The initial detection of human immunodeficiency virus 1 and its subsequent spread in prostitutes in Tamil Nadu, India.

To determine the prevalence of HIV-1 antibody and risk factors associated with a positive test in a heterosexually promiscuous female population, we initially screened 412 prostitutes in remand homes in three cites and three towns in Tamil Nadu state (southern India) and then tested all new entrants to one home in Vellore from 1986 to 1990. The proportion of women infected (10 of 102) from the port city of Madras was greater than from all other cities or towns combined (four of 310, p = 0.0002). The only significant risk factor for development of HIV-1 antibody was exposure to foreigners (odds ratio: 7.71; 95% confidence interval 4.2-11.2; p = 0.0004), after correcting for the influence of city. In Vellore the prevalence of HIV-1 antibody increased from 1.8% in 1986 to 28.6% in 1990, with a doubling time of 0.95 years. We hypothesize that HIV-1 infection has been introduced into India relatively recently into the heterosexually promiscuous population, where there has been some spread. Preventive measures should be urgently directed toward this population to prevent spread in the general population.

Epidemiological features of acquired immunodeficiency syndrome in southern India.

AIDS was diagnosed in 187 men and 24 women (M:F = 8:1) from April 1987 till December 1994 at the Christian Medical College Hospital, Vellore. The doubling time of the occurrence of AIDS cases was 14 months; during 1987-90 there were an average of 5.7 cases per year; in 1991-93 there were 28 per year; in 1994 there were 104 cases. The mean age of patients was 33 yr for men and 31 for women. Among men, the primary mode of infection was heterosexual contact with female commercial sex workers. Among women, the most common source of infection was their husbands. There were 4 bisexuals and one homosexual subject who might have acquired infection by having sex with other men. There were 135 subjects from urban and 76 from rural communities. Most subjects belonged to the lower socio-economic classes. These data show that HIV infection had been very widespread in this region, both urban and rural.

PIP: Under India's National AIDS Control Program, facilities and reagents for HIV antibody testing have been provided in 62 surveillance centers, 9 reference centers, and 150 zonal blood testing centers in the country. The authors summarized the epidemiological features of all AIDS cases diagnosed at the Christian Medical College Hospital, Vellore, during 1987-94 with the goal of familiarizing physicians and investigators with the epidemiology of AIDS. AIDS was diagnosed in 187 men and 24 women from April 1987 through December 1994, with the number of cases doubling every 14 months. During 1987-90, there was an average of 5.7 cases per year, 28 per year during 1991-93 and 104 in 1994. Male and female patients were of mean ages 33 and 31 years, respectively. Among men, the main mode of infection was heterosexual contact with female prostitutes. Among women, the most common source was their husbands. There were 4 bisexuals and one homosexual subject who may have acquired HIV infection by having sex with other men. 135 subjects were from urban areas and 76 from rural communities. Most were of lower socioeconomic level.