Formation of partnerships among young women and men in Pune district, Maharashtra

Young people in India face traditional age- and sex-stratified norms that espouse gender double standards. Premarital partnerships are taboo and anecdotal evidence suggests that in many settings in India, the hint of a romantic relationship or even social interaction between young girls and boys is sufficient to damage a family\u27s reputation and/or result in accelerated arranged marriage, particularly for the girl. While there is a prevailing perception at the community level that in these circumstances, premarital partnerships are rare, there is a small body of literature that suggests that such partnerships are indeed formed and sexual relations experienced, among, typically, fewer than 10 percent of young women and 15–30 percent of young men. At the same time, little is known about the lives of young people and the contexts in which they form romantic, marital, and other partnerships. This report describes the situation of young unmarried and married women and men aged 15–24 in rural and urban slum settings in India, namely Pune district, Maharashtra

Correlates of premarital relationships among unmarried youth in Pune District, Maharashtra, India

Context: Although premarital partnerships - whether or not they involve sex - are widely discouraged in India, some youth do form such partnerships. It is important to know more about the nature of and the factors associated with these relationships. Methods: Data are drawn from a community-based study of 15-24-year-olds in urban slum and rural settings in Pune District, Maharashtra. Multivariate analyses were conducted to identify associations between youths\u27 individual, peer and family factors and their experience of romantic relationships and physical intimacy, including intercourse. Results: Among young men, 17-24% had had a romantic relationship, 20-26% had engaged in some form of physical intimacy and 16-18% had had sex; the proportions among young women were 5-8%,4-6% and 1-2%, respectively. Exposure to alcohol, drugs or pornographic films and having more frequent interaction with peers were positively associated with romantic and sexual relationships for both young women and young men. Educational attainment was negatively associated with both types of relationships for young women, but only with sexual relationships for young men. Closeness to parents was negatively associated with relationships only for young women. Young women whose father beat their mother were more likely than other young women to form romantic partnerships, and those beaten by their family had an elevated risk of entering romantic and sexual partnerships. Youth who reported strict parental supervision were no less likely than others to enter relationships. Conclusions: Program interventions should ensure that youth are fully informed and equipped to make safe choices and negotiate wanted outcomes, while positively influencing their peer networks; encourage closer interaction between parents and children; and be tailored to the different circumstances and experiences of young women and men

Measuring agency among unmarried young women and men

In order to draw out and measure dimensions of agency (the capacity to make choices through the acquisition of a sense of self and a sense of personal competence) among unmarried young women and men, a survey was undertaken among young people in rural and urban slum settings in Pune. It looked at three key dimensions - mobility, decision-making and sense of self-worth. The findings show that agency was clearly constrained among youth inthis setting, irrespective of gender and the rural-urban divide. Second, young women had significantly lower levels of agency than young men on mobility and decision-making, but appeared to have a significantly higher sense of self-worth. Third, the rural-urban differences were negligible and considerably narrower than gender differences. Fourth, older respondents were progressively more likely to report agency on all three dimensions. Age and education were consistently and positively associated with almost every measure of agency for both young women and men

Romance and sex: Pre-marital partnership formation among young women and men, Pune District, India

Using qualitative and survey data in a rural and an urban slum setting in Pune district, India, this paper describes patterns of pre-marital romantic partnerships among young people aged 15-24, in spite of norms that discourage opposite-sex interaction before marriage. 25-40% of young men and 14-17% of young women reported opposite-sex friends. Most young people devised strategies to interact with others, largely from the same neighbourhood. There were wide gender differences with regard to making or receiving romantic proposals, having a romantic partner and experiencing hand-holding, kissing and sexual relations. For those who engaged in sexual relations, the time from the onset of the partnership to having sexual relations was short. Sex most often took place without protection or communication, and for a disturbing minority of young women only after persuasion or without consent. Among those who were unmarried, a large percentage had expected to marry their romantic partner, but for a third of young women and half of young men the relationship had been discontinued. Partnership formation often leads to physical intimacy, but intimacy should be wanted, informed and safe. Findings call for programmes that inform youth in non-threatening, non-judgmental and confidential ways, respect their sexual rights and equip them to make safe choices and negotiate wanted outcomes

Source Case Investigation for Children with TB Disease in Pune, India

Setting. Contact tracing is broadly encouraged for tuberculosis (TB) control. In many high-burden countries, however, little effort is made to identify contacts of newly diagnosed TB patients. This failure puts children, many of whom live in poor crowded communities, at special risk. Objectives. To perform source-case investigations for 50 pediatric TB cases in Pune, India. Design. A descriptive cross-sectional observational study of pediatric TB cases < 5 years of age. Information was collected about the index case and household contacts. Results. In 15 (30%) of the 50 pediatric index cases, the household contained known TB contacts, 14 (86%) of whom were adults. Prior to their own diagnosis of TB, only one of the 15 pediatric index cases who met criteria for isoniazid preventive therapy received it. The index cases with known household TB contacts had a longer delay in initiating TB treatment than those without TB contacts (17.5 versus 2 days; P=0.03). Use of contact tracing identified 14 additional household TB suspects, 8 (57%) of whom were children. Conclusions. This study identified missed opportunities for TB prevention, as contact tracing is poorly implemented in resource-limited countries, like India. Further strategies to improve the implementation of TB prevention, especially in young children, are urgently needed

Pregnancy Differentially Impacts Performance of Latent Tuberculosis Diagnostics in a High-Burden Setting

<div><p>Background</p><p>Targeted screening for latent TB infection (LTBI) in vulnerable populations is a recommended TB control strategy. Pregnant women are at high risk for developing TB and likely to access healthcare, making pregnancy an important screening opportunity in developing countries. The sensitivity of the widely-used tuberculin skin test (TST), however, may be reduced during pregnancy.</p><p>Methods</p><p>We performed a cross-sectional study comparing the TST with the QuantiFERON Gold In-tube (QGIT) in 401 HIV-negative women presenting antepartum (n = 154), at delivery (n = 148), or postpartum (n = 99) to a government hospital in Pune, India. A subset of 60 women enrolled during pregnancy was followed longitudinally and received both tests at all three stages of pregnancy.</p><p>Results</p><p>The QGIT returned significantly more positive results than the TST. Of the 401 women in the cross-sectional study, 150 (37%) had a positive QGIT, compared to 59 (14%) for the TST (p<0.005). Forty-nine (12%) did not have their TST read. Of 356 who had both results available, 46 (13%) were concordant positive, 91 (25%) were discordant (12 (3%) TST+/QGIT-; 79 (22%) TST−/QGIT+), and 206 (57%) concordant negative. Comparison by stage of pregnancy revealed that QGIT percent positivity remained stable between antepartum and delivery, unlike TST results (QGIT 31–32% vs TST 11–17%). Median IFN-γ concentration was lower at delivery than in antepartum or postpartum (1.66 vs 2.65 vs 8.99 IU/mL, p = 0.001). During postpartum, both tests had significantly increased positives (QGIT 31% vs 32% vs 52%, p = 0.01; TST 17% vs 11% vs 25%, p<0.005). The same trends were observed in the longitudinal subset.</p><p>Conclusions</p><p>Timing and choice of LTBI test during pregnancy impact results. QGIT was more stable and more closely approximated the LTBI prevalence in India. But pregnancy stage clearly affects both tests, raising important questions about how the complex immune changes brought on by pregnancy may impact LTBI screening.</p></div

Participant characteristics and LTBI test results by time point of screening in Pune, India.

a<p>Missing variables not included in calculations.</p>b<p>Excluding kitchen and bathroom.</p>c<p>Household Food Insecurity Access Scale: Category 1 =  Food Secure, Category 2 =  Mildly Food Insecure, Category 3 =  Moderately Food Insecure, Category 4 =  Severely Food Insecure.</p>d<p>All women enrolled within 24–48 hours of delivery.</p>e<p>TB symptom screen is positive if cough, fever, weight loss, or night sweats are present.</p><p>Abbreviations: HIV indicates human immunodeficiency virus, IPT indicates isoniazid preventive therapy, IQR indicates interquartile range, MDR-TB indicates multi-drug resistant tuberculosis, NA indicates not applicable, TB indicates tuberculosis, TST indicates tuberculin skin test, QGIT indicates QuantiFERON-TB Gold Test In-Tube.</p

Cross-sectional comparison of TST and QGIT positivity by stage of pregnancy^a.

<p>QGIT positivity was significantly higher than TST positivity at each stage of pregnancy. TST positivity was lowest during delivery and highest in postpartum women. QGIT positivity was stable during antepartum and delivery but was also higher in postpartum women. There was a trend towards a significant difference in TST positivity between antepartum versus delivery (p = 0.17) and antepartum versus postpartum (0.20), and a significant difference between delivery versus postpartum (0.009). There was no significant difference in QGIT positivity between antepartum versus delivery (p = 0.89), but there was a trend towards significance between antepartum versus postpartum (0.11) and a significant difference between delivery and postpartum (p = 0.02). ^aThe number of women who did not return for TST reading was 11 from antenatal, 5 from delivery and 29 from postpartum. Results shown here only include women with both TST and QGIT results. Abbreviations: QGIT =  QuantiFERON TB Gold In-tube Test; TST =  tuberculin skin test.</p