Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India

Abstract

Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India Results 26 focus group discussions were conducted, involving 302 participants. Participants had good knowledge about HIV and HIV voluntary counselling and testing (VCT) services, but awareness of other HIV services was low. The fear of the psychological impact of a positive HIV test result and the perceived repercussions of being seen accessing HIV services were key personal and interpersonal barriers to HIV service utilisation. Previous experiences of discrimination at government healthcare services, coupled with discriminatory attitudes and behaviours by VCT staff, were key structural barriers to VCT service uptake among those who had not been HIV tested. Among those who had used government-managed prevention of parent to child transmission and antiretroviral treatment services, poor physical facilities, long waiting times, lack of available treatment, the need to give bribes to receive care and discriminatory attitudes of healthcare staff presented additional structural barriers.Conclusions Embedding some HIV care services within existing programmes for vulnerable populations, as well as improving service quality at government facilities, are suggested to help overcome the multiple barriers to service utilisation. Increasing the uptake of HIV testing, treatment and care services is key to improving the quality and longevity of the lives of HIV-infected individuals. INTRODUCTIONEarly diagnosis and treatment of HIV-infected individuals is essential in promoting the long-term health and survival of people infected with HIV and can help prevent onward HIV transmission to sexual partners and infants of infected mothers. The few qualitative studies conducted with FSWs and MSM-T suggest that a lack of knowledge about HIV/AIDS, VCT and ART, lack of perceived risk, anxieties about a positive test result, fears about being seen accessing HIV services, discrimination by healthcare providers and the fear of arrest may act as major disincentives to HIV testing. 5e8 The 'double stigma' of an HIV-positive result, coupled with the potential disclosure of sex work and/or a stigmatised sexual orientation, can present additional barriers. 7 8India has an estimated 2.4 million people living with HIV. 9 The HIV epidemic is highly heterogeneous, with the majority of infections occurring through heterosexual transmission. Unprotected paid sex is a major transmission route, particularly in the southern Indian states. Karnataka state in south India has an estimated adult HIV prevalence of >1% in several districts and has the fourth highest HIV prevalence among the general population among Indian states. Karnataka has over 100 000 FSWs and 25 000 MSM-T, of whom approximately 17% are estimated to be infected with HIV. In response, the HIV prevention programmes began promoting improved access to VCTand HIV care services as part of eff...

Understanding the Intention to Undergo Regular HIV Testing Among Female Sex Workers in Benin

“…These results are in line with Beattie et al 37 and with the findings of Wang et al 32 and Wang et al, 33 which reveal that knowledge about HIV and VCT and the benefits of HIV testing (eg, perceived benefits of help in case of the positive test) is a factor favoring its use, whereas a low level of knowledge, along with fear, anxiety, and perceived negative consequences (rejection, stigma, and discrimination) are the main barriers. As in our study, having already undergone VCT is a factor associated with FSWs' motivation to go for VCT.…”

“…Despite differences in methodological and theoretical approaches, there are some convergences between our results and previous studies in Africa 26,36 and elsewhere 32,33,37,38 regarding beliefs associated with PBC among FSWs. The importance of beliefs perceived by FSWs as barriers or facilitators of intention or behavior has already been underlined in previous studies.…”

“…This is particularly crucial for vulnerable populations, such as FSWs, which would otherwise bear the double burden of social exclusion and stigma. 36 This factor was considered a salient belief that underlies PBC and CB and has been reported several times in the literature 26,32,33,37,38 as an obstacle to the use of VCT services. However, the perception of support from peers, managers of prostitution sites, and close family members is a factor facilitating the acceptance of VCT.…”

“…However, the perception of support from peers, managers of prostitution sites, and close family members is a factor facilitating the acceptance of VCT. 32,33,37,38 Wang et al 33 reported a positive peer influence that could promote utilization of VCT clinics. This supports the influence of normative factors (subjective or DN) in using VCT services.…”

Circumstances, experiences and processes surrounding women's entry into sex work in India

“…Structural interventions involving community mobilisation, collectivisation, and empowerment are known to improve access to HIV-related health services and reduce structural vulnerabilities faced by sex workers in India (Beattie et al 2012;Blanchard et al 2005;Gurnani et al 2011). It is now necessary to re-examine the roles of these structural interventions and develop novel strategies to address the needs of young women who have not yet entered into sex work, but may be considering doing so.…”