Correlates of HIV Transmission from Husband to Wife among Heterosexual Married Couples in ART-era in West Bengal, India

Abstract

Objective: To identify factors associated with HIV-transmission from husbands to their wives within the existing HIV prevention and control program environment in West Bengal, India. Methods: In this cross-sectional study, information was collected from the study participants on socio-demography and various health issues including sexually transmitted diseases (STDs). They were also tested for blood borne and sexually transmitted infections. Women living with HIV were compared for behavioral and biologic markers against women who did not have the virus. Both these groups of women were married to HIV sero-reactive men. To detect recent HIV infection, HIV sero-negative women were tested by Polymerase Chain Reaction. Results: Of the 234 married couples, 29% (69/234) lived in HIV discordant relationship where wives were not infected with HIV and the rest were concordant for HIV infection. Six of the 165 women living in concordant relationship acquired HIV infection recently. Fifty six percent of the husbands were in advanced stage of HIV disease with CD4 count ≤200/μl while tested for the first time at ART center. Factors independently associated with HIV concordance were 'wives experiencing any STD-symptom after marriage' (Adjusted Odds Ratio (AOR) 2.05; 95% CI 1.09 - 3.83; p=0.02) and 'self-reported male condom use/reduced frequency of sex with spouse' (AOR 2.99; 95% CI 1.29-6.94; p=0.01). Although 'HSV-2 concordance' (Odds Ratio (OR) 2.46; 95% CI 1.32-4.59; p=0.004) and 'bacterial vaginosis' (OR 2.57; 95% CI 1.18-5.61; p=0.02) were associated with HIV infection in wives in uni-variate analyses, the strength of such associations weakened in multi-variate model. ART intake by husbands did not offer any protection against HIV infection in wives. Conclusions: Early initiation of ART among HIV discordant couples, strengthening of STD prevention and control and limitation of self-reported sexual risk reduction to inform HIV-program in India are underscored.