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Indian Journal of Community Medicine

Prevalence of HIV Infection Among Patients of Pulmonary Tuberculosis Attending Chest Diseases Hospital, Jammu (Jammu and Kashmir)

Author(s): R Bahl, B Singh, R Singh

Vol. 32, No. 4 (2007-10 - 2007-12)

ISSN No. 0970-0218

R Bahl, B Singh, R Singh1

In the backdrop of increase in reporting of HIV positive cases in chest and tuberculosis hospital at Jammu, a study was carried out to assess the prevalence of HIV infection among cases of pulmonary tuberculosis (PTB) attending this hospital. The study was carried out in the chest diseases hospital of Government Medical College, Jammu, which is the only referral centre for cases of PTB in province. It included all such cases attending this centre during the study period w.e.f. 1 April 2003 to 30 June 2004 and involved analysis in respect of the demographic variables, i.e. age, sex, marital status, occupation and religion. A structured schedule was employed to interview the patients. Diagnosis was based on clinical examination by the chest disease specialist for TB or TB with HIV/AIDS followed by appropriate investigations, i.e. sputum for AFB and/or sputum for culture of AFB and/or radiological (X-ray chest PA view). Tuberculin test, ELISA for HIV infection (repeated with different kits in case of positivity). A total of 5387 patients were diagnosed who were suffering from PTB; 84 were dually infected with PTB and HIV. Seroprevalence of HIV among PTB patients was 1.6%.

Majority of the patients belonged to district Jammu (74.02%) followed by Kathua (16.88%), Udhampur (5.19%), Rajouri (2.59%) and Poonch (1.29%). Seven patients belonged to states out of Jammu and Kashmir (five males and two females). In district Jammu, 77.2% of patients belonged to rural areas and 22.80% belonged to urban areas. In district Kathua, 77.9% of patients belonged to rural areas and 23.07% belonged to urban areas. And all the patients in districts Udhampur, Rajouri and Poonch belonged to rural areas.

The majority of patients (over 75%) were in the middle age group of 21-40 years. Mean age was 34.83 years [male 36.01 years, female 36.46 years; sex ratio = 2:1 (male/female)]. The majority of patients in both sexes were in the age group 20-40 years (male – 60.71% and female – 75%) [Table 1].

The majority (84.5%) of patients were Hindus (male: female = 2:1) followed by Sikhs (13.1%; male: female = 2.66:1).

Forty-four percent of patients were educated up to middle school standard, whereas 17.9% each had studied up to primary and high school level, illiterates and just literates constitute over 20% of the total. The proportion of male literates was more than female literates. Illiteracy was more among females.

Thirty-one out of 56 males belonged to transport-related occupation [Table 2], eight (14.28%) males belonged to military/paramilitary and 27 (96.42%) females were housewives and one was a student [Table 2]; 70.23% had family income less than Rs. 5000 per month, 21.4% between 5000 and 7500, 2.4% between 7500 and 10,000 and 1.2% more than Rs. 10,000.

About 74.54% of males were married, 1.8% were widowers and 23.6% were unmarried. 53.4% females were currently married, 42.8% were widows and 3.57% were being unmarried (at the age of 8 years).

Discussion

Out of 5387 cases suffering from PTB, 84 were diagnosed as HIV positive. Seroprevalence of HIV among PTB patients was 1.6%. It is in contrast to the findings of other studies conducted in India and abroad, which showed higher prevalence of HIV among PTB patients.(1) The finding is in accordance to other studies.(2) A majority (79.2%) of patients (N = 61; 39 males and 29 females) belonged to rural areas and 20.8% (N = 16;

Table 1: Age and sex wise distribution of HIV seropositive PTB patients

S. No. Age (years) Male Female Total
1. 0-10 0 1 1
2. 10-20 1 0 1
3. 20-30 14 9 23
4. 30-40 20 12 32
5. 40-50 15 5 20
6. 50-60 5 1 6
7. 60-70 1 0 1
  Total 56 (66.66%) 28 (33.33%) 84

Table 2: Occupation wise distribution of HIV seropositive PTB patients

S. No. Occupation No. % Male Female
1. Housewife 27 32.14 0 27
2. Driver (local bus) 4 4.76 4
3. Driver
(auto rickshaw)
4 4.76 4
4. Driver (bus) 1 1.19 1
5. Driver (truck) 12 14.28 12
6. Cleaner 2 2.38 2
7. Porter (truck) 8 9.52 8
8. Service 8 9.52 8
9. Shopkeeper 6 7.14 6
10. Daily wager 3 3.57 3
11. Labourer 1 1.19 1
12. Farmer 2 2.38 2
13. Peon 1 1.19 1
14. Student 2 2.38 1 1
15. Beggar 03 3.57 3
  Total 84 100.00 56 28

12 males and four females) belonged to urban areas. Seven patients (five males and two females) belonged to states other than Jammu and Kashmir. It showed rural dominance in the prevalence of HIV among pulmonary tuberculosis cases. It is in contrast to study conducted in Central Africa.3

A majority (76.2%) of patients were in the middle age group and the mean age was 34.8 years (36.0 for males and 32.5 for females). There seems to be a lot of variability in the age of cases in the study in comparison to the studies carried out in the country and abroad. In a study carried out at New Delhi, majority of the patients were in the age group of 20-30 years. Similarly, some other studies are in accordance with our study with mean age of patients either same or lower. In a few studies, the age of males was higher than in our study.1,4

Of the total of 84 patients, 56 (66.67%) were males and 28 (33.33%) were females (sex ratio = 2:1). Similar findings have been observed in various other studies.1 A majority of patients were Hindus (84.5%) followed by Sikhs (13.1%) and Muslims (2.4%). Patients (83.3%) were literate (N = 70). It goes in slight deviation from a study conducted in Ahmedabad in 2002 by Dermal et al. wherein HIV positivity was seen equally among all religions and both sexes.2

None of the cases had studied beyond school. In a study conducted abroad also, the HIV infection was linked to low level of schooling.2,4

About 4% of males were involved in the occupations related to transport (drivers, conductors, porters, etc.) involving mobility within and outside the state and another 9.5% (eight males) were working in military and paramilitary forces subjecting them to risk behaviour due to long separation from families. Out of all the females (N = 28), 27 were housewives and one was a student who had acquired the infection in utero (maternofoetal transmission). These results go in accordance with the results of other studies where the occupations involving mobility were associated with the transmission of HIV infection.5

Seventy percent of patients hailed from families with income less than Rs. 5000 per month, 21.4% had family income between 5000 and 7500 showing that with increase in income, the seroprevalence of HIV decreased. It may be explained on the basis that due to better economic status, facilities such as electronic and print media were accessible, hence increasing awareness leading to healthy behaviours.

Conclusions

Since most of the patients belonged to the rural areas, had low literacy, low income and males were involved in various occupations, i.e. transport, military, trading, labour; and all females were housewives, there is a need to concentrate the BCC activities to these sections and upliftment of women and empowerment be seriously carried out to let them have discretion in sexual health.

References

  1. Jain NK, Agarwal JK, Chopra KK, Khanna SP. Prevalence of HIV infection among tuberculosis patients. Indian J Tuberculosis 1996;43:105-6.
  2. Dermal BS, Bhatnagar D, Kumar D, Deshpande VR. A study of prevalence of HIV in Tuberculosis cases. Indian J Community Med 2002;47:80-3.
  3. Multiple Sex partners: Results of a National HIV/AIDS Survey in the Central African Republic. BMJ 1993;307:644.
  4. Laquardia J, Merchan-Hamann E. Risk factors for tuberculosis disease in AIDS cases reported in Brazil, from 1980 to 2000. Rev Esp Salud Publica 2003;77:553-65.
  5. Jenkins RA, Jenkins PR, Nannis ED, Mckee KT Jr, Temoshok LR. Correlates of human immunodeficiency virus infection risk behavior in male attendees of a clinic for sexually transmitted disease. Clin Infect Dis 2000;30:723-9.

Departments of Community Medicine and (1)Chest Diseases, Government Medical College, Jammu,
Jammu and Kashmir, India

Correspondence to:
Dr. B. Singh,
Department of Community Medicine, Government Medical College, Jammu, Jammu and Kashmir, India.
E-mail: lionbhupinder(at)yahoo.co.in
Received: 14.08.06
Accepted: 24.08.07

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