Table 2

Summary of the key personal, interpersonal and structural factors influencing HIV service uptake by FSWs, MSM and transgenders in Karnataka state

	Barriers	Motivators
Personal	Lack of knowledge about HIV services; denial of HIV risk/fatalism; fear of mental health impact of a positive test result	Clear understanding of the benefits of knowing one's status
Interpersonal	Fear of discrimination by family, neighbours, schools and government officials following inadvertent disclosure of sex work, homosexuality and/or HIV infection	None provided
Structural
Quality of care	Discrimination and homophobia; derogatory comments; denial of treatment; diagnosing without examination; ineffective treatment; poor facilities at PPTCT service points	Empathetic and caring staff, with a good understanding of issues facing the FSW/MSM-T community; NGOs challenging discriminatory behaviour and bribes
Confidentiality	Location within hospitals; queuing for HIV services in hospital corridors; counselling facilities at VCT centres	Services located in non-public settings (eg, NGO STI clinics)
Access	Long distances; charges for ‘free’ services; long waiting times; quotas at ART centres; ID cards and ration cards; a ‘buddy’ to access ART services	FSW/MSM-T ‘exclusive’ services; peer educators accompanying community members to services

ART, antiretroviral treatment; FSW, female sex worker; MSM-T, men who have sex with men and transgenders; NGO, non-governmental organisation; PPTCT, prevention of parent to child transmission; STI, sexually transmitted infection; VCT, voluntary counselling and testing.