Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India

Abstract

BackgroundHeterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively.MethodsData on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity.ResultsThe average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age≥25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04).ConclusionIlliteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.

Inequalities in access to HIV and syphilis tests in prenatal care in Brazil

“…The higher risk of inadequate quantity of appointments in prenatal care was observed among women with less education and enrolled in cash transfer program. Similar inequalities have been described in other studies in Africa 15 and India 36 . Thus, poor Brazilian women are not likely to carry out the adequate quantity of appointments in prenatal care.…”

“…In both cases, the likelihood of absence of HIV and syphilis tests was more observed among women living in cities with low HDI, and with greater income inequality (Gini index). Inequalities have been described in other studies related to socioeconomic indicators in Africa 15,26 and India 36 .…”

Sero-Prevalence of Human Immunodeficiency Virus (HIV-1) among High Risk Groups in Abuja, Nigeria

“…The result of this study among pregnant women is comparable to latest Nigeria national prevalence figure of 3.0% of 2014. Though it is far below the trend analysis of state HIV prevalence rate of 5.8% in Abuja Federal Capital Territory [31] and the result of 7.9 from National Hospital Abuja [32] but higher than 1.5% reported by [33] in four states in Southern India. [23] reported prevalence of 0.6% among non-commercial partners in Northern Mexico.…”

Persistence of traditional and emergence of new structural drivers and factors for the HIV epidemic in rural Uganda; a qualitative study

“…For instance, in our data collection, women were reported as more likely to face higher risk for HIV infection in situations of domestic violence, widow inheritance, last funeral rites and traditional medical practices to treat female infertility. In India, illiteracy of the woman and early marriage have been shown to be major drivers of HIV infection in a multi state study in the south of the country [24].…”