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HIV, HSV-2 and syphilis among married couples in India: patterns of discordance and concordance
  1. Paul Arora1,
  2. Nico Nagelkerke2,3,
  3. Sema K Sgaier1,4,
  4. Rajesh Kumar5,
  5. Neeraj Dhingra6,
  6. Prabhat Jha1
  1. 1Centre for Global Health Research (CGHR), St. Michael's Hospital, Li Ka Shing Knowledge Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Community Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
  3. 3Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
  4. 4Bill & Melinda Gates Foundation, New Delhi, India
  5. 5School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  6. 6National AIDS Control Organization, Ministry of Health & Family Welfare, Government of India, Janpath, New Delhi, India
  1. Correspondence to Paul Arora, Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Li Ka Shing Knowledge Institute, 209 Victoria Street, 6th Floor, Toronto, ON M5B 1T8, Canada; paul.arora{at}


Objectives Differences in sexual networks probably explain the disparity in the scale of HIV epidemics in sub-Saharan Africa and India. HIV and sexually transmitted infection (STI) discordant couple studies provide insights into important aspects of these sexual networks. The authors quantify the role of male sexual behaviour in HIV transmission in married couples in India.

Methods The authors analysed patterns of HIV and STI discordance in married couples from two community surveys in India: the National Family Health Study-3 for HIV-1 and the Centre for Global Health Research health check-up for HSV-2 and syphilis. A statistical model was used to estimate the fraction of infections introduced by each of the two partners.

Results Only 0.8%, 16.0% and 3.5% of couples were infected (either partner or both) with HIV-1, HSV-2 and syphilis, respectively. A large proportion of infected couples were discordant (73.0%, 56.3% and 84.2% for HIV-1, HSV-2 and syphilis, respectively). This model estimated that, among couples with any STI, the male partner introduced the infection the majority of the time (HIV-1: 85.4%, HSV-2: 64.1%, syphilis: 75.0%).

Conclusions Male sexual activity outside of marriage appears to be a driving force for the Indian HIV/STI epidemic. Male client and female sex worker contacts should remain a primary target of the National AIDS Control Program in India.

  • HIV
  • India
  • sexually transmitted infections
  • herpes simplex virus 2
  • syphilis
  • AIDS
  • epidemiology (general)
  • public health
  • sexual health
  • HSV
  • prevention
  • primary HIV infection

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  • Disclosure The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of The Bill & Melinda Gates Foundation.

  • Competing interests None.

  • Ethics approval Ethical clearance for the study was obtained from the Health Ministry Screening Committee of the Indian Council of Medical Research and the Institutional Review Boards of the participating institutions (Nizam's Institute of Medical Science, St John's National Academy of Health Sciences, IERB/177/05, and Post Graduate Institute of Medical Education and Research). Written informed consent was obtained from all participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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