Vijay Yeldandi

HIV infection dynamics in rural Andhra Pradesh south India: a sexual-network analysis exploratory study.

Abstract The southern state of Andhra Pradesh (AP) has one of the highest rates of HIV-1 infection in India. Estimates of HIV infection in rural areas have begun to approximate the urban. Methods of HIV transmission in rural India are poorly understood. We examined risk factors for HIV transmission in a group of rural villages in AP through the use of a sexual-network analysis survey—the Indian Health and Family Life Survey (IHFLS). The study sample included 20 HIV-positive and 40 HIV-negative matched controls randomly selected from a population-based, voluntary counselling and testing program in rural AP. HIV-1 status was confirmed by Western Blot. The 405-item IHFLS is based upon the National Health and Life Survey which has been validated in the US and China. The sample mean age was 37 years and 22% were of a tribal caste. Among female respondents, none were commercial sex workers (CSWs) and there were no significant social or behavioral associations with HIV infection. Among male respondents, ever having bought sex and having more than one lifetime partner were found to be significantly associated with HIV infection (p=0.002 and p=0.017). Amongst sub-populations, all men who had sex with men (MSM) were married. Tribals were more likely to report a concurrent sexual relationship (p=0.04). All high-risk men, including MSM, men who buy sex and men with multiple lifetime female partners did not use condoms. Public health interventions aimed at reducing HIV transmission in rural AP should consider targeting sub-populations of men who engage in covert MSM or CSW, high-risk tribal caste members and at-risk wives.

Initial commitment to pre-exposure prophylaxis and circumcision for HIV prevention amongst Indian truck drivers.

Studies of HIV prevention interventions such as pre-exposure prophylaxis (PREP) and circumcision in India are limited. The present study sought to investigate Indian truck-drivers initial commitment to PREP and circumcision utilizing the AIDS Risk Reduction Model. Ninety truck-drivers completed an in-depth qualitative interview and provided a blood sample for HIV and HSV-2 testing. Truck-drivers exhibited low levels of initial commitment towards PREP and even lower for circumcision. However, potential leverage points for increasing commitment were realized in fear of infecting family rather than self, self-perceptions of risk, and for PREP focusing on cultural beliefs towards medication and physicians. Cost was a major barrier to both HIV prevention interventions. Despite these barriers, our findings suggest that the ARRM may be useful in identifying several leverage points that may be used by peers, health care providers and public health field workers to enhance initial commitment to novel HIV prevention interventions in India.

HIV infection, genital symptoms and sexual risk behavior among Indian truck drivers from a large transportation company in South India

Background: Sentinel surveillance conducted in the high Human Immuno-deficiency Virus (HIV) prevalent state of Andhra Pradesh includes sub-populations thought to be at high-risk for HIV, but has not included truck drivers. Novel HIV prevention programs targeting this population increasingly adopt public - private partnership models. There have been no targeted studies of HIV prevalence and risk behavior among truck drivers belonging to the private sector in India. Methods: A sample of 189 truck drivers, aged between 15 and 56, were recruited from Gati Limiteds large trucking depot in Hyderabad, India. A quantitative survey instrument was conducted along with blood collection for HIV 1/2 testing. Multivariate regression models were utilized to determine predictors of HIV infection and risk behavior. Results: 2.1% of subjects were infected with HIV. Older age was protective against self-reported genital symptoms (OR = 0.77; P = 0.03), but these were more likely among those truck drivers with greater income (OR = 1.05; P = 0.02), and those who spent more time away from home (OR = 25.7; P = 0.001). Men with higher incomes also reported significantly more sex partners (OLS coefficient = 0.016 more partners / 100 rupees in monthly income, P = 0.04), as did men who spent a great deal of time away from home (OLS coefficient = 1.30, P = 0.002). Drivers were more likely to report condom use with regular partners if they had ever visited a female sex worker (OR = 6.26; P = 0.002), but married drivers exhibited decreased use of condoms with regular partners (OR = 0.14, P = 0.008). Men who had higher levels of knowledge regarding HIV and HIV preventative practices were also more likely to use condoms with regular partners (OR = 1.22, P = 0.03). Conclusion: Time away from home, urban residence, income, and marital status were the strongest correlates of genital symptoms for Sexually Transmitted Infections (STI) and risk behaviors, although none were consistent predictors of all outcomes. Low HIV prevalence might be explained by a cohort that was mostly married, and at home. Novel HIV prevention interventions may be most cost effective when focusing upon young, single, and long-haul truck drivers.

A protective effect of circumcision among receptive male sex partners of Indian men who have sex with men.

The role of circumcision in the transmission of human immunodeficiency virus (HIV) among men who have sex with men (MSM) in resource restricted regions is poorly understood. This study explored the association of circumcision with HIV seroprevalence, in conjunction with other risk factors such as marriage and sex position, for a population of MSM in India. Participants (nxa0=xa0387) were recruited from six drop-in centers in a large city in southern India. The overall HIV prevalence in this sample was high, at 18.6%. Bivariate and multivariable analyses revealed a concentration of risk among receptive only, married, and uncircumcised MSM, with HIV prevalence in this group reaching nearly 50%. The adjusted odds of HIV infection amongst circumcised men was less than one fifth that of uncircumcised men [adjusted odds ratio (AOR) 0.17; 95% CI 0.07–0.46; Pxa0<xa00.001]. Within the group of receptive only MSM, infection was found to be lower among circumcised individuals (AOR, 0.30, 95% CI 0.12–0.76; Pxa0<xa00.05) in the context of circumcised MSM engaging in more UAI, having a more recent same sex encounter and less lubricant use when compared to uncircumcised receptive men. To further explain these results, future studies should focus on epidemiologic analyses of risk, augmented by social and sexual network analyses of MSM mixing.

General hygiene sexual risk behaviour and HIV prevalence in truck drivers from Andhra Pradesh South India: implications for prevention interventions.

The relationships between hygiene, sexual behaviour and HIV infection are poorly understood. We examine these relationships in Indian truck drivers, a group at high risk for HIV infection. Truck drivers (n = 189) were recruited into an integrated HIV and hygiene Information Motivation (IM) programme. Sociodemographic characteristics, sexual and hygiene behaviour and HIV prevalence were determined. Multivariate logistic regression and linear generalized estimating equation models were utilized. At baseline, 2.1% of drivers were HIV infected and 34% who reported having contact with female sex workers (FSWs) had contact within the previous six months. Those who washed their hands postdefecation were less likely to report genital symptoms (OR 0.02; P = 0.01) and have sex with an FSW (OR [odds ratio] 0.21; P = 0.05). After an IM intervention, there were no changes in sexual risk-taking behaviour (coefficient −0.15 to −0.02; P = 0.13–0.75); however, hygiene behaviour improved from baseline (coefficient 0.09–0.31; P < 0.01 to P = 0.03). Personal hygiene habits, like handwashing, seem to be a modifiable behaviour after a modest intervention, whereas HIV risk-taking behaviour was not. The association between hygiene and HIV risk-taking suggests the need for further evaluation of the relationship and that of other hygiene practices in high-risk men in India.

Field-Based Video Pre-Test Counseling, Oral Testing, and Telephonic Post-Test Counseling: Implementation of an HIV Field Testing Package Among High-Risk Indian Men

In India, men who have sex with men (MSM) and truck drivers are high-risk groups that often do not access HIV testing due to stigma and high mobility. This study evaluated a field testing package (FTP) that identified HIV positive participants through video pre-test counseling, OraQuick oral fluid HIV testing, and telephonic post-test counseling and then connected them to government facilities. A total of 598 MSM and truck drivers participated in the FTP and completed surveys covering sociodemographics, HIV testing history, risk behaviors, and opinions on the FTP. MSM and truck drivers equally preferred video counseling, although MSM who had been previously tested preferred traditional methods. Nearly all participants preferred oral testing. Rates of counseling completion and linkage to government centers were low, with one-third of newly identified positives completing follow-up. With increased public-private coordination, this FTP could identify many hard-to-reach preliminary positive individuals and connect them to government testing and care.

Pre-exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population

This exploratory study examined the facilitators of and barriers to acceptance of pre‐exposure prophylaxis (PrEP) and potential risk compensation behaviour emerging from its use among men who have sex with men (MSM) and transgender individuals (TGs) in India.

A Gold-Standard for Entity Resolution within Sexually Transmitted Infection Networks

Contact tracing for venereal disease control has been widespread since 1936 and relies on reported information about contacts’ attributes to determine whether two contacts may represent the same individual. We developed and implemented a gold-standard for determining overlap between contacts reported by different individuals using cell phone numbers as unique identifiers. This method was then used to evaluate the performance of using reported names and demographic characteristics to infer overlap. Cell-phone numbers, names and demographic data for a sample of high-risk men in India and their contacts were collected using a novel, hybrid instrument involving both cell-phone data extraction and Computer-Assisted Personal Interviewing (CAPI). Logistic regression was used to model the probability that a pair of contacts reported by different respondents were identical, based on the correspondence between their reported names and attributes. A discrete mixture model is proposed which provides predictions nearly as good as the logistic model but may be used in a new population without re-calibration. Despite achieving AUCs of 0.83–0.86, the low rate of true overlap among a very large number of contact pairs still results in a high rate of false positives. Next generation contact tracing calls for more archived or digital matching processes.

Prevalence of Vitamin D Deficiency, Metabolic Syndrome and Association Between the Two in a South Asian Population

Background: The etiological role of vitamin D in the metabolic syndrome among Asian Indians with good exposure to sunlight is not well understood. The objective of this was to estimate the prevalence of metabolic syndrome and vitamin D deficiency and to determine the association between vitamin D status and metabolic syndrome in an Asian Indian population from Hyderabad, India.Methods: 299 normal individuals were randomly selected, for this cross sectional study, from individuals who voluntarily participated in a health camp. Anthropometric measures were taken along with 25-hydroxyvitamin D, fasting blood glucose, complete lipid profiles were also assessed. Socio-demographic data such as sex, age, smoking status, physical activity and diet were also collected. Data was analyzed using t-tests and chi-square test of association.Results: 81.6% had 25 (OH) D deficiencies, 13.4% had insufficiency and 44% had metabolic syndrome. Females had lower levels of mean 25 (OH)D 18.33 ± 12.9 nmol/l as compared to males. 34.4% had 25 (OH)D deficiency as well as metabolic syndrome. A significant (p=0.02) association was observed between serum 25(OH)D and metabolic syndrome. Participants with 25(OH)D insufficiency had 4.6 (p-value=0.023) times higher odds of metabolic syndrome versus those with 25(OH)D >100 nmol/l, whereas those with deficiency had approximately 2 times higher odds.Conclusion: Vitamin D deficiency has become a pervasive problem with implications for cardiovascular health across age and gender groups. Our research indicates that women are at a higher risk of having metabolic syndrome than men if they have deficiency or insufficiency of vitamin D. Timely translational research needs to develop the appropriate interventions to stem this.

Women Connected to at Risk Indian Men Who Have Sex with Men: An Unexplored Network

Little is known about the women connected to Indian MSM and their impact on HIV risk. We surveyed 240 Indian MSM, who identified their social networks (nxa0=xa07,092). Women (nxa0=xa01,321) comprised 16.7xa0% of the network, with 94.7xa0% representing non-sexual connections. MSM were classified as having low, moderate, or high female network proportion. MSM with moderate female network proportion (8–24xa0% total network) had significantly lowered odds of HIV seropositivity (AORxa0=xa00.24, 95xa0% CIxa0=xa00.1–0.6). This suggests moderate proportions of female connections could mediate HIV risk. HIV prevention interventions in India could consider the greater involvement of women among their target audiences.AbstractoSe sabe poco sobre las mujeres conectadas a HSH en India y su impacto en el riesgo de VIH. Se encuestó a 240 HSH indios, quienes identificaron sus redes sociales (nxa0=xa07,092). Las mujeres (nxa0=xa01,321) formaron al 16.7xa0% de la red, del cual el 94.7xa0% representa conexiones no sexuales. Los HSH se clasificaron como baja, moderada o alta proporción de red femenina. HSH con proporción moderada de red femenina (8–24xa0% del red total) tuvieron un riesgo significativamente reducido de seropositividad de VIH (AORxa0=xa00,24; IC 95xa0%xa0=xa00,1–0,6). Esto sugiere que tener una proporción moderada de contactos femeninos podría atenuar el riesgo de VIH. Las intervenciones de prevención del VIH en India podrían considerar una mayor participación de las mujeres en su público objetivo.