Personal, inter-personal and structural barriers to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, India
B. Tara1, M. Suresh2, B. Parinita2
1London School of Hygiene and Tropical Medicine, Health Policy Unit, London, United Kingdom, 2Karnataka Health Promotion Trust, NGO, Davangere, India
Background: Despite high HIV prevalence rates among the most-at-risk groups, utilisation of free HIV testing, treatment and care services remains low in Karnataka state, south India. This study aimed to understand the barriers and identify potential solutions to improve HIV service utilisation.
Methods: Focus group discussions (FGDs) were carried out among homogenous groups of 6-15 female sex workers (FSWs), men having sex with men (MSM), transgenders and peer educators in six districts across Karnataka.
Results: 26 FGDs were conducted with 302 participants: 125 FSWs, 56 MSM, 6 transgenders and 115 peer educators. Knowledge about HIV and about HIV voluntary counselling and testing (VCT) services was generally good but awareness of other HIV services was low. The fear of the psychological impact of a positive HIV test result and the fear of being seen accessing HIV services presented key personal and inter-personal barriers to HIV service utilisation. Although the majority of FSWs who had accessed HIV VCT services reported positive experiences, previous experiences of discrimination at government health care services coupled with discriminatory attitudes and behaviours towards MSM / transgenders by VCT staff served as key structural barriers to VCT service uptake amongst those who not been HIV tested. Among the few individuals who had utilised prevention of parent to child transmission (PPTCT) and anti-retroviral treatment (ART) services, poor facilities, long waiting times, lack of available treatment, the need to give bribes to receive care, and discriminatory and homophobic attitudes of healthcare staff towards FSWs and MSM presented additional structural barriers.
Conclusions: Addressing the personal, inter-personal and structural barriers to HIV service utilisation among these populations will require a multi-faceted approach involving sex workers, HIV services, policies and legislation, as well as the broader population, but is key to improving the quality and longevity of the lives of HIV-infected individuals.