Regarding Blanchard and colleagues' comments on HIV and commercial sex in India

Abstract

Contrary to Blanchard and colleagues mis-statement of our position we do not say that HIV transmission through sex is unimportant. We argue that heterosexual commercial sex is very likely responsible for 2-15% of HIV infections among adults. But there are other sexual events to consider. We also do not say that injections are more important than sex in the transmission of HIV in India. We urge attention to all blood exposures not only injections. Other common blood exposures include for example surgeries at health camps blood tests tattooing and dental care. From the available evidence it is not possible to know if blood exposures are more important than sexual exposures. As Potterat pointed out in an editorial published with our article new studies and new evidence are required. Our estimate of the number of HIV infections from commercial sex depends on the number of contacts between female sex workers (FSWs) and clients and not directly on the number of FSWs. Our best and high estimates are that 7-10% of Indian men aged 15-64 years visit FSWs at an average of 7-12 times per year. If these estimates are accurate then debates about the number of FSWs do not undermine our estimate of HIV transmission through commercial sex. The number of FSWs in India and their average number of clients per year will vary according to the definition of FSW. For example in 2003 the India-Canada Collaborative HIV/AIDS Project estimated 11366 easily identifiable urban and rural FSWs in 17 of Karnatakas 28 districts. These FSWs averaged about eight clients per week. (excerpt)