HIV transmission among married men and women in districts with high out-migration in India: Study brief

This brief describes a study examining the links between male out-migration and HIV transmission among married men and women and other mechanisms by which HIV is transmitted within marital relationships in districts with high out-migration

Factors affecting enrolment of PLHIV into ART services in India

At the end of 2007, India had an estimated 2.31 million people living with HIV, and an HIV prevalence of 0.34 percent. Despite the low HIV prevalence, these statistics place India among countries with a large number of people living with HIV (PLHIV). To address the care and support needs of PLHIV, the Ministry of Health and Family Welfare, Government of India, initiated a national program in 2004 to provide free antiretroviral therapy (ART) for PLHIV. By March 2009, there were 211 functioning Antiretroviral Treatment Centers and 254 Community Care Centers across the country, and to date 217,781 individuals are receiving ART. A major challenge for the health system has been to increase utilization of ART services and enrollment into the program. The Population Council, with support from the National AIDS Control Organization, undertook a multisite study in four high-HIV-preva¬lence and three low-HIV-prevalence-states. This document describes the context and factors that influence the uptake of ART services in those states

Spousal discordance on reports of contraceptive communication, contraceptive use, and ideal family size in rural India: a cross-sectional study

Background Persistent low rates of spacing contraceptive use among young wives in rural India have been implicated in ongoing negative maternal, infant and child health outcomes throughout the country. Gender inequity has been found to consistently predict low rates of contraception. An issue around contraceptive reporting however is that when reporting on contraceptive use, spouses in rural India often provide discordant reports. While discordant reports of contraceptive use potentially impede promotion of contraceptive use, little research has investigated the predictors of discordant reporting. Methods Using data we collected from 867 couples in rural Maharashtra India as part of a men-focused family planning randomized controlled trial. We categorized couples on discordance of men’s and women’s reports of current contraceptive use, communication with their spouse regarding contraception, and ideal family size, and assessed the levels of discordance for each category. We then ran multinomial regression analyses to determine predictors of discordance categories with a focus on women’s empowerment (household and fertility decision-making, women’s education, and women’s knowledge of contraception). Results When individuals reported communicating about contraception and their spouses did not, those individuals were also more likely to report using contraception when their spouses did not. Women’s empowerment was higher in couples in which both couples reported contraception communication or use or in couples in which only wives reported contraception communication or use. There were couple-level characteristics that predicted husbands reporting either contraception use or contraception communication when their wives did not: husband’s education, husband’s familiarity with contraception, and number of children. Conclusions Overall there were clear patterns to differential reporting. Associations with women’s empowerment and contraceptive communication and use suggest a strategy of women’s empowerment to improve reproductive health. Discordant women-only reports suggest that even when programs interact with empowered women, the inclusion of husbands is essential. Husband-only discordant reports highlight the characteristics of men who may be more receptive to family planning messages than are their wives. Family planning programs may be most effective when working with couples rather than just with women, and should focus on improving communication between couples, and supporting them in achieving concordance in their reproductive preferences. Trial registration Clinical Trials Number: NCT01593943, registered May 4, 2012 at clinicaltrials.gov

Migration and HIV in India: Study of select districts

Report of a study assessing the important role of migration in the spread of HIV in districts with high out-migration in India. The study suggests a considerable spread of HIV linked to migrants’ extramarital sexual behaviors, and subsequent delay in treatment for infected spouses. In order to control the spread of HIV, the study provides programmatic recommendations made by the study participants and the counselors from ICTCs and ART centers. These suggestions include village-level mapping of at-risk persons, mainstreaming HIV prevention interventions within current health resources, improving various village level HIV prevention programs, and involving women left behind by migrant spouses to participate in these programs

A gender synchronized family planning intervention for married couples in rural India: study protocol for the CHARM2 cluster randomized controlled trial evaluation.

BackgroundPrior research from India demonstrates a need for family planning counseling that engages both women and men, offers complete family planning method mix, and focuses on gender equity and reduces marital sexual violence (MSV) to promote modern contraceptive use. Effectiveness of the three-session (two male-only sessions and one couple session) Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention, which used male health providers to engage and counsel husbands on gender equity and family planning (GE + FP), was demonstrated by increased pill and condom use and a reduction in MSV. However, the intervention had limited reach to women and was therefore unable to expand access to highly effective long acting reversible contraceptives such as the intrauterine device (IUD). We developed a second iteration of the intervention, CHARM2, which retains the three sessions from the original CHARM but adds female provider- delivered counseling to women and offers a broader array of contraceptives including IUDs. This protocol describes the evaluation of CHARM2 in rural Maharashtra.MethodsA two-arm cluster randomized controlled trial will evaluate CHARM2, a gender synchronized GE + FP intervention. Eligible married couples (n = 1200) will be enrolled across 20 clusters in rural Maharashtra, India. Health providers will be gender-matched to deliver two GE + FP sessions to the married couples in parallel, and then a final session will be delivered to the couple together. We will conduct surveys on demographics as well as GE and FP indicators at baseline, 9-month, and 18-month follow-ups with both men and women, and pregnancy tests at each time point from women. In-depth interviews will be conducted with a subsample of couples (n = 50) and providers (n = 20). We will conduct several implementation and monitoring activities for purposes of assuring fidelity to intervention design and quality of implementation, including recruitment and tracking logs, provider evaluation forms, session observation forms, and participant satisfaction surveys.DiscussionWe will complete the recruitment of participants and collection of baseline data by July 2019. Findings from this work will offer important insight for the expansion of the national family planning program and improving quality of care for India and family planning interventions globally.Trial registrationClinicalTrial.gov, NCT03514914

Experience of violence and adverse reproductive health outcomes, HIV risks among mobile female sex workers in India

<p>Abstract</p> <p>Background</p> <p>Female sex workers (FSWs) are a population sub-group most affected by the HIV epidemic in India and elsewhere. Despite research and programmatic attention to FSWs, little is known regarding sex workers' reproductive health and HIV risk in relation to their experiences of violence. This paper therefore aims to understand the linkages between violence and the reproductive health and HIV risks among a group of mobile FSWs in India.</p> <p>Methods</p> <p>Data are drawn from a cross-sectional behavioural survey conducted in 22 districts from four high HIV prevalence states (Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu) in India between September 2007 and July 2008. The survey sample included 5,498 FSWs who had moved to at least two different places for sex work in the past two years, and are classified as mobile FSWs in the current study. Analyses calculated the prevalence of past year experiences of violence; and adjusted logistic regression models examined the association between violence and reproductive health and HIV risks after controlling for background characteristics and program exposure.</p> <p>Results</p> <p>Approximately one-third of the total mobile FSWs (30.5%, n = 1,676) reported experiencing violence at least once in the past year; 11% reported experiencing physical violence, and 19.5% reported experiencing sexual violence. Results indicate that FSWs who had experienced any violence (physical or sexual) were significantly more likely to be vulnerable to both reproductive health and HIV risks. For example, FSWs who experienced violence were more likely than those who did not experience violence to have experienced a higher number of pregnancies (adjusted odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.0-1.6), ever experienced pregnancy loss (adjusted OR = 1.4, 95% CI = 1.2-1.6), ever experienced forced termination of pregnancy (adjusted OR = 2.4, 95% CI = 2.0-2.7), experienced multiple forced termination of pregnancies (adjusted OR = 2.2, 95% CI = 1.7-2.8), and practice inconsistent condom use currently (adjusted OR = 1.97, 95% CI: 1.4-2.0). Among FSWs who experienced violence, those who experienced sexual violence were more likely than those who had experienced physical violence to report inconsistent condom use (adjusted OR = 1.8, 95% CI: 1.4-2.3), and experience STI symptoms (adjusted OR = 1.3, 95% CI: 1.1-1.7).</p> <p>Conclusion</p> <p>The pervasiveness of violence and its association with reproductive health and HIV risk highlights that the abuse in general is an important determinant for reproductive health risks; and sexual violence is significantly associated with HIV risks among those who experienced violence. Existing community mobilization programs that have primarily focused on empowering FSWs should broaden their efforts to promote reproductive health in addition to the prevention of HIV among all FSWs, with particular emphasis on FSWs who experienced violence.</p

Food insufficiency, violence and HIV risk behaviors among female sex workers in India

Background: Food insufficiency is one of the important contributing factors among female sex workers (FSWs) to engage in risky sexual behaviors and cause of HIV infection in developing countries. Studies exploring linkages between food insufficiency and HIV risk behaviors among FSWs are limited despite having potential program and policy implications. This study attempts to assess the food insufficiency among FSWs and examine its relationship with HIV risk behaviors and violence in India. Materials and Methods: Data were drawn from the Avahan-III baseline evaluation survey- 2015, conducted among FSWs (n=4098) using a three-stage cluster sampling approach in four states of India. Multivariate logistic regression (with adjusted odds ratios (AOR) and their 95% confidence intervals (CI)), bivariate analysis and frequency were used to assess the relationships between food insufficiency, HIV risk behaviors and violence. Results: Nearly one-fifth of FSWs (17%) reported of facing food insufficiency in past 6 months. More than 35% of FSWs had entertained more clients to cope with the situation of food insufficiency followed by defaulted on loans (24%), borrowed money from informal sources (20%) and had sex without condoms (7%). The likelihood of consistent condom use with non-regular (67% vs. 77%; AOR: 0.6; 95% CI: 0.4-0.9) and regular partner (22% vs. 51%; AOR: 0.3; 95% CI: 0.2-0.4) were significantly lower among FSWs who reported food insufficiency than among those who did not. The likelihood of consistent condom use with occasional (90% vs. 95%; AOR: 0.5; 95% CI: 0.4-0.7) and regular clients (88% vs. 91%; AOR: 0.8; 95% CI: 0.6-0.9) were significantly lower among FSWs who reported food insufficiency compared to those who did not. FSWs who reported food insufficiency were also significantly more likely to report STI symptoms (28% vs. 13%; AOR: 2.7) and any violence (16% vs. 9%; AOR: 2.1) than their counterparts. Conclusions: The findings of the study highlight that FSW’s food insufficiency is significantly associated with HIV risk behaviors and violence. This study underscores the need for community-led interventions focusing on food insufficiency and economic strengthening activities to reduce HIV vulnerability among FSWs. However, further evidence-based research and advocacies on food insufficiency is required to ensure that HIV prevention programs are appropriately addressed

Non-disclosure of violence among female sex workers: Evidence from a large scale cross-sectional survey in India

Objective: One of the indicators critical to the success of violence reduction programmes among female sex workers (FSWs) is the pattern of disclosure of violence. This study examines the rate of non-disclosure of violence among FSWs in India by perpetrators of violence and programme exposure. Methods: Data were drawn from a cross-sectional study conducted among FSWs in 2009 across four states of India: Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. The analytical sample included 1341 FSWs who experienced physical violence in past six months. Multilevel logistic regression stratified by state was conducted to examine predictors of non-disclosure. Results: About 54% of FSWs did not disclose their experience of violence to anyone with considerable variations in the pattern of disclosure across states. Another 36% of FSWs shared the experience with NGO worker/peer. Compared to violence perpetrated by paying partners/stranger, that by non-paying partner were twice more likely to report non-disclosure (53% vs. 68%, Adjusted Odds Ratio [AOR]: 1.8, 95% Confidence Interval [CI]: 1.3–2.4). Similarly, FSWs who were not registered with an NGO/sex worker collective were 40% more likely to report non-disclosure of violence against those registered (58% vs. 53%, AOR: 1.4, 95% CI: 1.1–1.9). Conclusions: Non-disclosure of physical violence is quite high among FSWs which can be a barrier to the success of violence reduction efforts. Immediate efforts are required to understand the reasons behind non-disclosure based on which interventions can be developed. Community collectivisation and designing gender-based interventions with the involvement of non-paying partners should be the way forward