"This is one of the first studies to demonstrate the spread of HIV from relatively high- risk groups of female prostitutes and their male sex partners to a group previously thought to be at very low risk," says Thomas C. Quinn, M.D., professor of medicine. "The only risk factor we found for HIV infection among the married women in the study was sexual contact with their only sex partners--their husbands."
"The married women in our study probably represent a larger population of low-income women whose husbands have multiple partners," says Margaret E. Bentley, Ph.D., associate professor of international health. "Also, the women are unlikely to discuss with their husbands the lack of condom use and other risky sexual behaviors because their culture discourages discussions of sexual behavior outside efforts at birth control."
Quinn, also with the National Institutes of Health, is senior author of a report on the study published in the Dec. 17 issue of the Journal of the American Medical Association. The study was supported by the National Institutes of Health, Family Health International and the National Institute of Allergy and Infectious Diseases.
The HIV spread to monogamous wives is particularly acute in India, says Quinn, because of its large population. "There already are three to five million people there infected with HIV, the largest number of any one country in the world," he says. "And because there are almost a billion people in India, there is great potential for a dramatic, continued spread of infection."
"Unless information about sexually transmitted diseases and AIDS is made available throughout India, especially among females prior to marriage and sexual activity, women and infants will suffer the most."
The researchers studied 916 women who visited sexually transmitted diseases clinics in Pune between May 1993 and July 1996. A total of 525 were female sex workers, of whom 49.9 percent were infected with HIV, while 13.6 percent of the 391 non-female sex workers were infected with HIV.
The study found that risk factors for HIV infection among female sex workers included inconsistent condom use, more than 1,000 lifetime sexual partners and a current diagnosis of genital ulcer disease or genital warts. But among married women, the only significant risk factor for HIV infection was sexual contact with a partner who had a sexually transmitted disease.
This social situation makes development and promotion of protective products that women can control especially urgent, says Bentley. "These women need products such as vaginal washes that kill microbes," she says.
Other authors of the study include Raman R. Gagakhedkar, Anand D. Divekar, Deepak Gadkari and Sanjay M. Mehendale (National AIDS Research Institute, Pune, India); and Robert C. Bollinger (Johns Hopkins).
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