Understanding the Factors Affecting the HIV Epidemic in Maharashtra: Application of Proximate Determinants Framework

The 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 to understand the drivers of the epidemic. A proximate determinants (PD) framework is used to tease out factors affecting HIV vulnerability and to segregate the interplay of multiple factors operating within the framework. This study focuses on low-risk general males and high-risk male clients who form bridges between high-risk and low-risk populations. Data from NFHS-III, IBBA-1 and BSS have been used. The 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, marital status and alcohol for general men, and marital status, education, age at first intercourse and prior HIV testing for clients.