Seroprevalence of sexually transmitted viruses in the tribal population of Central India

The Prevalence of HIV Infection in Minority Indigenous Populations of the South-East Asia and Western Pacific Regions: A Systematic Review and Meta-analysis

A random effects meta-analysis was used to estimate the pooled prevalence of HIV infection within minority indigenous populations of the South-East Asia (SEAR) and Western Pacific Regions (WPR). Sub-group analyses were conducted, and the sources of heterogeneity explored through meta-regression. The majority of studies were undertaken in high HIV risk subpopulations. There was a paucity of data for many countries with data from China representing 70% of the comparative studies. Within minority indigenous populations the pooled prevalence of HIV infection was 13.7% (95% CI 8.9, 19) and 8.4% (95% CI 6.3, 10.7) among other populations. The prevalence differential between populations was significant in the WPR (adjusted odds ratio 1.1, 95% CI 1.0, 1.2). Across both regions, in contrast to other populations, minority indigenous did not experience any significant reduction in HIV prevalence over the years of data collection. There was large heterogeneity in the prevalence of HIV across studies.

High Prevalence of Hepatitis C Virus Infection in Primitive Tribes of Eastern India and Associated Sociobehavioral Risks for Transmission: A Retrospective Analysis

Purpose: The primitive tribal groups (PTGs) need special attention because of their low population growth: declining population size with high mortality rates. Scanty reports are available on the prevalence of hepatitis C virus (HCV) infection in primitive tribes of the country emphasizing their cultural and social practices associated with transmission of the disease.

Methods: The study was conducted on 1765 tribal individuals covering 5 PTGs, namely Lodha, Saora, Khadia, Juanga, and Mankidia, from 6 districts of Odisha. Serum samples were tested for the anti-HCV antibody using commercially available enzyme immunoassays. HCV RNA was detected based on the 5′ NCR region and genotyping was done by direct sequencing of the core region. Potential risk factors for HCV transmission were collected using a questionnaire and subjected to regression analysis through SPSS, version 17.0.

Results: Antibody to HCV was detected in 0%, 3.3%, 5.7%, 8.5%, and 13.4% in Saora, Lodha, Khadia, Juanga, and Mankidia tribes, respectively. HCV RNA was detected in 8.6% (11/127) of the samples tested. Genotyping of HCV isolates in all HCV RNA-positive samples revealed genotype 1b. Sharing of razors and shaving by the village barber were found to be significantly (p<0.05) associated with HCV transmission in males, whereas tattooing and multiple injections were found to be significant risk factors for females.

Conclusion: This study indicated a high prevalence of HCV infection in Mankidia and Juanga tribes in comparison with the national scenario, which needs public health attention.

Epidemiology of sexually transmitted infections in global indigenous populations: data availability and gaps

Socioeconomic and health disadvantage is widespread within and across indigenous communities in the world, leading to differentials in morbidity and mortality between indigenous and non-indigenous populations. Sexually transmitted infections (STIs), including HIV/AIDS, among indigenous populations are an emerging public health concern. The focus of this paper is on examining the STI epidemiology in indigenous communities in various parts of the world utilizing a range of data sources. Most of the STI research on global indigenous communities has concentrated on developed countries, neglecting more than half the world's indigenous people in the developing countries. This has resulted in major gaps in data at global level for STIs and HIV/AIDS among indigenous populations. Available data show that the prevalence of STIs is increasing among the indigenous communities and in several instances, the rates of these infections are higher than among non-indigenous populations. However, HIV still remains low when compared with the rates of other STIs. The paper argues that there is an urgent need to collect more comprehensive and reliable data at the global level across various indigenous communities. There is also an opportunity to reverse current trends in STIs through innovative, evidence-based and culturally appropriate targeted sexual health programmes.

A QUESTION MODULE FOR ASSESSING COMMUNITY STIGMA TOWARDS HIV IN RURAL INDIA

This paper describes a simple question module to assess community stigma in rural India. Fear of stigma is known to prevent people from seeking HIV testing and to contribute to further disease transmission, yet relatively little attention has been paid to community stigma and ways of measuring it. The module, based on a vignette of a fictional HIV-positive woman, was administered to 494 married women and 186 unmarried male and female adolescents in a village in rural Maharashtra, India. To consider the usefulness of the question module, a series of hypotheses were developed based on the correlations found in other studies between HIV-related stigma and socio-demographic characteristics (age, education, discussion of HIV with others, knowing someone living with HIV, knowledge about its transmission and whether respondents acknowledged stigmatizing attitudes as their own or attributed them to others). Many of the study's hypotheses were confirmed. Among married women, correlates of stigma included older age, lack of discussion of HIV and lack of knowledge about transmission; among adolescents, lower education and lack of discussion of HIV were the most significant correlates. The paper concludes that the question module is a useful tool for investigating the impact of interventions to reduce stigma and augment social support for people living with HIV in rural India.

A systematic review and meta-analysis of risk factors for sexual transmission of HIV in India

Background

Approximately 2.4 million people are living with HIV in India. This large disease burden, and potential for epidemic spread in some areas, demands a full understanding of transmission in that country. We wished to quantify the effects of key sexual risk factors for HIV infection for each gender and among high- and low-HIV risk populations in India.

Methodology

We conducted a systematic review of sexual risk factors for HIV infection from 35 published studies. Risk factors analyzed were: male circumcision/religion, Herpes Simplex Virus 2, syphilis, gonorrhoea, genital ulcer, multiple sexual partners and commercial sex. Studies were included if they met predetermined criteria. Data were extracted and checked by two researchers and random-effects meta analysis of effects was conducted. Heterogeneity in effect estimates was examined by I² statistic. Publication bias was tested by Begg's test and funnel plots. Meta regression was used to assess effect modification by various study attributes.

Results

All risk factors were significantly associated with HIV status. The factor most strongly associated with HIV for both sexes was HSV-2 infection (OR_men: 5.87; 95%CI: 2.46–14.03; OR_women: 6.44; 95%CI: 3.22–12.86). The effect of multiple sexual partners was similar among men (OR = 2.46; 95%CI: 1.91–3.17,) and women (OR = 2.02; 95%CI: 1.43–2.87) and when further stratified by HIV-risk group. The association between HSV-2 and HIV prevalence was consistently stronger than other STIs or self-reported genital ulcer. If the strong associations between HSV-2 and HIV were interpreted causally, these results implied that approximately half of the HIV infections observed in our study population were attributable to HSV-2 infection.

Conclusions

The risk factors examined in our analysis should remain targets of HIV prevention programs. Our results confirm that sexual risk factors for HIV infection continue to be an important part of Indian HIV epidemic 26 years after it began.

Prevalence of herpes simplex virus type 2 in different risk groups: thirty years after the onset of HIV

BACKGROUND

Herpes simplex virus type 2 (HSV2) is a sexually transmitted disease causing a lifelong persisting infection.

OBJECTIVE

To determine the seroprevalence of anti-HSV2-IgG in a German collective. We evaluate the German serological status, point out trends in the chronological spread of HSV2 infection, and position our findings in a global context.

METHODS

Serum samples from 29,694 patients at the University Hospital Frankfurt am Main, Germany, were screened for anti-HSV2-IgG using ELISA. We evaluated five defined groups containing patients from the departments of pediatrics (PED), gynecology (GYN), dermatology (DER), psychiatrics (PSY) and patients suffering from HIV/AIDS (HIV).

RESULTS

We retrospectively evaluated an overall seropositivity to anti-HSV2-IgG of 13.6% (95% CI 13.1-14.1), with a significantly higher level in females (15.9%, 95% CI 15.4-16.5) than in males (11.4%, 95% CI 10.9-11.9). The highest seroprevalence was detected in HIV (34.7%, 95% CI 30.3-39.3). The lowest rate was observed in PED (9.9%, 95% CI 9.4-10.6) with an estimated number of 18 infections at delivery between 1/1/2000 and 1/1/2011.

CONCLUSIONS

HSV2 infections are widespread in Germany with a tremendous health risk for newborns. Therefore, the public's perception of HSV2 should be strengthened and protected sexual intercourse should be propagated.

Seroprevalence and risk factors of herpes simplex virus type-2 infection among pregnant women in Northeast India

Background

Herpes simplex virus type-2 (HSV-2) is one of the most common sexually transmitted infections that facilitate human immunodeficiency virus (HIV) acquisition by over two fold or more. The development of HSV-2 control methods as a measure to control HIV epidemic in high HSV-2/HIV areas has become a priority. Two out of the six high HIV prevalent states of India are located in the Northeastern region of India. Due to lack of documented HSV-2 studies from this part of the country; there was a need for estimating the seroprevalence and risk factors of HSV-2 infection in this defined population.

Methods

Pregnant women (n = 1640) aged18 years and above attending antenatal clinics of tertiary referral hospitals in five Northeastern states of India were screened for type specific HSV-2 IgG antibodies. Blood samples were collected from all the participants after conducting interviews. Univariate and multivariate analyses were performed to identify the risk factors associated with HSV-2 seropositivity.

Results

Overall seroprevalence of HSV-2 infection was 8.7% (142/1640; 95% CI 7.3-10.0) with a highest prevalence of 15.0% (46/307; 95% CI 11.0-19.0) in the state of Arunachal Pradesh. Higher seroprevalence was observed with increasing age (Adj. Odds Ratio [AOR] 1.9 for 22-25 years old, AOR 2.29 for > 29 years old). The risk factors associated with HSV-2 seropositives were multiple sex partners (AOR 2.5, p = 0.04), condom non-user's (AOR 4.7, p <0.001), early coitarchal age (age of first intercourse) 'less than 18 years' (AOR 9.6, p = 0.04), middle income group (AOR 2.1, p = 0.001) compared to low income group and low level of education (AOR 3.7, p = 0.02) compared to higher education. HSV-2 seropositivity was higher among Christians (12.6%) compared to Muslims (3.8%). The most frequent clinical symptoms among HSV-2 seropositives were excess vaginal discharge in last one year (53.5%, 76/142) and pelvic pain (26.1%, 37/142). While among subjects with genital ulcers, HSV-2 seroprevalence was 36.8% (7/19).

Conclusions

Overall seroprevalence of HSV-2 infection among pregnant women of Northeast India is relatively low. The generation of awareness among high risk groups may have played key role to limit the infection. The role of vaccination against HSV-2 in near future and elimination of HSV-2 viral shedding along with genital tract inflammation in high HIV/HSV-2 areas may be an option for initiating successful intervention strategies to reduce the transmission and acquisition of HIV infection in Northeast India.