Can data on HIV sero-reactivity among blood donors provide an insight into HIV prevalence in the general population?

INTRODUCTION & OBJECTIVES: Surveillance of HIV epidemic serves the important purposes of situation analysis for programme design, implementation, monitoring and evaluation. For HIV surveillance among general population, HIV prevalence data from pregnant women attending sentinel sero-surveillance sites, and prevention of parent to child transmission (PPTCT) services as well as data from population based surveys are used. Data on HIV prevalence among voluntary donors can be yet another source of information on the prevalence and progress of HIV infection. METHODS: HIV prevalence data from 10 PPTCT centers, 58 Government blood banks and 9-13 sentinel sero-surveillance sites during 2004-2006 in West Bengal were analyzed. RESULTS: During this period, estimated HIV prevalence ranged between 0.40% to 0.86% among the ANC attendees of sentinel sero-surveillance sites, between 0.15-0.18% at PPTCT centers, and between 0.29-0.49% among voluntary blood donors. CONCLUSION: Data on HIV prevalence among voluntary blood donors can provide a fairly good understanding of trends and patterns of HIV prevalence among the general population specially among young males. For making meaningful inferences from such analysis, standardization in terms of blood collection, testing for HIV infection, reporting and analysis is called for. This is a very cost-effective method of estimating HIV prevalence, and is amenable to detailed analysis of spatial and temporal trends of HIV infection in the general population.

Prevalence of sexually transmitted infections and performance of STI syndromes against aetiological diagnosis, in female sex workers of red light area in Surat, India.

OBJECTIVES: To measure prevalence of selected sexually transmitted infections (STI) and HIV among female sex workers (SWs) in the red light area of Surat, India, and to evaluate the performance of STI syndrome guidelines (for general population women in India) in this group against the standard aetiological diagnosis of STIs by laboratory methods. METHODS: In a cross sectional study, 124 out of an estimated total of 500 SWs were mobilised to a health camp near the red light area during 2000. After obtaining consent, a behavioural questionnaire was administered, followed by clinical examination and specimen collection for different STIs. 118 SWs completed all aspects of the survey. HIV testing was unlinked and anonymous. RESULTS: The mean number of different sexual partners of SWs per day was five. 94.9% reported consistent condom use with the clients. 58.5% of SWs had no symptoms related to STDs at the time of examination. Reported symptoms included lower abdominal pain (19.5%), abnormal vaginal discharge (12.7%), painful sexual intercourse (12.7%), painful micturition (11.0%), itching around the genital area (10.2%), and genital ulcer (5.9%). The prevalence of STI "syndromes" were vaginal discharge syndrome 51.7%, pain in lower abdomen 19.5%, enlarged inguinal lymph nodes 11.9%, and genital ulcer 5.9%. Based on the laboratory reports (excluding HIV tests), 62 (52.5%) SWs did not have any of the four tested STIs. Prevalence of laboratory confirmed STIs were syphilis 22.7% (based on reactive syphilis serology tests), gonorrhoea 16.9%, genital chlamydial infection 8.5%, and trichomoniasis 14.4%. HIV prevalence was 43.2%. The performance of Indian recommended treatment guidelines for vaginal discharge syndrome (VDS) and genital ulcer syndrome (GUS) against aetiological diagnosis was poor. CONCLUSION: Prevalence of different STIs and HIV among the FSWs in the Surat red light area is high despite high reported condom use with clients. Syndromic case management is missing a large number of asymptomatic cases and providing treatment in the absence of disease. Therefore, it is necessary to explore alternative strategies for control of STIs in female sex workers. STI services need to be improved.