Table 2

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

  • 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
InterpersonalFear of discrimination by family, neighbours, schools and government officials following inadvertent disclosure of sex work, homosexuality and/or HIV infectionNone provided
 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

  • 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)
  • 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.