Married women in India who experience physical and sexual violence from their husbands have an increased risk of HIV infection, compared with women who are not abused by their husbands, according to a study in the August 13 issue of JAMA, a theme issue on violence and human rights.

"India is home to approximately 2.5 million people living with human immunodeficiency virus (HIV), the third largest number of cases of any country in the world, and is recognized as the source of increasing HIV prevalence among its South Asian neighbors," the authors write. "Despite reductions in prevalence of … infection among the general population of India, women account for a rising percentage of all HIV cases, with husbands' risk behavior described as the major source of women's infection. Intimate partner violence (IPV) has been described as being associated with heterosexual transmission of HIV to women in India and elsewhere."

Jay G. Silverman, Ph.D., of the Harvard School of Public Health, Boston, and colleagues conducted a study in 2007 and 2008 to assess the relationship between experiencing IPV and the occurrence of HIV infection in a nationally representative sample of married Indian women tested for HIV. The researchers analyzed data on 28,139 married women who provided IPV data and HIV test results as part of a national family health survey conducted across India during 2005 and 2006.

Approximately one-third of married Indian women (35.49 percent) reported they had experienced physical IPV, with or without sexual violence, from their husbands. About one-fourth (27.8 percent) reported experiencing physical IPV without sexual violence, while 7.68 percent reported both physical and sexual IPV. Approximately one in 450 women (0.22 percent) tested positive for HIV.

"In this first national population-based study of the relationship of husbands' violence against wives to wives' HIV infection status (as indicated via diagnostic testing), married Indian women who experienced both physical and sexual IPV demonstrated an HIV infection prevalence approximately four times greater than that of non-abused women," the authors report.

Physical IPV alone was not associated with the risk of HIV infection. Women's personal sexual risk behaviors (condom use and multiple partners) were not associated with HIV infection prevalence.

"Prevention of IPV may augment efforts to reduce the spread of HIV/AIDS," the authors assert.

"Findings of the present study, based on both the large population-based sample and the use of standard diagnostic testing for HIV infection, should serve to confirm the nature of this relationship and move public health policy-makers and practitioners to increase recognition of IPV as a critically important target in the global fight against HIV/AIDS," they conclude.

(Agencies August 13, 2008)