incidence rates in FSWs and male patients with STIs over time. The lack of change in HIV infection risk among non-sex worker women highlights the need for additional targeted HIV prevention interventions.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Condoms / trends
  • Female
  • HIV Infections / prevention & control*
  • HIV-1*
  • HIV-2*
  • Humans
  • Incidence
  • India / epidemiology
  • Male
  • Prospective Studies
  • Regression Analysis
  • Risk Factors
  • Safe Sex
  • Sex Work