Sexually Transmitted Infections among Women in the Reproductive Age Group in Shevgaon, Ahmednagar District, Maharashtra, India

This study was conducted in 2011.

Sexually transmitted infections (STIs) constitute a significant epidemiological burden all over the world especially in middle and low income countries. Women are more vulnerable to STIs due to several biological and socio-economic reasons. Although transmission of STIs is behaviour related, in women it is more associated with the behaviour of her partner on which she has little control. Married monogamous women are considered to be a low risk population in India; however marriage (due to risky behaviour of the husbands) is the most important risk factors for acquisition of STIs and HIV in this group. There is also a strong correlation between the spread of STIs and HIV transmission. Both ulcerative and nonulcerative
STIs increase the risk of sexual transmission as well as acquisition of HIV. In women, silent asymptomatic infections can be more serious than symptomatic ones however current syndromic approach fails to identify these asymptomatic infections.

Although the absolute number of Indian adults at potential risk for STIs is large, due to the sheer size of the denominator, the adult population at high risk for HIV in India might represent only a small percentage. Therefore, finding such “at-risk” population is a challenging task. It has not been possible to conduct any Phase IIb/III clinical trial on HIV prevention options among women in India including vaginal microbicides due to inability to find appropriate high risk women with required HIV incidence. A vaccine for prevention of STIs such as HPV infection is now available and others such as HSV-2 vaccine is in the
pipeline. Vaccine against HIV is one of the priority research agenda. When available, universal vaccination with such vaccines will neither be possible nor practical. Identification of populations at higher risk of such infections will help in defining eligible population to provide most cost effective interventions to the high risk population.

There is anecdotal evidence that risk taking behaviours of husbands increase when women get pregnant immediately after marriage or leave for their maternal house (as a traditional custom in India) for the first delivery. Outpatient clinics where women obtain antenatal care and immunization/contraceptive services following pregnancy may be an important access
point for identification of high-risk married women. This proposal aims to evaluate the incidence of HIV and STIs among women of the reproductive age group. We plan to enrol women attending the antenatal clinics between 6 to 9 months of pregnancy and then follow them up every 6 months for 24 months to evaluate the incident HIV infections and STIs. A
demographic and risk profile for these at risk women with incident STIs will help in developing a cost effective strategy for identifying potential female candidates for preventive interventions as well as participants for future HIV prevention trials including clinical trials on vaginal microbicides.