Volume 6 • Issue 1 • 1000417 Open Access Research Article J AIDS Clin Res ISSN: 2155-6113 JAR an open access journal Panda et al., J AIDS Clin Res 2015, 6:1 DOI: 10.4172/2155-6113.1000417 Correlates of HIV Transmission from Husband to Wife among Heterosexual Married Couples in ART-era in West Bengal, India Samiran Panda 1 , Debabrata Bandyopadhaya 2 , Malay K Saha 1 , Sobha Pahari 3 , Sekhar Chakraborti 1 and Swapan K Niyogi 1 1 National Institute of Cholera and Enteric Diseases (NICED) / Indian Council of Medical Research (ICMR), Kolkata, India 2 Professor and Head, Department of Dermatology, Medical College, Kolkata (formerly with RG Kar Medical College and Hospital), India 3 Society for Positive Atmosphere and Related Support to HIV/AIDS (SPARSHA), India *Corresponding author: Samiran Panda, NICED (ICMR), P-33 CIT Road, Scheme- XM, Beliaghata, Kolkata, Pin - 700010, West Bengal, India, Tel: 91-33-23633373; Fax: 91-33-23632398; E-mail: pandasamiran@gmail.com Received November 24, 2014; Accepted January 08, 2015; Published January 17, 2015 Citation: Panda S, Bandyopadhaya D, Saha MK, Pahari S, Chakraborti S, et al. (2015) Correlates of HIV Transmission from Husband to Wife among Heterosexual Married Couples in ART-era in West Bengal, India. J AIDS Clin Res 6: 417. doi:10.4172/2155-6113.1000417 Copyright: © 2015 Panda S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: HIV; ART; Herpes Simplex Virus-2; India; Heterosexual- couples Introduction During the third round of the National Family Health Survey (NFHS- 3 2005-2006) in India, among 27000 married couples undergoing HIV test, 0.11% were in HIV-concordant and 0.39% in HIV-discordant relationship [1]. Extrapolating this fnding as well as drawing on other information, a desk review had estimated HIV afected heterosexual couples in reproductive age group in the country to be 1.18 million [2]. It is important to appreciate that the spread of HIV infection in married monogamous Indian women was recognized in the early phase of HIV epidemic. Detection of 14% women attending sexually transmitted disease (STD) clinics (who were not female sex workers) as HIV sero-reactive [3] and 45% HIV prevalence among wives of HIV positive injection drug users (IDUs) who had never injected drugs nor reported sex outside marriage [4] underlined such spread. In addition to these studies from west (Maharashtra) and north-eastern part of the country (Manipur) respectively, the rural and urban settings of the southern State of Tamilnadu witnessed a similar phenomenon [5]. Role of STDs in HIV transmission in stable heterosexual relationship was discussed in these studies. A secondary analysis of couple-linked information collected during NFHS-3, further revealed that 'sexual violence', 'multiple wives' and 'lower educational status' of husbands were associated with HIV infection in married women in India who had been currently living with their husbands [6]. None of the afore-mentioned articles had the opportunity to examine issues of HIV transmission in marriage in the context of anti-retroviral therapy (ART), provided free of cost by the Ministry of Health and Family welfare, Government of India since 2004 (starting with only eight government hospitals in six States) [7]. Subsequent studies on the topic of HIV transmission in marriage have been scarce. We therefore undertook the current investigation in West Bengal, an eastern Indian State, where spread of HIV is characterized by patronage of female sex workers by men within or outside the State and unsafe injecting practices by drug users in certain districts. Methodology Study participants Te National Institute of Cholera and Enteric Diseases (NICED), a premier institute under Indian Council of Medical Research (ICMR), in collaboration with the civil society organization named 'Society for Positive Atmosphere and Related Support to HIV/AIDS' (SPARSHA) conducted this study during 2009 to 2012. SPARSHA is an organization Abstract Objective: To identify factors associated with HIV-transmission from husbands to their wives within the existing HIV prevention and control program environment in West Bengal, India. Methods: In this cross-sectional study, information was collected from the study participants on socio-demography and various health issues including sexually transmitted diseases (STDs). They were also tested for blood borne and sexually transmitted infections. Women living with HIV were compared for behavioral and biologic markers against women who did not have the virus. Both these groups of women were married to HIV sero-reactive men. To detect recent HIV infection, HIV sero-negative women were tested by Polymerase Chain Reaction. Results: Of the 234 married couples, 29% (69/234) lived in HIV discordant relationship where wives were not infected with HIV and the rest were concordant for HIV infection. Six of the 165 women living in concordant relationship acquired HIV infection recently. Fifty six percent of the husbands were in advanced stage of HIV disease with CD4 count ≤200/µl while tested for the frst time at ART center. Factors independently associated with HIV concordance were 'wives experiencing any STD-symptom after marriage' (Adjusted Odds Ratio (AOR) 2.05; 95% CI 1.09 - 3.83; p=0.02) and 'self-reported male condom use/reduced frequency of sex with spouse' (AOR 2.99; 95% CI 1.29-6.94; p=0.01). Although 'HSV-2 concordance' (Odds Ratio (OR) 2.46; 95% CI 1.32-4.59; p=0.004) and 'bacterial vaginosis' (OR 2.57; 95% CI 1.18-5.61; p=0.02) were associated with HIV infection in wives in uni-variate analyses, the strength of such associations weakened in multi-variate model. ART intake by husbands did not offer any protection against HIV infection in wives. Conclusions: Early initiation of ART among HIV discordant couples, strengthening of STD prevention and control and limitation of self-reported sexual risk reduction to inform HIV-program in India are underscored. J o u r n a l o f A I D S & C l i n i c a l R e s e a r c h ISSN: 2155-6113 Journal of AIDS & Clinical Research