Shaping the epidemic: application of proximate determinant framework in understanding the factors affecting HIV in Maharashtra

Nidhi Sharma, International institute for Population Sciences (IIPS)
Shri Kant Singh, International Institute for Population Sciences (IIPS)
Sudipta Mondal, Family Health International (FHI)

Indian HIV epidemic is exhibiting a declining trend, providing an opportunity for meta-analysis and data-synthesis by triangulation to delineate the comprehensive picture and understand drivers of epidemic. Proximate determinant (PD) framework is used to tease-out factors affecting HIV vulnerability and application of decomposition analysis segregating interplay of multiple factors operating within the framework. Study focuses at low-risk general males and high-risk male clients who form bridges between high-risk and low-risk population. Data from NFHS-III, IBBA-1 and BSS have been used. Findings underscore multi-partner, condom-use and partner-mixing as PD for general men, with coital frequency an additional determinant for clients. Partner type and number of lifetime partners are significant determinants for both groups. Significant underlying determinants, after adjustment for PDs, are younger age (p<0.1), marital status (p<0.05) and alcohol (p<0.05) for general men and marital status (p<0.05), education (p<0.01), age at first intercourse (p<0.05) and prior HIV testing (p<0.05) for clients.