Title

Rural Indian tribal communities: an emerging high-risk group for HIV/AIDS

Creator

Eknath Naik

Arun Karpur

Richard Taylor

Balasubramaniam Ramaswami

Sagar Galwankar

John Sinnott

Sarah Nabukera

Hamisu M Sadhu

Date

February 21, 2005

extracted text

BMC international health and
Human flights

O
BioFVled Central

Research article

Open.'

Rural Indian tribal communities: an emerging high-risk group for
HIV/AIDS

Eknath Naik1-3, Anin Karpur1’2, Richard Taylor1,
Balasubramaniam Ramaswami2, Seetharam Ramachandra2,
Bindu Balasubramaniam2, Sagar Galwankar1, John Sinnott3,
Sarah Nabukera4 and Hamisu M Sadhu*4
Address: 1 Department of Epidemiology and Biosiaiistics, College of Public I lealth, University of South Florida, Tampa, Florida, USA, 3Swami
Vivekananda Youth Movement, Mysore, Karnataka, India, ’Division of Infectious Diseases, Department of Internal Medicine, University of South
Florida, Tampa, Florida, USA and ^Department of Maternal & Child Health, School of Public I lealth, University of Alabama at Birmingham, USA
Email: Eknath Naik - enaik^hsc.usf edu; Anin Karpur - akarpur^hsc.usf.edu, Richard Taylor naylor^hsc.usf.edu,
Balasubramaniain Ramaswami - R.im.i^hoimail.umi; Sceth.u.un Raimahandia - cinimucss(r/?yahoo.com;
Bindu Balasubramaniam biiidiibalu^vlh net, Sagai Galwankar ■ g<sagartf#yahoo corn; John Sinnott johiUsinnotl^gmail coin;
Sarah Nabukera nahukvia^uab edu, Hamisu MSalihu* hsalihu(a>tiab.cdti
• (kirrcspomlmg author

Published: 21 February 2005

B/dC International Health and Human Rights 2005, 5.1

doi: 10 I I 86/I472-698X-5-1

Received: 28 September 2004
Accepted 21 February 2005

This article is available from- hup://www.biomedcentral .com/14 7 2-69 8X75/1
© 2005 Naik et al. licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http;//crcatiYecommon5.c)r^/licen5e5/by/2.0).
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Rural Indian tribes are anthropologically distinct with unique cultures, traditions and
practices. Over the years, displacement and rapid acculturation of this population has led to
dramatic changes in their socio-cultural and value systems. Due to a poor health infrastructure, high
levels of poverty and ignorance, these communities arc highly vulnerable to various health
problems, especially, communicable diseases including HIV/AIDS. Our study sought to assess
knowledge, attitudes and practices regarding sexuality, and the risk factors associated with the
spread of HIV/AIDS and STDs among these communities.
Methods: A nested cross sectional study was undertaken as part of the on going Reproductive
and Child Health Survey. A total of 5,690 participants age 18—44 were recruited for this study. Data
were obtained through home interviews, and focused on socio-demographics, knowledge, attitudes
and behaviors regarding sexuality, HIV/AIDS and other STDs.
Results: The study revealed that only 22% of adults had even heard of AIDS, and 18 % knew how
it is transmitted. In addition, only 5% knew that STDs and AIDS were related to each other. AIDS
awareness among women was lower compared to men (14% vs.30 %). Regarding sexual practices,
35% of the respondents reported having had extramarital sexual encounters, with more males than
females reporting extramarital affairs.
Conclusion: Lack of awareness, permissiveness of tribal societies for premarital or extra-marital
sexual relationships, and sexual mixing patterns predispose these communities to HIV/AIDS and
STD infections. There is a dire need for targeted interventions in order to curtail the increasing
threat of HIV and other STDs among these vulnerable populations.

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Karnataka

Figure I
Map of India showing the region of Karnataka where the study was conducted. Used with permission from lndia-tourism.com

HIV/AIDS, as well as other relevant demographic infor­
mation not included in the RCHS. The instalment was
developed in F.nglish, translated to the native language,
and subsequently back translated to F.nglish for content
and language verification. The survey instrument was
field-tested for validity purposes and modified
accordingly.

separately to ensure confidentiality. Each interviewer read
out each of the questions and response choices (where
appropriate) to the interviewees and recorded all answers
directly on the questionnaire. Verbal informed consent
was obtained from each respondent prior to starting the
interview.
Data analysis

Doto collection
A team of ten interviewers from the local tribal communi­
ties with a minimum of high school education were
selected and trained for two weeks to ensure uniform and
high-quality data collection. All adults were interviewed

Data were entered into an electronic database using
Sybase Central Software (Sybase, Inc. Dublin, CA). To
ensure confidentiality, all respondent identifiers were
expunged to create a secondary data set that was used for
the final analysis. Frequency tables were generated for

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BMC International Health and Human Rights 2005, 5 1

Tabic I: Demographic profile of the study participants

Characteristics
Mean age

Number (%) (N = 5.690)

3 1 years

Sex

Men

3,016 (S3)

Women

2.674 (47)

Currently living in tiled-roof housing

3,812 (67)

Access to potable water

2,276 (40)

Migrated to find work

1.992 (35)

Currently married
Men
Women
All

2.353 (78)•
2,433 (91)’*
4.786 (84)

Literacy***
Men

814 (27)
*

Women
All

802 (30)**

1,616 (28)

Mean age of first marriage

Mean years (95% Cl)

Men
. Women

22.0 (19 5-24.5)
13.0 (11.2-14.7)

All

150 (I I 2-18 8)

‘Percentages are based on the total number of men in the study.
’•’Percentages are based on the total number of women in the study
■**‘Literacy as defined by census operations of India is the ability to
read and write in any of the Indian languages.
Cl = Confidence interval

Table 2: Self reported sexual practices of respondents
N = 5.690

Characteristics

Age at first sexual activity
Men

Women
Premarital or extramarital sexual
encounters
Males
Females
Total
Sex with commercial sex worker
within a year after spouse giving
birth (men only n = 3,016)

Mean years (95% Cl)
17.0 (13.4-20.6)
13.0 (1 1.5-14.5)
Number (n)
(%)

1.434
558
1.992
470

72 0
28.0
*
35
20

* Percent based on the total sample of 5.690 respondents

four percent were married (91% females £> 78% males).
The average age al marriage was 13 years for females, and
22 years for males Only 28% (27% female, & 30% male)
of the population was literate i.e. able to read and write in
any of the Indian languages. The majority of respondents
(67 %) reported living in tiled roof houses with mud
Hooting, while only 10 % indicated easy access to potable
water Agriculture was the major source of income in these
communities. The reported average daily income ranged
from US $1 50 to $2.00. Approximately 35% of the
respondents migrated on average three to four months
each year to nearby areas for work.

Unique sexual practices among tribal members
The findings revealed that these tribal communities did
not have a strut lured marital system; instead members
pratlited a form of serial monogamy in which they
th.inge partners anil remarry every four to five years.
Regarding sexual practices. 35% of the respondents
reported either premarital affairs or extramarital affairs
( t able 2) I lowever such practices were more common in
men compared to women furthermore, 20% of the male
participants reported having had sex with a commercial
sex worker (CSW) during the period the wife had had a
child
Knowledge and beliefs about HIV/AIDS and STDs
Among these communities, there was a low level of
knowledge on IIIV/AIDS; only 22 % of all study partici­
pants (n = 1,252) had heard of AIDS (Table 3). Among
those who have heard ol AIDS, less than 20 % (n = 250)
knew how HIV/AIDS was transmitted (16.8 % male vs.
8% females). About 98 % were not aware of the methods
to prevent I IIV/AIDS transmission. As many as 30 % (n =
376) ol those who hail heard of AIDS believed that "sin­
ners" will get AIDS, while 10 % (n = 125) believed that
AIDS and STDs could be prevented by the sterilization of
women, l-iltcen percent (n = 188) thought "AIDS is
acquired by looking at a person who has AIDS," and 18 %
(n = 225) believed that "AIDS is acquired by talking to a
person who has AIDS." Only 5 % knew that a relationship
exists between I IIV/AIDS anti SI Ds. Interestingly, ‘I per
cent (n = 51) believed that there was a cure lor AIDS. Most
had not heard of S I Ds, anti of those who had heard of
them only 1 percent (n = 16) were aware ol associated
symptoms.
Discussion

In today's modern world, it is difficult to imagine societies
that are still socially and culturally isolated Irom the rest
of civilization; however, they do exist. The tribal societies
throughout India have remained socially and culturally
alienated from mainstream Indian society until develop­
mental and conservation activities in tribal areas forced
interactions between. them. Displacement of the tribal

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Authors' contributions

All the authors were involved in the design of the study,
analysis, interpretation and development of the
manuscript.
Acknowledgements
Wc would like to acknowledge and thank staff of Swami Vivckananda Youth
Movement for their valuable logistic support in the data collection We
would also like to acknowledge lndia-tourism.com and the RCHS for allow­
ing us access to their maps.

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