Clustering of Pregnancy Wastages among Young HIV-Positive Women in a High HIV Prevalence District in India

Context: This paper examined the clustering of pregnancy wastage among HIV-infected pregnant women, particularly focusing on the outcomes of abortions and stillbirths, from a large sample of HIV-positive women to bridge the existing information gap. Methods: Data from a cross-sectional survey conducted among currently married HIV positive women aged 15-29 years in Bagalkot district, Karnataka, India were used. Further to assess the clustering of pregnancy wastage, the binomial distribution was used. Results: The study shows that 2% of the women account for 32% of the total pregnancy wastages and 7% of all the interviewed HIV positive women account for 62% of the total pregnancy wastages. The study further shows that a higher percent observed (29.6%) than expected (15.5%) who had experienced 2 pregnancy wastages suggesting 14.1% more women experienced 2 pregnancy wastages than expected. Again, a positive deviant of 19.2 among women with at least 3 pregnancy wastage also suggests a higher observed than expected pregnancy wastages, and suggests clustering of pregnancy wastages among HIV-positive women. After adjusting for the socio-economic characteristics, the variance of the observed and expected has reduced only marginally. Conclusions: Clustering of pregnancy wastages among HIV positive women suggests for an increased attention on reproductive health of this marginalized group. The findings will be useful for the interventions working with WLHA in India, particularly the knowledge of clustering would help policy makers and program implementers to focus on high risk women who are likely to experience multiple pregnancy losses.

Using data from‘visible’populations to estimate the size and importance of‘hidden’populations in an epidemic:A modelling technique

We used reported behavioural data from cisgender men who have sex with men and transgender women(MSM/TGW)in Bangalore,mainly collected from‘hot-spot’locations that attract MSM/TGW,to illustrate a technique to deal with potential issues with the representativeness of this sample.A deterministic dynamic model of HIV transmission was developed,incorporating three subgroups of MSM/TGW,grouped according to their reported predominant sexual role(insertive,receptive or versatile).Using mathematical modelling and data triangulation for‘balancing’numbers of partners and role preferences,we compared three different approaches to determine if our technique could be useful for inferring characteristics of a more‘hidden’insertive MSM subpopulation,and explored their potential importance for the HIV epidemic.Projections for 2009 across all three approaches suggest that HIV prevalence among insertive MSM was likely to be less than half that recorded in the surveys(4.5e6.5%versus 13.1%),but that the relative size of this subgroup was over four times larger(61e69%of all MSM/TGW versus 15%).We infer that the insertive MSM accounted for 10e20%of all prevalent HIV infections among urban males aged 15e49.Mathematical modelling can be used with data on‘visible’MSM/TGW to provide insights into the characteristics of‘hidden’MSM.A greater understanding of the sexual behaviour of all MSM/TGW is important for effective HIV programming.More broadly,a hidden subgroup with a lower infectious disease prevalence than more visible subgroups,has the potential to contain more infections,if the hidden subgroup is considerably larger in size.