Article Text

other Versions

PDF
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
  1. Tara S H Beattie1,
  2. Parinita Bhattacharjee2,
  3. M Suresh2,
  4. Shajy Isac2,
  5. B M Ramesh2,3,
  6. Stephen Moses3,4
  1. 1Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Karnataka Health Promotion Trust, Bangalore, Karnataka, India
  3. 3Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  4. 4Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Tara S H Beattie, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; tara.beattie{at}lshtm.ac.uk

Abstract

Background Despite high HIV prevalence rates among most-at-risk groups, utilisation of HIV testing, treatment and care services was relatively low in Karnataka prior to 2008. The authors aimed to understand the barriers to and identify potential solutions for improving HIV service utilisation.

Methods Focus group discussions were carried out among homogeneous groups of female sex workers, men who have sex with men and transgenders, and programme peer educators in six districts across Karnataka in March and April 2008.

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.

  • HIV testing
  • ART
  • female sex work
  • MSM
  • transgender
  • epidemiology
  • sexual health
  • AIDS
  • prevention

Statistics from Altmetric.com

Footnotes

  • Funding Support for this study was provided by the Bill and Melinda Gates Foundation. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill and Melinda Gates Foundation.

  • Competing interests None.

  • Ethics approval Ethical approval for this study was granted by the Institutional Review Board of St. John's Medical College and Hospital in Bangalore, India.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles