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   2012| October  | Volume 136 | Issue 7  
    Online since December 1, 2012

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The Integrated Behavioural & Biological Assessments - Tool for analysis & evaluation of trends in HIV epidemic
Ramesh S Paranjape, Lakshmi Ramakrishnan, Bitra George
October 2012, 136(7):1-3
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Index based mapping of high risk behaviours for HIV among female sex workers in India
Vasna Joshua, MD Gupte, Rajatashurva Adhikary, Ramesh S Paranjape, Mandar K Manikar, G.N.V. Brahmam, J Mahanta, BM Ramesh
October 2012, 136(7):14-22
Background & objectives: Integrated Behavioral and Biological Assessment (IBBA) study is the first cross-sectional survey to study large number of covariates of HIV/STI (sexually transmitted infection) in India. Generally, districts are identified as of HIV high or low based on its prevalence. Instead, it would be optimal to label the districts based on several high-risk related covariates in the concurrent set up. The objectives of the present study were to obtain an index for each district, to discover 'natural' clusters and a map with Kriged estimates. Methods: The study population consisted of 10461 female sex workers (FSWs) from 29 sites spread over 24 districts from five HIV high prevalent States. Covariates based on demographic characteristics, sexual practices, knowledge of HIV/STI and biological variables were studied. The analyses were done on weighted estimates based on principal component analysis, cluster analysis and Kriging technique. Five factors were extracted and improved using varimax rotation and standardized factor scores obtained. Natural clusters in a multivariate setting were identified. Each district was expressed as geographic co-ordinates and using the standardized scores the Kriged estimates were obtained. Results: The proxy determinants were 'never used a condom', 'wanted to use a condom but did not use', 'experience of condom breakage' and 'current STI that needs a doctor'. Dimapur district stood first rank demanding the greatest attention. The cluster analysis branded Dimapur, Warangal, Prakasam, and Chittoor districts as a cluster, which required greatest attention and kriged estimates showed the high-risk concentrated regions as Andhra Pradesh, Maharashtra and northeast region. Interpretation & conclusions: The results of this study may help the programme officials and policy managers to concentrate on the key factors, and districts/regions, which need greater attention in the order of priority.
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Spatial modeling of HIV prevalence among the clients of female sex workers in Tamil Nadu, south India
Vasna Joshua, V Selvaraj, Thilakavathi Subramanian, CP Girish Kumar, Lakshmi Ramakrishnan, Prabuddhagopal Goswami, Ramesh S Paranjape, Mandar K Manikar
October 2012, 136(7):23-29
Background & objectives: The spread of HIV infection is diverse and unpredictable and is often associated with the geographic factors. The objectives of this study were to identify significant predictors of HIV prevalence using spatial modeling and to produce a smoothened map of predicted values of HIV prevalence using the geographic information system (GIS) technology. Methods: A large cross-sectional survey Integrated Behavioural and Biological Assessment (IBBA) for 1203 clients of female sex workers (FSWs) from three districts (Chennai, Madurai and Salem) of Tamil Nadu, India during October and December 2006, were studied. The survey focused on a number of social, demographic, behavioural and biological indicators and spatial parameters that could be associated with the risk of HIV infection. These were used in a multivariate logistic regression model to predict the probability for positive cases of HIV among the clients of FSWs. To interpolate the prevalence levels across Tamil Nadu and to predict values for areas not covered in the sampling, the study area was divided into 26 clusters or polygons. The predicted HIV probability (prevalence) was aggregated to cluster/polygon level. For interpolation, the inverse distance weighting method (IDW) was used in the GIS methodology. Results: Literate clients, first sex at the younger age of 20 yr or less, clients not undergone HIV testing and who were sampled at the proximity of major roads and busy stations were at greater risk of being infected with HIV in Tamil Nadu. The smoothened surface obtained using GIS methodology showed the wide regional variation of predicted value of HIV prevalence in Tamil Nadu. Interpretation & conclusions: This study shows significance of the emerging GIS technology in the field of HIV/AIDS. The significant predictors of HIV infection and the regional variation of predicted values of HIV prevalence could accomplish better understanding and planning for the health officials in future.
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Sexual activity as risk factor for hepatitis C virus (HCV) transmission among the female sex workers in Nagaland
Purnima Barua, Jagadish Mahanta, Gajendra Kumar Medhi, Jayesh Dale, Ramesh S Paranjape, Gay Thongamba
October 2012, 136(7):30-35
Background & objectives: Female sex workers (FSWs) of north-east India form a unique group as they are exposed to an enormous injecting drug user (IDU) clientele. This association makes them more vulnerable to blood borne viral infections. Over and above some of them also indulge in drug injecting practices along with their partners. The present study was carried out on FSWs to assess the prevalence of hepatitis C virus (HCV) infection and possibility of sexual transmission of HCV and associated risk factors among them. Methods: A sample of 426 FSWs was recruited cross-sectionally using respondent driven sampling methods. Univariate and multivariate logistic regression analysis was carried out to determine the factors associated with HCV infection. Results: The seroprevalence of HCV among 426 FSWs was 9.6 per cent, antibody to HIV was present in 13.4 per cent, 4.9 per cent were co-infected with HIV and HCV. Seroprevalence of HCV among participants without history of injecting drugs use, tattooing or blood transfusion was 7.5 per cent. An increased risk of HCV seropositivity was associated with history of injecting drug use (OR 10.41, CI 4.30-25.22), use of oral drugs (OR 4.7, CI 2.4-9.08), having sexual partners who were injecting drug users (OR 2.9, CI 1.5-5.6), having live-in relationship (OR 7.1, CI 1.59-31.52), HIV seropositivity (OR 10.18, CI 5.05-20.54) and HSV-2 seropositivity (OR 2.86, CI 1.45-5.43) in univariate analysis. In the multivariate analysis, history of injecting drug use, HIV and HSV-2 seropositivity were found to be significantly associated with HCV seropositivity. Interpretation & conclusion: Although acquisition of HCV by sexual route may not be as efficient as parenteral route, yet sexual transmissibility of HCV among FSWs poses high risk to the community.
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Recruitment of at-risk population through network based sampling: experiences from Maharashtra IBBA Round-I survey
Sucheta Deshpande, Anjalee Kohli, Sunil Rathod, Mandar Mainkar, Shirin Kazi, Dilip Pardeshi, Jayesh Dale, Shailaja Aralkar, Narayan Panchal, Uma Mahajan, Ramesh Paranjape
October 2012, 136(7):36-43
Background & objectives: Respondent Driven Sampling (RDS) method is increasingly being used for surveys among hard to reach populations. It essentially relies on the networking among the target population. Key behavioural indicators, HIV and sexually transmitted infection (STI) prevalence were measured under Integrated Behavioural and Biological Assessment (IBBA), designed to study the impact of Avahan India AIDS Initiative. RDS surveys were conducted in 2006 and 2007 among high risk populations. Methods: Four separate surveys covered female sex workers (FSW) (Mumbai, Parabhani), Bar Girl (Mumbai) and injecting drug users (IDU) (Mumbai-Thane) population through RDS. Respondents were recruited through the personal and social networks of the initially selected "seeds". Successive recruitments were done through snowball effect. Duel compensation for participation and recruitment was given. Three uniquely numbered coupons were given to recruit peers from network. Through subsequent waves of recruitment desirable sample was achieved. Informed and voluntary consent was obtained. Results: A total of 338 bar girls, 403 FSWs (Mumbai), 367 FSW (Parbhani) and 376 IDUs (Mumbai/Thane) were recruited through RDS. The desired samples were achieved within three months period. Average seeds recruited for each survey ranged from 22 to 35. Average reported network size ranged from 4.8 to 13.2. Homophily index for each survey group was found to be 0.0 except for bar girl survey (0.3). Some seeds yielded multiple waves of recruitment while many failed to go beyond first wave. Interpretation & conclusions: Our findings suggest that RDS does not appear to recruit more marginalized or undercovered section of the targeted group. Greater preparatory activity and better understanding of networks may be required for setting up appropriate venues across geographical boundaries. Further in-depth network analysis is needed in diverse regional structures and population coverage in conducting RDS surveys locally.
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Heterosexual risk behaviour among long distance truck drivers in India: Role of marital status
Arvind Pandey, Ram Manohar Mishra, Damodar Sahu, Sudhir K Benara, Mandakranta Biswas, Utpal Sengupta, Mandar K Mainkar, Rajatshurva Adhikary
October 2012, 136(7):44-53
Background & objectives: The long distance truck drivers play an important role in the spread of HIV and sexually transmitted infections (STIs). The present study was carried out to examine association of marital status with heterosexual risk behaviour, condom use and prevalence of STI and HIV among long-distance male truck drivers in India. Methods: Using the time location cluster sampling approach, major transshipment locations covering the bulk of India's transport volume were surveyed in 2007. A total of 2,066 long-distance male truck drivers were surveyed and, after consent, interviewed about their socio-demographic characteristics, sexual behaviours, condom use practices, and tested for HIV, reactive syphilis serology, Neiserria gonorrhoeae and Chlamydia trachomatis. The key variable of this study marital status was divided in two categories: married and unmarried. Data were analyzed using multiple logistic regression methods with following four binary outcome variables (i) whether had sex with any non-regular partners in past 12 months; (ii) whether used condom consistently in past 12 months; (iii) whether tested positive for any STI; and (iv) whether tested positive for HIV. Results: Compared to married truck drivers, unmarried were significantly more likely to have sex with non-regular female partners (30.2 versus 66.9%, OR: 5.7, 95% CI 3.6-8.9), less likely to use condom consistently with non-regular female partners (50.1 versus 38.8%, OR: 0.7, 95% CI: 0.4-1.1) and more likely to have HIV (3.7 versus 3.4%, OR: 2.7, 95% CI: 1.1-6.5). Interpretation & conclusions: Unmarried truck drivers have a higher HIV risk behaviour and consequently they were more likely to have HIV than married drivers. Despite of high-risk behaviours, risk-perception remains low among both married and unmarried truck drivers. This belief coupled with inconsistent condom use put currently married long distance truck drivers as well as their wives at risk of getting infected from STI and HIV.
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Decline in unprotected sex & sexually transmitted infections (STIs) among female sex workers from repeated behavioural & biological surveys in three southern States of India
Rajatashuvra Adhikary, Abhishek Gautam, Satya Ranjan Lenka, Prabuddhagopal Goswami, Lakshmi Ramakrishnan, Bitra George, Mandar K Mainkar, S Thilakavathi, G.N.V. Brahmam, Ramesh R Paranjape
October 2012, 136(7):5-13
Background & objectives: Since 2003, Avahan the India AIDS Initiative, has been working with female sex workers (FSW) in Andhra Pradesh (AP), Maharashtra (MH) and Tamil Nadu (TN) using a package of preventive services. Two rounds (R1 and R2) of Integrated Behavioural and Biological Assessment (IBBA) surveys were done to measure changes in condom use and prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in the three Southern States. Methods: Two rounds of bio-behavioural surveys were conducted among FSWs in selected districts of AP, MH and TN during 2005-2007 and 2009, respectively. Survey districts and methodology were consistent across rounds. Participants were selected through two stage conventional cluster sampling from fixed sites and time-location cluster sampling from floating groups. Information on sexual behaviour was collected by face-to-face interview. Participants provided urine and blood samples for testing of STIs. Results: At aggregate level, condom use at every sex act with occasional and regular clients, taken as a whole, increased from 66.8 per cent in R1 to 85.2 per cent in R2 (AOR 3.5, P<0.001). Levels of HIV and syphilis declined from 14.1 to 11.9 per cent (AOR 0.9, P<0.5) and 10.8 to 5.0 per cent (AOR 0.4, P<0.001), respectively. Odds of using condom among FSWs who availed Avahan services was significantly more than those who did not (P<0.01). Interpretation & conclusions: An increase in consistent condom use along with decrease in STIs was observed among FSWs. The increase in safer sexual practices was more among those exposed to Avahan interventions.
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An exploratory analysis of spatial mobility of injection drug users in the northeast region of India
Vasna Joshua, Ramesh S Paranjape, Rajatashurva Adhikary, J Mahanta, Prabuddhagopal Goswami, Mandar K Manikar, GK Medhi, S Brogen Akijam, Bernice Dzuvichu
October 2012, 136(7):54-63
Background & objectives: Injection drug users (IDUs) are generally a mobile group who engage in risky behaviour not only in their locale but also outside areas. The IDUs of the northeast region of India form the major victims of HIV/AIDS infections. Hence an attempt was made to explore their mobility pattern of networking and risky behaviour. Methods: A large cross-sectional Integrated Behavioural and Biological Assessment survey (IBBA) was conducted among 1699 IDUs in four districts (Bishnupur and Churachandpur of Manipur; Phek and Wokha of Nagaland) in the northeast region of India by India AIDS initiative, the Avahan during January and May 2006. The mobility patterns of the IDUs were viewed as two different types, mobility of networking and frequent mobility. The networking mobility has been portrayed using exploratory spatial analysis. The frequently mobile IDUs profile, risky behaviour, HIV and other infections are discussed based on the RDSAT estimates. The volume of mobility and their average movement were also studied. Results: More than 48 per cent of the IDUs had networked far and wide outside their places of residence. One fourth or more of the mobile IDUs were young, more than 35 per cent were literate, more than one fourth were unemployed and nearly 31 per cent or more were living alone. The frequently mobile IDUs risky behaviour was two times higher compared to the non-mobile IDUs (except in Phek district). The average movements of IDUs who had at least one movement inside and outside the district were higher in Wokha district. Interpretation & conclusions: The pattern of networking and the mobile IDUs risky behaviour showed an alarming signal. Mobility being a general phenomenon, the attention towards their surrogate risky factors had to be focussed to control the spatial epidemic wave.
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Factors associated with ever HIV testing among injecting drug users (IDUs) in two HIV high prevalent States of India
Gajendra Kumar Medhi, Jagadish Mahanta, Ramesh S Paranjape, Rajatashuvra Adhikary, Senjam Gojendra Singh, S Brogen Akoijam, Prabuddhagopal Goswami
October 2012, 136(7):64-71
Background & objectives: Injecting drug use plays a major role in HIV transmission in northeastern States of India. HIV testing is the fundamental component of HIV prevention, treatment and care; but it remains relatively low among injecting drug users (IDUs) in the northeast region of the country. We assessed the factors associated HIV testing among IDUs in the two northeastern States (Nagaland & Manipur) of India. Methods: A total of 1699 IDUs from four districts of Manipur (Churachandpur and Bishenpur) and Nagaland (Phek and Wokha) were recruited through respondent driven sampling (RDS). Multivariate logistic regression analysis was performed to determine the factors associated with ever HIV testing. Results: Only 286 (16.8%) respondents were ever tested for HIV. Factors associated with ever HIV testing were: having 5-10 years of education (AOR: 2.41, 95% CI: 1.15-5.06), having >11 years of education (AOR: 3.96, 95% CI: 1.83-8.57), being a businessman (AOR: 1.79, 95% CI: 1.14-2.85), having been contacted by HIV programme workers (AOR: 1.92, 95% CI: 1.37-2.68), having received counselling services (AOR: 2.02, 95% CI: 1.45-2.81), having knowledge that HIV can be prevented (AOR: 4.33, 95% CI: 2.05-9.12), having self-perceived risk of HIV infection (AOR: 1.68, 95% CI: 1.26-2.24) and being a resident of Churachandpur district (AOR: 2.26, 95% CI: 1.36-3.75). Interpretation & conclusions: Increased uptake of HIV testing was associated with exposure to HIV programmes, knowledge of HIV prevention, self-perceived risk of HIV, and higher educational attainment. Urgent measures need to be undertaken based on these findings to promote uptake of HIV testing among the IDUs in this region.
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Some Forthcoming Scientific Events

October 2012, 136(7):72-73
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