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SHORT COMMUNICATION
Year : 2012  |  Volume : 56  |  Issue : 3  |  Page : 231-234  

Sexual practices of people living with HIV/AIDS attending school of tropical medicine, Kolkata


1 Assistant Professor,BS Medical College, Bankura, West Bengal, India
2 Professor,Department of Preventive and Social Medicine, All India Institute of Hygiene & Public Health, Kolkata, India
3 Professor and Head,Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India

Date of Web Publication3-Dec-2012

Correspondence Address:
Pranita Taraphdar
Assistant Professor, BS Medical College, Bankura, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.104259

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   Abstract 

A hospital-based, cross-sectional, observational study of People Living with HIV/AIDS (PLWHAs) attending the School of Tropical Medicine (STM), Kolkata was carried out for a period of 6 months from May 2006 to October 2006, to assess the sexual practices of PLWHAs. Past sexual practice of PLWHAs revealed that 93.4% males were polygamous, compared to 16.4% females. Of them, 45.7% males and 92.8% females reported sex with a nonregular sex partner (NRSP) in 1 year. Consistent condom use was low in both sexes. Current sexual practice showed that more than four-fifth (87.9%) of the new patients and two-thirds (68.9%) of the indoor patients were currently sexually active in 1 month recall period (P=3.79, Z=0.0000). However, consistent condom use was found only in 35.5% indoor patients and 15.5% of new patients and the difference was statistically significant.

Keywords: Condom use, People living with HIV/AIDS, sexual practices


How to cite this article:
Taraphdar P, Dasgupta A, Saha B. Sexual practices of people living with HIV/AIDS attending school of tropical medicine, Kolkata. Indian J Public Health 2012;56:231-4

How to cite this URL:
Taraphdar P, Dasgupta A, Saha B. Sexual practices of people living with HIV/AIDS attending school of tropical medicine, Kolkata. Indian J Public Health [serial online] 2012 [cited 2019 Dec 16];56:231-4. Available from: http://www.ijph.in/text.asp?2012/56/3/231/104259

The rapid sexual spread of HIV has been attributed to behavioral factors, such as frequent change of partners and unprotected sex, biological factors such as presence of sexually transmitted infections (STIs), and managerial factors such as inadequate health infrastructure and poor access to effective treatment. Of these, the mainstay of HIV/AIDS prevention lies in the practice of safe sex, and therefore, risk reduction interventions are designed to encourage people to avoid risky sexual behavior. For sexually active people it means consistent condom use, limiting the number of sexual partners and treatment of STIs. [1]

There is some concern among public health authorities and epidemiologists that the availability and achievements of antiretro viral therapy (ART) in high income countries may lead to complacency, and encourage unsafe sexual behavior, due to a decrease in the perceived risk of sexual transmission of HIV. Some studies have supported this claim and found that the rate of unprotected sex increased among individuals taking ART. [2],[3] However, other studies have not found that the rate of unprotected sex increased among individuals taking ART, regardless of any changes in perception regarding risk of transmission. [4],[5],[6]

Against this background, a study was conducted to assess and compare the sexual practices among newly diagnosed and old patients living with HIV/AIDS.

A hospital-based, cross-sectional, observational study of HIV/AIDS patients attending the School of Tropical Medicine (STM), Kolkata was carried out for a period for 6 months from May 2006 to October 2006. The study was granted permission by Institution Ethics Committee. The study subjects were:

  1. Newly diagnosed patients: Patients attending the Integrated Counseling and Testing Centre (ICTC) at the Department of Virology, STM, for the first time, and newly diagnosed to be HIV infected.
  2. Old patients: Patients previously diagnosed (before 6 months) with HIV, now admitted in STM, with AIDS, or presenting with various infections/complications. Moribund patients or seriously ill and newly diagnosed cases were not included in the study.


The sampling frame comprised of newly diagnosed HIV-positive patients attending the ICTC, and previously diagnosed old patients admitted into the hospital. Considering feasibility, 10% of the average number of patients attending ICTC and testing HIV positive in the past 3 years (1980) was taken as the desired sample size (198) for newly diagnosed. Similarly, 20% of the average number of HIV/AIDS patients admitted in the indoor in the last 3 years (470) was taken as the desired sample size (94) for old patients. A list of all HIV-positive indoor patients admitted on the first day of the week, was obtained from the admission register, and updated weekly, whereas for ICTC patients, a similar list was prepared after HIV testing, and updated daily. The study subjects were selected by systematic random sampling, till the desired sample size of 292 PLHWAs was obtained, after taking informed consent, and ensuring anonymity and confidentiality. A total of 284 people living with HIV/AIDS (PLWHAs) were reported as being ever sexually active, and were therefore included in the study. A predesigned, pretested, semistructured schedule was prepared in English, and then translated into Bengali for interviewing the study subjects. Data were analyzed using percentages, and Z tests for proportions.

The study sample consisted of 90 indoor patients and 194 newly diagnosed HIV/AIDS patients attending the ICTC. Majority of the patients were male (80.4% of indoor and 66.5% of ICTC patients). Overall, 77.7% patients were below 40 years of age. Mean age, standard deviation (SD) and standard error (SE) of the study population were 34.28, 7.85, 0.54 years for males and 29.87, 9.28, 1.00 years for females, respectively. Hindus constituted the majority (80.5%) of the population, followed by Muslims (15.1%), Christians (2.4%), and others (2.2%). More than one-fourth (26.4%) PLWHAS belonged to the scheduled caste. Educational status of PLWHAs ranged from just literate (20.4% of indoor and 24% ICTC patients) to graduation (8.7% indoor and 5% ICTC patients). Three-fourth of the study population (71.9%) belonged to rural areas., Half (50.7%) of the study subjects had a history of migration, mainly to Mumbai, Pune, and Kolkata. Overall, 72.6% of patients were currently married and 17% were unmarried.

Past sexual practice of PLWHAs revealed that more than two-thirds (70.4%) were in polygamous relationships, having multiple partners at the same time, with males surpassing females extensively (93.4% males versus 16.4% females), the difference being statistically significant. (Z=12.8, P=0.0000). Of these patients, almost half (49%) reported having sex with a non-regular sex partner (NRSP), defined as a nonmarital noncohabiting partner, in 1 year. In this regard, however, the proportion of females (92.8%) outnumbered the males (45.75%), because all these females who had sex with NRSPs were commercial sex workers. Condom use, which is a most effective and efficient safe sexual practice was low among those with NRSP in 1 year. Overall, 73.5% had not used condoms during the last sex with NRSP, with 25.5% male and 22.4% female patients reporting they had occasionally used condoms. Only 1.1% of the male patients had consistently used condoms, that is, used a condom each time during every sex act. Condom use was generally advised by the partner in both sexes [Table 1]. Thus, it is evident that there is a channel for transmission of HIV infection, which could be easily checked by simply using this barrier contraceptive. Moreover, the desirability of having PLWHAs engage in safer sex behaviors is apparent from the standpoint of the society; it is unlikely that this will occur, unless they become convinced of the benefits of safe sex. They must understand that unprotected sex leads to sexually transmitted disease (STD) infection or infection with other HIV viruses and the havoc that this is likely to play on an already compromised immune system.
Table 1: Distribution of people living with HIV/AIDS (PLWHAs) by their past sexual practice

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Previous analysis of Indian adults also revealed that heterosexual promiscuity was a major source of infection among the male population irrespective of their habitat and marital status whereas among females, the infection was transmitted from their spouses. [7],[8]

On being interrogated about current sexual activity (within a recall period of 1 month), more than four-fifth (89.7%) of the newly diagnosed patients attending ICTC and two-thirds (68.9%) of the indoor patients said they were currently sexually active (Z=3.79, P=0.0000). However, consistent condom use was found only in 35.5% of the indoor patients and 15.5% of the new patients. This difference was statistically significant (Z=2.49, P=0.012) and was probably the result of counseling, as all these patients were repeatedly counseled about condom use, every time they sought health care [Table 2].
Table 2: Distribution of people living with HIV/AIDS (PLWHAs) by their current sexual practice

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The beneficial effects of counseling are well documented. A study to gauge the impact of counseling on HIV-infected individuals attending the National AIDS Research Institute (NARI) clinic at Pune showed that married couples who were counseled for consistent condom use reported regular condom use. [9] However, a study in Ethiopia [10] on PLWHAs revealed that it was difficult for them to change their sexual behavior even if their current practice of not using condoms endangered their partners. Consistent condom use was 3% among newly diagnosed HIV-positive patients in a case-control study conducted in south India. [11] A study of condom use among women in 16 developing countries [12] found that the median percent of married couples currently using condoms was 2.1%. In an intervention study on STD patients, [13] the use of condoms increased from 14.6% to 74.8% after counseling.

Many individuals especially women acquire HIV because of infidelity of their spouses. In such settings, marriage and cohabitation cannot be regarded as safe, and exclusive emphasis on condom use only for nonmarital sexual contacts is no longer adequate. The study shows that in spite of a nationwide condom promotion campaign, condom use is still not popular, though they are simple to use, affordable and life saving for PLWHAs as they not only prevent transmission of infection to their spouses/partners but also prevent coinfection with other HIV viruses, or other STIs. Thus, greater emphasis on behavior modification by repeated counseling is needed to make condom use a more effective tool for controlling HIV infection.

 
   References Top

1.Lamtey P, Wigley M, Carr D, Collymore Y. Facing the HIV/AIDS pandemic. Popul Bull 2002;57:24.  Back to cited text no. 1
    
2.Dukers NH, Goudsmit J, de Wit JB, Prins M, Weverling GJ, Coutinho RA. Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS 2001;15:369-78.  Back to cited text no. 2
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3.Scheer S, Chu PL, Klausner JD, Katz MH, Schwarcz SK. Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. Lancet 2001;357:432-5.  Back to cited text no. 3
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4.Glass TR, Young J, Vernazza PL, Rickenbach M, Weber R, Cavassini M, et al. Is unsafe sexual behaviour increasing among HIV-infected individuals? AIDS 2004;18:1707-14.  Back to cited text no. 4
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5.Elford J, Bolding G, Sherr L. High-risk sexual behaviour increases among London gay men between 1998 and 2001: What is the role of HIV optimism? AIDS 2002;16:1537-44.  Back to cited text no. 5
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6.van der Straten A, Gómez CA, Saul J, Quan J, Padian N. Sexual risk behaviors among heterosexual HIV serodiscordant couples in the era of post-exposure prevention and viral suppressive therapy. AIDS 2000;14:F47-54.  Back to cited text no. 6
    
7.Giri TK, Wali JP, Meena HS, Pande I, Uppal S, Kailash S. Sociodemographic characteristics of HIV infection in northern India. J Commun Dis 1995;27:1-9.  Back to cited text no. 7
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8.Newmann S, Sarin P, Kumarasamy N, Amalraj E, Rogers M, Madhivanan P, et al. Marriage, monogamy and HIV: A profile of HIV-infected women in south India. Int J STD AIDS 2000;11:250-3.  Back to cited text no. 8
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9.ICMR. Annual report 2002-2003. New Delhi: ICMR; 2004. p. 71.  Back to cited text no. 9
    
10.Admassu A. Coping with the challenges of AIDS: The experience of persons living with HIV/AIDS in Addis Ababa. Northeast Afr Stud 2000;7:81-100. Available from: http:// muse.jhu.edu/journals/northeast_african_studies/v007/7.2.admassu.html. [Last accessed 2007 Jan 24].  Back to cited text no. 10
    
11.George S, Jacob M, John TJ, Jain MK, Nathan N, Rao PS, et al. A case-control analysis of risk factors in HIV transmission in South India. J Acquir Immune Defic Syndr Hum Retrovirol 1997;14:290-3.  Back to cited text no. 11
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12.Ali MM, Cleland J, Shah IH. Condom use within marriage: A neglected HIV intervention. Bull World Health Organ 2004;82:180-6.  Back to cited text no. 12
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13.Grover V, Kannan AT, Indrayan A. Counselling: Effect of KAP against HIV/AIDS and STDs among a high risk group. In: Agarwal OP, Sharma AK, Indrayan A, editors. HIV/AIDS research in India. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India; 1997. p. 275-7.  Back to cited text no. 13
    



 
 
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