Introduction

Sexually transmitted diseases (STDs) and HIV infection have major demographic, economic, social, and political impact particularly in Asia and Africa. Heterosexual promiscuity, homosexuality, multiple sex partners, and lack of condom use are some of the high risk behaviours.

Despite the extent of the STD problem and its contribution to the rapid spread of the HIV epidemic relatively few studies have been performed on HIV risk factors among men and women in India.

Methods

In all, 260 patients (210 males and 50 females) attending the STD clinic (J J Hospital) with genital lesions and or history of exposure were interviewed and subjected to clinical examination and microbiological investigations.

Results

The overall HIV prevalence in STD patients was 31.18%, with 29.5% in males and 38% in females. It was 44% in 31–40 years age group.

Table 1 shows the prevalence of HIV infection to be higher in non-Muslims (34.5%) than in Muslims (20.6%).

Patients with more than five sexual partners, with past history of STDs, and condom users showed 41.5%, 42.1%, and 30% HIV prevalence, respectively.

Factors associated with a high prevalence of HIV infection in the univariate analysis included high risk occupational groups (CSWS, drivers, and unemployed patients) (51.61%), past history of STDs (42.1%), multiple sexual partners (41.5%), and uncircumcised status (34.62%). Patients with secondary syphilis, herpes genitalis, and condyloma accuminata showed 64.71%, 33.3%, and 41.46% HIV seropositivity, respectively.

Discussion

HIV seropositivity was high in the sexually and economically active group as documented by other authors.^1,2 There were fewer females because of the social stigma attached to STDs that forbid them from seeking medical treatment and lack of clinical features of STDs.

High risk groups (commercial sex workers (CSWs), drivers, waiters) showed high HIV seropositivity as is well reported by other studies.^3,4 With their high risk behaviours they pose a major threat to the spread of HIV. The majority (86%) had heterosexual behaviour and this type is the most important mode of HIV transmission in Mumbai, India. Low prevalence of HIV infection in circumcised patients has been documented by other authors.^5,6 It could be that circumcision had a protective effect against HIV transmission.

Patients with secondary syphilis showed high prevalence as a result of the long duration of disease. High prevalence was seen in those with herpes genitalis and condyloma accuminata, suggesting that multiple viral infections occur simultaneously.

Repeated exposures and inadequate treatment make these patients susceptible to HIV infection. Early diagnosis and treatment facilities at the primary healthcare level should be made available through the syndromic approach.

Information education and communication (IEC) activities on sexual relationships and condom use should be strengthened. For CSWs successful intervention programmes of longer duration that target “madams” and clients are needed at multiple sites in Mumbai.