Objective: To investigate the risk factors for HIV infection in patients attending clinics for sexually transmitted diseases in India. Design: Descriptive study of HIV serology, risk behaviour, and findings on physical examination. Subjects: 2800 patients presenting to outpatient clinics between 13 May 1993 and 15 July 1994. Setting: Two clinics and the National AIDS Research Institute, in Pune, Maharashtra State, India. Main outcome measure: HIV status, presence of sexually transmitted diseases, and sexual behaviour. Results: The overall proportion of patients infected with HIV was 23.4% (655/2800); 34% (184) of the women and 21% (459) of the men were positive for HIV infection. Of the 560 women screened, 338 (60%) had a reported history of sex working, of whom 153 (45%) were infected with HIV-1. The prevalence of HIV-1 infection in the 222 women who were not sex workers was 14%. The significant independent characteristics associated with HIV infection based on a logistic regression analysis included being a female sex worker, sexual contact with a sex worker, lack of formal education, receptive anal sex in the previous three months, lack of condom use in the previous three months, current or previous genital ulcer or genital discharge, and a positive result of a Venereal Disease Research Laboratory test. Conclusions: In India the prevalence of HIV infection is alarmingly high among female sex workers and men attending clinics for sexually transmitted diseases, particularly in those who had recently had contact with sex workers. A high prevalence of HIV infection was also found in monogamous, married women presenting to the clinics who denied any history of sex working. The HIV epidemic in India is primarily due to heterosexual transmission of HIV-1 and, as in other countries, HIV infection is associated with ulcerative and non-ulcerative sexually transmitted diseases.
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