Men’s heavy alcohol use and risk of HIV acquisition and transmission to sexual partners within marriage in India

Background: Heavy episodic drinking by men in India and elsewhere is associated with their sexual risk behaviors, thereby increasing the risk for HIV. This paper assesses whether heavy episodic drinking is associated with acquisition of HIV among married men and its transmission to their spouses in India. Methods: A case-control study was conducted from March-August 2010 among 595 cases (HIV positives) and 611 controls (HIV negatives) aged 18 years and above, recruited from HIV testing and treatment centers in seven districts of eastern and northern India. Logistic regression analyses were used to assess the associations between heavy episodic drinking (defined based on frequency and quantity) in the past 7 days and the following outcome variables: extramarital sex, men’s HIV status and their spouse’s HIV status. Results: No significant difference was observed in the HIV status of men reporting heavy episodic drinking and those reporting light drinking (41% vs. 50%, adjusted odds ratio [AOR] = 0.7, 95% confidence interval [CI] = 0.5-1.0, p=0.083). However, men reporting heavy episodic drinking were more likely to have had sex with a paid partner (past 12 months) than light drinkers (25% vs. 12%, AOR = 3.0; 95% CI = 1.9-4.7, p \u3c 0.001). A higher proportion of men who were heavy episodic drinkers reported having an HIV positive wife than light drinkers (53% vs. 42%, AOR = 4.1; 95% CI = 1.8-9.2, p \u3c 0.001). Conclusions: Men’s heavy episodic drinking is associated with higher prevalence of HIV infection among their spouses. Prevention of heavy episodic drinking and associated men’s risk behaviors may augment efforts to reduce the secondary transmission of HIV

Male out-migration: a factor for the spread of HIV infection among married men and women in rural India.

INTRODUCTION: Thus far, the reasons for increasing HIV prevalence in northern and eastern Indian states are unknown. We investigated the role of male out-migration in the spread of human immunodeficiency virus (HIV) infection through a case-control study in rural India. METHODS: Currently married men and women were recruited from HIV testing and treatment centers across seven selected districts with high rates of male out-migration in eastern and northern India in 2010 using a case-control study design. Case subjects (men: 595, women: 609) were people who tested HIV seropositive and control subjects (men: 611, women: 600) were those tested HIV seronegative. For each gender, we obtained adjusted odds ratios (AORs) and population attributable risks (PARs) for migration, and behavioral factors. RESULTS: For men, the prevalence of HIV was significantly higher among those with a migration history (AOR, 4.4); for women, the prevalence of HIV was higher among those with migrant husbands (AOR, 2·3). For both genders, the returned male migration (men: AOR, 3·7; women: AOR, 28) was significantly associated with higher prevalence of HIV infection. The PAR associated with male migration was higher for men (54.5%-68.6%) than for women (32·7%-56·9%) across the study areas. DISCUSSION: Male out-migration is the most important risk factor influencing the spread of HIV infection in rural areas with high out-migration rates, thereby emphasizing the need for interventions, particularly, for returned migrants and spouses of those migrants

Male Out-Migration: A Factor for the Spread of HIV Infection among Married Men and Women in Rural India

INTRODUCTION: Thus far, the reasons for increasing HIV prevalence in northern and eastern Indian states are unknown. We investigated the role of male out-migration in the spread of human immunodeficiency virus (HIV) infection through a case-control study in rural India. METHODS: Currently married men and women were recruited from HIV testing and treatment centers across seven selected districts with high rates of male out-migration in eastern and northern India in 2010 using a case-control study design. Case subjects (men: 595, women: 609) were people who tested HIV seropositive and control subjects (men: 611, women: 600) were those tested HIV seronegative. For each gender, we obtained adjusted odds ratios (AORs) and population attributable risks (PARs) for migration, and behavioral factors. RESULTS: For men, the prevalence of HIV was significantly higher among those with a migration history (AOR, 4·4); for women, the prevalence of HIV was higher among those with migrant husbands (AOR, 2·3). For both genders, the returned male migration (men: AOR, 3·7; women: AOR, 2·8) was significantly associated with higher prevalence of HIV infection. The PAR associated with male migration was higher for men (54·5%–68·6%) than for women (32·7%–56·9%) across the study areas. DISCUSSION: Male out-migration is the most important risk factor influencing the spread of HIV infection in rural areas with high out-migration rates, thereby emphasizing the need for interventions, particularly, for returned migrants and spouses of those migrants

Understanding the association between injecting and sexual risk behaviors of injecting drug users in Manipur and Nagaland, India

Background: In India, as in rest of the world, HIV prevention programs have focused on HIV transmission through unsafe injecting practices with less attention on sexual risk behaviors among injecting drug users (IDUs). This study examines the sexual risk taking behaviors of IDUs associated with their pattern of drug use in India. Methods: Data were obtained from the behavioral tracking survey conducted in 2009 among 1,712 IDUs in two districts each of Manipur and Nagaland states in Northeastern part of India. Sexual risk behaviors among IDUs were assessed in terms of multiple sex partners, sex with a paid female partner in the last 12 months and inconsistent condom use with any female partner. Results: More than one-fourth (27%) in Manipur and almost one in two (47%) IDUs reported having had sex with two or more female partners in the past 12 months. In Manipur where heroin is commonly used, the odds of having multiple sex partners were higher among non-heroin users than heroin users (42% vs. 23%, Adjusted Odds Ratio (AOR): 1.7, 95% Confidence Interval (CI): 1.1–2.6) and who shared needles/syringes in the last one month than who did not share (46% vs. 26%, AOR: 2.2, CI: 1.2–4.0). In Nagaland, where Spasmoproxyvon (SP, a synthetic opioid analgesic that contains dextropropoxyphene, dicyclomine hydrochloride and paracetamol) is most common, regular injectors as compared to occasional injectors were more likely to report multiple sex partners (67% vs. 42%, AOR: 2.7, CI: 1.8–4.1) and sex with paid partners (13% vs. 3%, AOR: 6.0, CI: 3.0–12.1). Sharing of needles/syringes was positively associated with multiple sex partners (51% vs. 44%, AOR: 1.6, CI: 1.2–2.2), and inconsistent condom use (93% vs. 80%, AOR: 3.0, CI: 1.8–5.1). Conclusions: IDUs with unsafe injecting practices also engage in risky sexual practices magnifying the risk of HIV infection. There is a need to focus on prevention of sexual transmission among high-risk IDUs, particularly in areas where Spasmoproxyvon is commonly used

Effect of peer-led outreach activities on injecting risk behavior among male drug users in Haryana, India

Background: For the past two decades, there has been an enduring HIV epidemic among injecting drug users (IDUs) in India, and the Indian national AIDS control program (NACP) led by the National AIDS Control Organization (NACO) has kept IDUs at the forefront along with other key populations, in its efforts to prevent HIV. Given this, the objective of this study is to examine the association between IDUs’ degree of exposure to peer-led education sessions (under NACP) and their needle sharing practices in Haryana, India. Methods: The data for this study were drawn from a program monitoring system for the years 2009–2010 and 2010–2011. The relationship between IDUs’ background characteristics/injecting practices and degree of exposure to the program was assessed using chi-square and Student’s t tests. Generalized estimating equations (GEE) were used to examine changes in needle sharing practices over time by degree of exposure to peer-led education sessions. Further, the analysis was stratified by frequency of injecting drug use. All statistical analyses were conducted using STATA version 11. Results: The proportion of IDUs who shared needles substantially decreased from 2009 to 2011, particularly among those who attended three or more peer-led education sessions (49% vs 11%, p \u3c 0.001) in a month. Further, subgroup analysis by frequency of injecting drugs demonstrates that this decline was significant among IDUs who injected frequently (adjusted odds ratio = 0.6, 95% confidence interval = 0.3–0.9, p = 0.043). Conclusion: The study results indicate that repeated peer-led outreach sessions are more effective than exposure to a single education session. Hence, HIV prevention programs must promote repeated peer contacts with IDUs every month (at least two meetings) in order to promote safe injecting practices and behavior change

Male out-migration and HIV in East and North India, 2010.

*<p>AOR: adjusted odds ratio; model controlled for age, education, occupation, duration of marriage, type of referral, study district, and reported sex with partner in exchange of money/gifts, lifetime.</p>†<p>PAR: Population-attributable risk; CI: Confidence interval; NE: Not estimable.</p

Socio-demographic and sexual characteristics of HIV seropositive and HIV seronegative men and women—East and North India, 2010.

*<p>AOR: adjusted odds ratio; model controlled for age, education, occupation, duration of marriage, type of referral, study district, and reported sex with partner in exchange of money/gifts at least once in their lifetime.</p>1<p>Dependent variable: HIV seropositive (yes/no).</p

Sexual/behavioral characteristics of HIV seropositive and HIV seronegative men by male out-migration status—East and North India, 2010.

*<p>AOR: adjusted odds ratio; model controlled for age, education, occupation, duration of marriage, type of referral, and study district.</p>†<p>PAR: Population-attributable risk; CI: Confidence interval.</p