AIDS activists shout slogans during a protest. (AFP)

New Delhi, Aug. 17: An abusive husband in India is dangerous in more ways than previously believed.

A new study by Indian and American researchers has shown that abusive husbands in India, apart from causing physical and psychological trauma, are also likely to spread HIV to their wives.

Married women in India who experience violence from their husbands have a four-fold higher risk of getting infected with HIV than women who do not face spouse abuse, according to the study by researchers at the Harvard School of Public Health and Indian collaborators.

The study, that appeared this week in the Journal of the American Medical Association, is the first nationwide study to analyse domestic violence and HIV infection. It relied on more than 28,000 married women who provided information about intimate partner violence.

“Abusive men are more likely to be having extramarital affairs and more likely to be going to commercial sex workers and not using condoms,” said Jay Silverman, the study leader at Harvard. “A man who is abusive is more likely to get himself infected and then transmit the infection to his wife,” Silverman told The Telegraph over the phone.

About one in three (35 per cent) of the married women reported they had experienced violence — about 28 per cent had suffered physical violence, while another 7 per cent had experienced physical and sexual violence.

Physical violence alone did not appear to increase the risk of HIV infection to the women. But HIV prevalence was four times higher in the women who experienced both physical and sexual violence.

Intimate partner violence thus appears directly involved in the transmission of the virus. “The abuse could be associated with forced or coerced sex, which is more likely to cause injuries that can increase the risk of transmission of HIV,” Silverman said.

“These findings should be a wake-up call for us,” said Donta Balaiah, the deputy director at the National Institute of Research in Reproductive Health, Mumbai, a study collaborator. “India may need to expand its HIV prevention efforts to address HIV transmission driven by sexual violence at home,” Balaiah said.

The study has also shown that women’s HIV infection was not related to their own sexual behaviour. The results support the idea that India’s HIV epidemic among married women is driven by male behaviour.

Public health experts believe India is witnessing a feminisation of the HIV epidemic — infections among women are growing faster than among men — a trend similar to what the US and Africa have experienced.

Silverman said the feminisation of HIV epidemics in the US and Africa had been partly driven by women’s inability to shield themselves from unprotected sex that can follow abusive behaviour from male partners.

Most current HIV prevention programmes in India have been aimed at high-risk groups such as commercial sex workers or their clients or intravenous drug users.

“We have no intervention specially designed to prevent the spread of infection between married couples,” said Niranjan Saggurti, programme officer at the Population Council, New Delhi, a global non-government organisation involved in public health issues.

“This study has helped identify a subset of married people who are at a high risk of infection.”