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Editor,—The association between the occurrence of HIV infection and the presence of other STDs has been strongly established. STDs act as important co-factors that promote HIV transmission. The trend of HIV infection in STD clinic attendees, one of the high risk groups, may reflect the trends of HIV epidemic in the community. To estimate the frequency of HIV infection among various STD patients over a period of 6 years from January 1995 to December 2000 and to observe the interrelation between HIV infection and different other STDs, we analysed the HIV status of 1504 STD clinic attendees (M:F ratio 1:0.1, average age of 25.2 years) in Dr RML Hospital, a centrally located major tertiary care centre in Delhi. The breakdown in the number of STD attendees tested for HIV voluntarily out of total STD attendees was as follows: 180 out of 407 (44%) in 1995, 261 out of 513 (51%) in 1996, 245 out of 414 (59%), in 1997, 280 out of 363 (77%) in 1998, 235 out of 368 (63%) in 1999, and 296 out of 442 (67%) in 2000. This variation of percentage from year to year is due to the voluntary nature of testing. HIV testing was done with one of the ELISA/rapid/simple tests. Any reactive serum sample was retested using a different assay. A sample that was positive in both the tests was considered HIV positive. The other STDs were diagnosed clinically and using appropriate laboratory tests.
Out of 1504 STD patients screened for HIV infection, 42 (2.8%) were found to be seropositive (40 males out of 1354 and two females out of 150). Annual breakdown revealed a slow but gradual increase in HIV prevalence (1.7% in 1995, 2.2% in 1996, 2.1% in 1997, 2.5% in 1998, 2.7% in 1999, and 3.4% in 2000). The cumulative prevalence of HIV seropositivity in different STDs is shown in table 1.
HIV positivity was observed in 4.5% patients with GUDs, in contrast with only 1.7% HIV positivity among non-ulcerative STD patients, which is statistically significant (p >0.002). All but one male HIV positive patients gave a history of sexual contact with at least one commercial sexual worker. Out of two HIV positive women, one possibly was infected by her husband and the other from her regular sexual partner; both were not pregnant at the time of HIV testing. Five (19%) HIV seropositive patients had more than one STD.
HIV sentinel surveillance in India shows the HIV epidemic at different stages of evolution in different states of India.1 Six out of 32 states have HIV prevalence of more than 1% in antenatal clinics (ANC) and are classified as high prevalence states including Maharashtra and Tamil Nadu. In seven other states the ANC rates are less than 1% but prevalence among STD clinic attendees is more than 5% classified as moderate prevalence. The remaining 19 states including Delhi are low prevalence states because HIV prevalence among STD attendees is less than 5%.1, 2 The HIV sentinel surveillance data of Delhi show 1.6% and 3.2% HIV infection in 1998 and 2000, respectively, among STD attendees from four other major STD clinics in Delhi, where anonymous HIV testing was done from VDRL blood samples.3 These data as well as ours are comparable and support the belief that Delhi is still in a low level epidemic category.
From the experience of the Mwanza trial in Tanzania and the Rakai trial in Uganda, it is speculated that the effect of STD control on HIV transmission may decrease with the maturation of the HIV epidemic.4 Therefore, it is high time to extend vigorous intervention programmes in all high risk groups as well as the general population of this city which is still in the early epidemic phase to ensure this cost effective opportunity is not missed.
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