Incident HIV infection among men attending STD clinics in Pune, India: Pathways to disparity and interventions to enhance equity

Mary E. Shepherd, Raman R. Gangakhedkar, Seema Sahay, Steven J. Reynolds, Manisha V. Ghate, Arun R. Risbud, Ramesh S. Paranjape, Robert C. Bollinger, Sanjay M. Mehendale

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12 Scopus citations


Systematic disparities in rates of HIV incidence by socioeconomic status were assessed among men attending three sexually transmitted disease (STD) clinics in Pune, India, to identify key policy-intervention points to increase health equity. Measures of socioeconomic status included level of education, family income, and occupation. From 1993 to 2000, 2,260 HIV-uninfected men who consented to participate in the study were followed on a quarterly basis. Proportional hazards regression analysis of incident HIV infection identified a statistically significant interaction between level of education and genital ulcer disease. Compared to the lowest-risk men without genital ulcer disease who completed high school, the relative risk (RR) for acquisition of HIV was 7.02 (p<0.001) for illiterate men with genital ulcer disease, 3.62 (p<0.001) for men with some education and genital ulcer disease, and 3.02 (p<0.001) for men who completed high school and had genital ulcer disease. For men with no genital ulcer disease and those with no education RR was 1.09 (p=0.84), and for men with primary/middle school it was 1.70 (p=0.03). The study provides evidence that by enhancing access to treatment and interventions that include counselling, education, and provision of condoms for prevention of STDs, especially genital ulcer disease, among disadvantaged men, the disparity in rates of HIV incidence could be lessened considerably. Nevertheless, given the same level of knowledge on AIDS, the same level of risk behaviour, and the same level of biological co-factors, the most disadvantaged men still have higher rates of HIV incidence.

Original languageEnglish (US)
Pages (from-to)251-263
Number of pages13
JournalJournal of Health Population and Nutrition
Issue number3
StatePublished - Sep 2003


  • Acquired immunodeficiency syndrome
  • HIV
  • Health equity
  • India
  • Prospective studies
  • Sexually transmitted diseases
  • Sexually transmitted infections
  • Socioeconomic status

ASJC Scopus subject areas

  • Food Science
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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