Shri Kant Singh

A Nexus between Diversity in Women's Empowerment and Violation of their Sexual Rights in India: Evidence from National Family Health Surveys

Concern of women empowerment in terms of violence reduction has become a burning issue in India since last few decades. Highlighting these issues would be impossible without realization of sexual rights of women. Mounting evidences of women empowerment in the country does not make women privileged in providing them, their sexual rights. This study aims to explore whether diverse situation of women’s empowerment is influencing violence against women including their perceived sexual rights by using data of National Family Health Survey fourth round, conducted in 2015-2016. Findings of this study reveal that upswing in the status of women in different dimension of empowerment has reduced the percentage of women who experienced spousal violence across all states of India except Meghalaya, Manipur, Chhattisgarh, Haryana and Karnataka. Further, lack of equity in women empowerment is adversely related to their perceived sexual rights. It is found that the percentage of women perceiving about sexual rights has decline in India from 75% in NFHS-3 to 70% in NFHS-4. Even after being financially empowered and holding rights in household decision making, women lack in negotiation power in individual decision making which relates to their reproductive and sexual rights. Thus, the recent upswing in different dimension of women’s empowerment is not leading towards qualitative change in life of women and they are still victim of violence which largely affects their physical and mental health.

Major Correlates of Anemia among Women (Age 15-49) in India and Spatial Variation, Evidence from National Family Health Survey-4

Background: In the developing countries like India, Anemia continues to remain a serious nutritional problem. The National Family Health Survey (2015-16) has reported a 53% prevalence of Anemia among women, a sluggish decline from 58% in NFHS-3. Objective: The study determines the prevalence of anemia among women by several background characteristics. It also tries to examine the socio-economic inequality in anemia among women across Indian states and attempts to analyze the spatial correlation of anemia among women and its co-variates across 640 districts of India. Methods: The data is taken from the IV round of National Family Health Survey (2015-2016) conducted by the International Institute for Population Sciences, Mumbai. Bivariate analysis and Binary Logistic Regression analysis were used to assess the effects of socio-economic characteristics. Concentration Index and Poor-Rich ratios have been calculated to understand the socio-economic inequality whereas spatial analysis was done to understand the spatial correlation among women and its covariates. Results: Anemia is highly prevalent among women belonging to rural areas and lowest wealth quantiles. Some behavioral factors of women were found to be positively associated with anemia. The highest inequality is being observed in the north-eastern states like Manipur, Nagaland etc. Morans I value depicts high auto correlation; the hotspots were found in the Eastern and Western regions of India. Discussion: Despite slight improvements, hemoglobin concentrations remain low while anemia prevalence remains high in poorest parts of the world. The rich and poor gap seems to be a big matter of concern. Women in India are not only suffering from economic inequalities but also inequalities in terms of food and malnutrition. Wealth is the strongest determinant of anemia among women followed by education and caste.

Linkages between hypertension and coronary heart disease in India: Evidence from India human development survey-2 (2011–2012)

Background: Cardiovascular diseases (CVDs) are the leading causes of death globally (nearly 17.5 million deaths/year). Hypertension and coronary heart disease (CHD) are two of the most important CVDs. There is a dearth of studies at a large scale in India to ascertain the factors as well as social differentials in the prevalence of heart disease associated with hypertension. This paper attempts to bridge the gap in the relevant area. Methodology: Secondary analysis of the data obtained from India Human Development Survey (IHDS), conducted in two rounds in 2004–2005 and 2011–2012, was done (n = 147,201). Bivariate and logistic regression analyses have been used. Results: In India, the prevalence for CHD is 1.1% for 2011–2012. Findings showed that persons with hypertension are 11 times (odds ratio [OR] = 11.58, P < 0.01) more likely to be affected by CHD among adults (15 and above years) as compared to nonhypertensive adults. When the odds are adjusted for socioeconomic and demographic variables, hypertensives are found to be 5 times more likely (OR = 5.096, P < 0.01) to be having CHD as compared to nonhypertensives. Conclusions: The unadjusted odds of suffering from CHD when hypertension is a predictor are much higher than when the odds are adjusted for socioeconomic and demographic variables. Along with hypertension, age, education, and place of residence have also been found to be important determinants of CHD.

Co-infection with Human Immunodeficiency Virus and Hepatitis C Virus among Injecting Drug Users in North-Eastern States of India

Background: Co-infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is a significant problem, especially among injection drug users (IDUs). Coinfection with HIV and HCV is a significant global public health problem. The study aims to examine co-infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among injecting drug users (IDUs) in Northeastern states of India. Materials & method: Data were obtained from a crosssectional bio-behavioural survey Integrated behavioural and biological assessment round 2 (2009-2010) among 1650 IDUs in two north-eastern states, Manipur and Nagaland of India. Univariate with Chi-square test and Binary logistic regression were used for analysis. Results: Co-infection with HIV and HCV was found 15.0% of IDUs in the North-East state of India. The HCV prevalence was 93% among HIV positive IDUs and 34.4% among HIVnegative IDUs respectively. The prevalence of HIV in HCV positive and in HCV negative was 34.3% and 1.7%, respectively. Univariate analysis with Chi-Square test found that age, education, marital status, living status, age at first starting drug use, age at first injecting drug use, duration of first drug use and first injecting drug, shared needle/ syringes with partner, injection with prefilled syringe, draw up drug solutions from a common container, cleaning of needle/syringes and being sexually active were significantly associated with coinfection with HIV and HCV. Multivariate logistic regression revealed that divorced/separated/ widowed (2.8 times, p ≤ 0.001), age at starting drug use 26 years and above (2.2 times, p ≤ 0.001), draw up drug solution from a common container (1.8 times, p ≤ 0.10), injection with prefilled syringes (1.3 times, p ≤ 0.002), cleaning of needle/syringes (2.9 times, p ≤ 0.05) and sexually active (0.56 times, p ≤ 0.05) were independently associated with co-infection with HIV and HCV. Conclusion: Study emphasizes that there should be preventive strategies to control hepatitis C infection among IDUs.

Understanding the Factors Associated with Alcohol Use among Female Sex Workers in a High HIV Prevalence Northeast State of India

Background: The paper illustrates the factors associated with alcohol use among FSWs in Dimapur, an important commercial hub of Nagaland, which is a high HIV prevalence state of India. Methods: The analysis is based on 417 FSWs aged 18 years or older who participated in round 2 of Integrated Behavioural and Biological Assessment (IBBA). Results: There is a significant association between ever consumption of alcohol use in the past month among FSWs and socio-demographic, sexual behaviour and safe sexual practices (p 10th standard of education (0.311 times, p ≤ 0.001), drug use (5 times, p ≤ 0.001), sharing of injecting drugs with the partner ( 3.7 times, p ≤ 0.001) were independently associated with Alcohol use respectively .Those FSWs have first sex and first started sex work at age 15-20 years were 6.3 (p ≤ 0.05) and 2.4 (p ≤ 0.05) times more likely to use alcohol . One significant finding is those female sex workers were less likely to use alcohol consumption that has 5-9 clients per week. Alcohol using older (25+ years) FSWs were 9 times more likely to have HIV. Married FSWs those using alcohol, were less likely to have HIV, and those alcohol using FSWs aged at first sex was 15-20 years, 5 times more likely to have HIV seropositivity. Alcohol using FSWs were 30 times more likely to have HIV, who served their client at Lodge/ Hotel. Conclusion: The findings suggest a need to integrate intervention for alcohol use and related problems in multilevel contexts and with multiple components to effectively reduce alcohol use and to mitigate inconsistent condom use.

An analysis of non response in HIV testing in India: evidences from National Family Health Survey-3

Analysis of sexual behavior of the respondents in terms of number of sexual partners in the last 12 months, condom use with the last sexual partner and pattern of alcohol consumption portrays relatively lower non response among those reported to indulge in risky sexual behavior. Women and men living in urban areas, completed atleast 10 years of schooling and coming from wealthier households are significantly more likely than their respective counterparts to refuse for HIV testing after participating in the interview. The odds of refusals are 0.5 times less likely among rural women and men (p < 0.001). Adult men reporting two or more sexual partners in the last 12 months and women reporting not using condom in their last sexual encounter are significantly less likely to refuse HIV testing. HIV prevalence is predicted among those who were not tested based on a model of HIV for those who were tested. Separate predictions are made for the “interviewed, not-tested” and “eligible, but not interviewed, not-tested” groups. Adjusted HIV prevalence is calculated as a weighted average of the observed prevalence in the tested group and predicted prevalence in the two non-tested groups. The missed population analysis uses reasonable assumptions about HIV prevalence in the nonhousehold population. Given the low HIV prevalence in the general population, it is highly unlikely that the prevalence in the missed population would exceed 10%. Even if we assumed that the prevalence rate in the missed population was as high as 10%, HIV prevalence in the total population would increase from 0.3% to only 0.4%. Discussion On the basis of the adjusted values of these predictors, the hypothesis of relationship between risky sexual behaviour and non response in HIV testing is rejected with 95% confidence interval and hence the non response to HIV testing in NFHS-3 is not likely to under estimate the HIV prevalence in India.