Abstract
Background: HIV prevalence varies between 0% and 1.6% in India's states. The factors underpinning this variation are poorly defined. Methods: We evaluated the relationship between HIV prevalence by state and a range of risk factors in the Indian 2015 National Family Health Survey. Pearson's correlation was used to assess the relationship between HIV prevalence and each variable. The prevalence of each risk factor was compared between five high-HIV-prevalence states (>1% prevalence) and a large low-HIV-prevalence state (Uttar Pradesh; HIV prevalence, 0.06%). Results: There was an association between HIV prevalence and men's mean lifetime number of partners (r = 0.55; P = 0.001) and men reporting sex with a non-married, non-cohabiting partner (r = 0.40; P = 0.014). In general, men in high-prevalence states were less likely to be circumcised and (with the exception of Chandigarh) use condoms at last sex. In two high prevalence states (Mizoram and Nagaland), men reported a higher number of lifetime partners and a higher prevalence of multiple partners and high-risk sex in the past year. Conclusions: Variation in circumcision prevalence and sexual behavior may contribute to the large variations in HIV prevalence by state in India.
Highlights
There is little consensus as to whether or not differences in sexual behavior play an important role in determining the large differences in HIV prevalence between populations
Certain authors have claimed that non-behavioral factors such as differences in prevalence of herpes simplex virus 2 infection, circumcision rates and sexually transmitted infections (STIs) treatment efficacy are responsible for differences in HIV prevalence[1,2]
This is a population-level characteristic and ecological studies are required to assess if correlates of this network structure are associated with HIV prevalence[7]
Summary
There is little consensus as to whether or not differences in sexual behavior play an important role in determining the large differences in HIV prevalence between populations. Other authors have found that HIV prevalence is associated with high-risk sexual behavior[3,4,5] These latter studies have included ecological-level analyses. The rationale behind ecological studies is that the prevalence of sexually transmitted infections (STIs) is, to an important extent, determined by the structure of the local sex network[6] This is a population-level characteristic and ecological studies are required to assess if correlates of this network structure are associated with HIV prevalence[7]. A number of studies[3,5,8,9], but not all studies[10], have found that correlates of network connectivity, such as rate of partner change and the prevalence of sexual partner concurrency, are positively associated with HIV prevalence.
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