|Year : 2018 | Volume
| Issue : 1 | Page : 14-17
Sociodemographic and immunological profile of human immunodeficiency virus patients in tribal population
Naveen Kumar Dulhani, Yasmeen Khan
Department of Medicine, Late BRK Memorial Medical College, Jagdalpur, Chhattisgarh, India
|Date of Web Publication||05-Nov-2018|
Dr. Naveen Kumar Dulhani
Department of Medicine, Late BRK Memorial Medical College, Jagdalpur - 494 001, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Aim: To study the sociodemographic and immunological profile of HIV seropositive patients attending antiretroviral therapy (ART) center of a tertiary care hospital. Methodology: This was a retrospective observational study conducted at an ART center of a tertiary care hospital from October 2016 to December 2017. It was a retrospective cohort study. Results: In our study, the total number of patients was 295. Majority of the patients were between 15 and 45 years of age. Males were 52% and females were 46%, with a male-to-female ratio of 1.3:1. Married tribal patients were the most affected. Majority of the patients were homemakers and nonagricultural workers; larger group belonged to low socioeconomic status. Heterosexual transmission was the commonest route of infection. Conclusion: Reproductive age group, low socioeconomic status, illiterate, tribal population, and homemakers were found to be associated with HIV positivity; heterosexual transmission was the commonest mode of infection.
Keywords: Antiretroviral therapy, heterosexual, human immunodeficiency virus, immunological, seropositivity, sociodemographic
|How to cite this article:|
Dulhani NK, Khan Y. Sociodemographic and immunological profile of human immunodeficiency virus patients in tribal population. J Integr Health Sci 2018;6:14-7
|How to cite this URL:|
Dulhani NK, Khan Y. Sociodemographic and immunological profile of human immunodeficiency virus patients in tribal population. J Integr Health Sci [serial online] 2018 [cited 2019 May 25];6:14-7. Available from: http://www.jihs.in/text.asp?2018/6/1/14/245027
| Introduction|| |
India has around 2.4 million people with human immunodeficiency virus (HIV); among these, one-third are residing in urban and two-third in rural areas. HIV infection is acquiring a shape of global pandemic, and India is ranked 3rd among the HIV-infected countries.
HIV targets the reproductive age which leads to political, economical, and sociodemographic consequences. India is booming economically, but it has diversity in terms of religion, languages, and moreover Indian culture is still traditional. The World Bank has estimated India as a low-income country. HIV prevalence in India is also affected by all these factors and varies geographically and is becoming a major health problem and also a major health priority.
To understand HIV at sociodemographic level, in tribal region of Chhattisgarh, this study was undertaken. Finding of this study shall be helpful in developing effective approach for prevention, redesigning the strategy for disease control through awareness generation, and also recommendation in lifestyle in tribal people.
| Methodology|| |
This was a retrospective study conducted at the antiretroviral therapy (ART) center of a tertiary care center from October 2016 to December 2017. HIV-positive patients were received from all departments of college and also from urban, rural, and tribal areas. The patients who attended were from nearby districts which included Kondagaon, Kanker, Bijapur, Sukma, Narayanpur, Dantewada, and others. The records of HIV-positive patients who attended were assessed and their demographic details and personal history were recorded in a structured format. The collected data were analyzed with the help of Microsoft Office, Microsoft Corp. 2009. This study was started after permission from Ethical Committee and in-charge of ART center. No conflict of interest was directly or indirectly associated with study conduction. Care was taken to have appropriate confidentiality of patients.
| Results|| |
In our study, the total number of patients was 295. The age of patients ranged from 15 months to 80 years, with a mean age of 33.87 years (standard deviation ± 8.3). Majority of the patients were between the ages of 21 and 45 years, i.e., in reproductive age group. Males were 52% (n = 156) and females were 46% (n = 137), whereas transgender/transsexual were 0.67% (n = 2). Males were more than females [Figure 1]. Discordant couple was noted in 18.9% (n = 56) and concordant couple was noted in 26.78% (n = 79). We noted that majority came from tribal population (59.6% [n = 176]), while those from urban area were 22.3% (n = 66) and those from rural area were 17.9% (n = 53) [Figure 2]. The majority of patients were from schedule tribes (47.7% [n = 141]) followed by general category (22.7% [n = 67]), schedule caste (11.52% [n = 34]), and other backward class (19.6% [n = 58]). Majority of the patients belonged to illiterate class (38.30% [n = 113]), 30.50% (n = 90) had received primary education, 21.35% (n = 63) had studied up to secondary school, while 9.8% (n = 29) had attended college [Table 1]. In our study, we found that 56.2% (n = 166) of the respondents were unemployed population and 43.7% (n = 129) were employed [Figure 2]. In the present study, homemakers constituted 32.2% (n = 95) of the study population and the next was nonagricultural laborer and self-employed. Income class was calculated by using the modified B G Prasad Scale; lower class contributed the major group (38.30% [n = 113]) followed by lower middle class (18.64% [n = 55]), middle class (15.82% [n = 47]), upper class (18.30% [n = 54]), and upper middle class (8.81% [n = 26]). In our study, majority of the patients who showed seropositivity were married (59.32% [n = 175]) followed by single (21.35% [n = 63]), widowed (11.5% [n = 34]), divorcee (6.1% [n = 18]), and live in relationship 1.6% (n = 5), pregnant women (4.4% [n = 13]), patients addicted to tobacco was noted in 22.37% (n = 66) and 14.23% (n = 42) were found to be alcohol addict. The CD4 count was <50 in 10.50%, between 51 and 200 in 38.30%, 201 and 350 in 27.70%, and >350 in 23.38% [Figure 3].
Pertaining to the entry point, self-reporting, i.e., patients, directly attending the ART center was 81.69% (n = 241). Other entry points are as mentioned in [Figure 4]. Mode of transmission in majority was heterosexual 82.71% (n = 244). Others were truckers 5% (n = 15), sex workers 3.3% (n = 10), mother-to-child transmission 3.72% (n = 11), unsafe injection 1.35% (n = 4), and blood transfusion 2.03% (n = 6). Among 1.69% (n = 5) of the respondents, the risk factor was unknown [Figure 4].
Family history of HIV infection in majority of the patients constituted of history in spouse followed by parents and children; 24.74% (n = 73), 6.44% (n = 19), 5.4% (n = 16), and 5.4% (n = 16), respectively. Voluntary direct reporting was the most common entry point in 81.69% (n = 241) followed by referral from Prevention of Parent-to-Child Transmission 7.1% (n = 21), Revised National Tuberculosis Control Program, commercial sex worker, referral from private practitioner and sex clinics constituted 5.08% (n = 15), 3.38% (n = 10), 1.35% (n = 4), and 1.35% (n = 4), respectively [Figure 4]. Maximum number of patients 53.89% (n = 159) were in State I of clinical disease, 24.74% (n = 73) were in Stage 2, 21.01% (n = 62) in Stage 3, and 0.34% (n = 1) were in Stage 4. Nearly 6.10% (n = 18) of patients on ART expired, while 3.05% (n = 9) from pre-ART group expired. Lost to follow-up constituted 3.38% (n = 10) and those who missed treatment constituted 4.06% (n = 12).
| Discussion|| |
In this study, males were 52% and were more as compared to females (46%), with a male-to-female ratio of 1.3:1 [Figure 1]. Majority of the patients were in the age group of 15–45 years – 75% (n = 223). This is slightly lower as compared to a study conducted by National AIDS Control Organization, in which 89% were in the age group of 15–44 years and 74% were males. Our study is in concordance with the study conducted by Sudhir et al., in which a majority belonged to the age group of 15–45 years (65.45%) with male preponderance and is also similar to the study by Deshpande et al., Kumari et al., Jha et al., Chatterjee et al., and Nojomi et al. Predominance of seropositivity in the age group of 15–45 years may be due to the reason that this section of population is more affected because they are more sexually active and also may be due to economically more productive years of life. Male predominance may be due to more exposure of male to outer world for occupation and because of existing social milieu, in which females do not seek medical advice due to fearing ostracism and loss of family support, little say in decision-making, like condom use with their partners, especially if she is economically dependent on her husband. HIV is having a tremendous impact on the livelihood of the affected people and their families by affecting economically productive and sexually active group.
In North America, Europe, and Australia, about 51% of the cases are homosexual, but in our study, no homosexual history was present. This is similar to the study by Dandona et al. Two transgenders/transsexuals were present in our study.
Majority of the patients in our study belonged to tribal and rural population (77.6%), whereas the urban population was 22.3% [Figure 3]. This is similar to a study conducted by Sudhir et al., in which majority of patients were from rural area (59.2%). It is also similar to a study conducted by Dandona et al., NFHS 2005–2006 which reported 67% of patients were from rural area and dissimilar to study conducted by Jha et al. in which 69.4% of the patients were from urban area. The reason for such result in our study could be migration of tribal and rural population for occupational reason and also Bastar is a land of tribes and 70% of the total population of Bastar comprises of tribals, which is 26.76% of the population of Chhattisgarh; hence, more number of tribal population with seropositivity was recorded in our study. Majority of the patients in our study were married (59.32%), followed by single (21.5%), widowed (11.5%), divorcee in (0.61%), and HIV positivity in live in relationship (6.01%) [Figure 2]. Highest percentage of HIV positivity in married patients were also noted by Shobhana et al. and Zaheer et al. Majority of the patients were illiterate (65.4%). Among literates, those who had primary education comprised of 30.5%, secondary education of 21%, and college and above comprised of 9.6%. This shows that as the literacy advances, the rate of infection decreases. This is similar to a study conducted by Jha et al., and Deshpande et al. which demonstrated higher seropositivity among patients of lesser education, low education status, unemployment, less awareness regarding safe sex could be the reason for high prevalence among this group living in tribal area. Most of the patients in the present study came from lower class (65.4%) and other from lower middle class (18.6%) and upper class (18.3%) as per the modified B G Prasad Scale. The income profile indicated that a substantial number of HIV-positive people were living below poverty line; here, we see a window of opportunity; if specific measures are applied, it can help in improving the socioeconomic status leading to decrease in HIV transmission. Most of the population belonged to unemployed (56.2%) and homemakers were the next group which constituted high percentage of seropositivity (32.2%) and next group were nonagricultural respondents (24.7%). In tribal region of Chhattisgarh, most people do not find employment all the year round, in Bastar plateau irrigation, coverage is 1.2% and the usage of traditional agriculture equipment has lowered the production of agriculture; hence, they go for nonagricultural profession for livelihood. High percentage among homemakers could be due to them being at the mercy of their counterparts who are ignorant of their spouses illness, Bastar having different sexual practices one of them being ghotul ceremony, which is an ancient ritual that binds the tribes together with partners being periodically changed, other reason could be that maximum population lives in remote areas having scarce knowledge about HIV and also very important tradition of tattooing is prevalent in tribal region with sharing of same needle could be the cause.
In the present study, heterosexual was the most common mode of transmission (82.9%), which is also the most common mode of transmission in India. This was consistent to a study conducted by Sudhir et al. which showed that heterosexual mode of transmission accounted for (90%) of the total cases, more or less similar to our study. In our study, the distribution of entry point (referred from) showed that majority of the people (81.6%) opted for direct voluntary testing which is a very good sign in otherwise tribal area where HIV and other sexual disease are considered as social stigma.
| Conclusion|| |
A significant number of patients were of economically productive age group. Majority were males, from tribal population, living below poverty line, and illiterate. ince higher literacy helps in better employment and increased per capita income in turn leading to increased awareness and modification of other social demographic determinants, authorities need to focus on this aspect which will help in preventing the spread of the pandemic.
Heterosexual mode was the most common mode of infection. Attendance of the patient from direct reporting was much encouraging in the tribal region with different sociodemographic background, this might be due to holistic approach of the nature of AIDS control programme to reach these socially marginalized people to make them aware of the modes of transmission of HIV and to motivate them to use to use method of protection from HIV.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
NACO (National AIDS Control Organization) India HIV Estimate 2015, Technical Report. Available from: http//www.naco.gov.in
. [Last accessed on 2018 Sep 22].
Sudhir A, Rahul R, Dhiraj K, Varun Y. Socio demographic profile of HIV seropositive patients at ART centre, PGIMS, Rohtak. Int J Med Health Res 2017;3:32-6.
Deshpande JD, Giri PA, Phalke DB. Clinico-epidemiological profile of HIV patients attending ART centre in rural Western Maharashtra, India. South East Asia J Public Health 2012;2:16-21.
Kumari R, Mritunjay K, Mahapatra SC. Socio-demographic and immunological profile of HIV patients attending ART clinic in a tertiary care hospital in North India. Int J Community Public Health 2017;4:3166-73.
Jha AK, Chadha S, Uppal B, Bhalla P, Kishore J, Deewan R. Socio-demographic and immunological profile of HIV patients attending ART clinic in a tertiary care hospital in North India. J HIV Clin Sci Res 2014;1:7-10.
Chatterjee S, Saha I, Sarkar AP, Mishra R, Akbar F, Saha R. A study on socio-demographic profile of HIV/AIDS patients receiving antiretroviral therapy in an ART center of Burdwan District, West Bengal. J Commun Dis 2015;47:1-4.
Nojomi M, Anbary K, Ranjbar M. Health-related quality of life in patients with HIV/AIDS. Arch Iran Med 2008;11:608-12.
Dandona L, Dandona R, Kumar GA, Reddy GB, Ameer MA, Ahmed GM, et al.
Risk factors associated with HIV in a population-based study in Andhra Pradesh State of India. Int J Epidemiol 2008;37:1274-86.
National Health And Family Survey-3, (NHFS-3) 2005-2006, for the States of Andra Pradesh and Maharastra, National Health and Family Survey, India.
Shobhana A, Guha SK, Neogi DK. Mucocutaneous manifestations of HIV infection. Indian J Dermatol Venereol Leprol 2004;70:82-6.
] [Full text]
Zaheer MS, Rabbani MU, Zuber A, Tamkin K, Rewari BB, Pandey DK. Clinical and demographic profile of patients of AIDS in and around Aligarh. J Indian Acad Clin Med 2003;4:121-6.
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