Exploring positive women\u27s lives in Namakkal District, India

This report describes an initiative that was undertaken to document the experiences of HIV-positive ever-married women in Namakkal district, Tamil Nadu, India. The initiative sought to explore the circumstances in which women learned about their HIV status; their feelings on finding out they were HIV-positive; the nature of husband–wife relationships prior to and following disclosure of women’s HIV status; the extent of support or discrimination that women experienced from family members, friends, and neighbors; treatment-seeking behaviors; and women’s perspectives about ways in which the multiple needs of HIV-infected women can be met. Drawing on the testimonies of these women gathered by trained investigators who were themselves HIV-positive, the report attempts to bring faces and voices to the reality of the HIV epidemic, particularly among married women. Findings show that women living with HIV face multiple vulnerabilities, ranging from physical and mental ill-health to concerns about financial security, family and peer support, and securing the future of their children. The findings call, correspondingly, for multiple efforts that address HIV-positive women’s health and well-being as well as empower them to lead their lives with confidence and dignity

Forced sexual relations among married young women in developing countries

Recent research in developing countries suggests that a considerable number of young women may experience forced sex within marriage, but most women may be inhibited from reporting these experiences due to shame, fear of reprisal, or deep-rooted unequal gender norms. In September 2003, a global consultative meeting on nonconsensual sex among young people in developing countries was held in New Delhi, India. The meeting was organized by the Population Council in collaboration with World Health Organization/Department of Reproductive Health and Research, and Family Health International/YouthNet. Participants included researchers, legal analysts, representatives from community-based NGOs, policy-makers, and young people themselves. Papers highlighting the nature and prevalence of coercion among married young women were presented. Sessions examined the following issues in relation to nonconsensual sex: experiences of young females and males: prevalence, forms, and contexts; youth perspectives; patterns of transactional sex; roles of the legal system; outcomes of coercion at the individual and community level; interventions to prevent nonconsensual sex and to support and treat victims; and research design and methods. Several recommendations for action to address factors that heighten young women’s vulnerability to coercive sexual relationships within marriage were presented

Sexual coercion: Young men\u27s experiences as victims and perpetrators

Available evidence suggests that a considerable number of young people experience nonconsensual sex across the world, however research has mainly concentrated on the experiences of young girls and their perspectives of perpetrators of violence. Little is known about coercion among young males as victims or perpetrators. Case studies presented at an international consultative meeting in September 2003 in New Delhi, India, challenged the common assumption that only women are victims of violence, and shed light on the experiences of young males as victims of sexual coercion. These case studies also discussed the perspectives of young males as perpetrators of violence against young women. The evidence comes from small-scale studies from Goa, India; Ibadan, Nigeria; Leon, Nicaragua; Mexico City, Mexico; Phnom Penh, Cambodia, and selected settings in Peru and South Africa. The findings therefore are instructive but not representative. Common themes drawn from these diverse studies and key issues are discussed in this brief

The adverse health and social outcomes of sexual coercion: Experiences of young women in developing countries

Although evidence from developing countries is limited, what is available suggests that significant numbers of young women have experienced coercive sex. Studies in diverse settings in Africa, Asia, and Latin America reveal that forced sexual initiation and experiences are not uncommon in all of these settings. Many young victims of abuse fear disclosure as they feel they may be blamed for provoking the incident or stigmatized for having experienced it, and suffer such incidents in silence. Presentations at a meeting held in New Delhi in September 2003 highlighted findings from recent studies that suggest an association between early experiences of sexual violence and a range of adverse physical and mental health and social outcomes. Given that data on the consequences of nonconsensual sex are limited and restricted to a few geographical settings, the scale of the problem and its implications for policies and programs are yet to be established. As noted in this document, presentations at the New Delhi meeting highlighted the need for urgent programmatic action to address young people’s vulnerability to coercive sex and its possible far-reaching consequences

Factors associated with HIV testing among male injecting drug users: findings from a cross-sectional behavioural and biological survey in Manipur and Nagaland, India

BACKGROUND: Although targeted interventions in India require all high-risk groups, including injecting drug users (IDUs), to test for HIV every 6 months, testing uptake among IDUs remains far from universal. Our study estimates the proportion of IDUs who have taken an HIV test and identifies the factors associated with HIV testing uptake in Nagaland and Manipur, two high HIV prevalence states in India where the epidemic is driven by injecting drug use. METHODS: Data are drawn from the cross-sectional Integrated Behavioural and Biological Assessment (2009) of 1650 male IDUs from two districts each of Manipur and Nagaland. Participants were recruited using respondent-driven sampling (RDS). Descriptive data were analysed using RDSAT 7.1. Multivariate logistic regression analysis was undertaken using STATA 11 to examine the association between HIV testing and socio-demographic, behavioural and programme exposure variables. RESULTS: One third of IDUs reported prior HIV testing, of whom 8 % had tested HIV-positive. Among those without prior testing, 6.2 % tested HIV-positive in the current survey. IDUs aged 25–34 years (adjusted odds ratio (OR) = 1.41; 95 % confidence interval (CI) = 1.03–1.93), married (Adjusted OR = 1.56; 95 % CI = 1.15–2.12), had a paid sexual partner (Adjusted OR = 1.64; 95 % CI = 1.24–2.18), injected drugs for more than 36 months (Adjusted OR = 1.38; 95 % CI = 1.06–1.81), injected frequently (Adjusted OR = 1.49; 95 % CI = 1.12–1.98) and had high-risk perception (Adjusted OR = 1.68; 95 % CI = 1.32–2.14) were more likely than others to test for HIV. Compared to those with no programme exposure, IDUs who received counselling, or counselling and needle/syringe services, were more likely to test for HIV. CONCLUSIONS: HIV testing uptake among IDUs is low in Manipur and Nagaland, and a critical group of HIV-positive IDUs who have never tested for HIV are being missed by current programmes. This study identifies key sub-groups—including early initiators, short duration and less frequent injectors, perceived to be at low risk—for promoting HIV testing. Providing needles/syringes alone is not adequate to increase HIV testing; additionally, interventions must provide counselling services to inform all IDUs about HIV testing benefits, facilitate visits to testing centres and link those testing positive to timely treatment and care

Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India

Among marginalised groups in India, HIV prevalence is highest among transgender persons; however, little is known about their HIV vulnerability. This study describes transgender sex workers’ experiences of stigma and violence, a key driver of the HIV epidemic, and explores their coping responses. In-depth interviews were conducted with 68 respondents in Maharashtra state, India. Findings show that respondents face pervasive stigma and violence due to multiple marginalised social identities (transgender status, sex work, gender non-conformity), which reinforce and intersect with social inequities (economic and housing insecurity, employment discrimination, poverty), fuelling HIV vulnerability at the micro, meso and macro levels. Several factors, such as felt and internalised stigma associated with psycho-social distress and low self-efficacy to challenge abuse and negotiate condom use; clients’ power in sexual transactions; establishing trust in regular partnerships through condomless sex; norms condoning violence against gender non-conforming persons; lack of community support; police harassment; health provider discrimination and the sex work environment create a context for HIV vulnerability. In the face of such adversity, respondents adopt coping strategies to shift power relations and mobilise against abuse. Community mobilisation interventions, as discussed in the paper, offer a promising vulnerability reduction strategy to safeguard transgender sex workers’ rights and reduce HIV vulnerability

Male migrants\u27 non-spousal sexual partnerships in the place of origin: An in-depth investigation in two rural settings of India

Male migrants in India are at disproportionately high risk for HIV, not only because of their sexual behaviours in destination areas but also due to their risk behaviours in their place of origin. While studies have documented male migrants’ risky behaviours in the home setting, few have attempted to understand the underlying socio-cultural context in which they engage in such behaviours. This paper examines the patterns and context of male migrants’ non-spousal sexual partnerships in two high-out-migration districts of India. Data, drawn from a cross-sectional behavioural mixed-methods study conducted in 2008, included a structured survey with 1272 migrants, followed by in-depth interviews with 33 male migrants. Results suggest that sexual activity was common in the place of origin: around 50% of migrants had sex with a non-spousal female partner and two-fifths had initiated sex in this setting. Migrants’ non-spousal sexual behaviours in the home village were influenced by the prevailing socio-cultural context, including migrants’ enhanced socio-economic status, attitudes to non-spousal sex and accessibility of sexual partners. Male migrants’ non-spousal sexual partnerships in source areas are influenced by socio-cultural factors, which must be considered when designing HIV programmes in India and elsewhere

Factors associated with HIV testing among male injecting drug users: Findings from a cross-sectional behavioural and biological survey in Manipur and Nagaland, India

Background: Although targeted interventions in India require all high-risk groups, including injecting drug users (IDUs), to test for HIV every 6 months, testing uptake among IDUs remains far from universal. Our study estimates the proportion of IDUs who have taken an HIV test and identifies the factors associated with HIV testing uptake in Nagaland and Manipur, two high HIV prevalence states in India where the epidemic is driven by injecting drug use. Methods: Data are drawn from the cross-sectional Integrated Behavioural and Biological Assessment (2009) of 1650 male IDUs from two districts each of Manipur and Nagaland. Participants were recruited using respondent-driven sampling (RDS). Descriptive data were analysed using RDSAT 7.1. Multivariate logistic regression analysis was undertaken using STATA 11 to examine the association between HIV testing and socio-demographic, behavioural and programme exposure variables. Results: One third of IDUs reported prior HIV testing, of whom 8 % had tested HIV-positive. Among those without prior testing, 6.2 % tested HIV-positive in the current survey. IDUs aged 25–34 years (adjusted odds ratio (OR) = 1.41; 95 % confidence interval (CI) = 1.03–1.93), married (Adjusted OR = 1.56; 95 % CI = 1.15–2.12), had a paid sexual partner (Adjusted OR = 1.64; 95 % CI = 1.24–2.18), injected drugs for more than 36 months (Adjusted OR = 1.38; 95 % CI = 1.06–1.81), injected frequently (Adjusted OR = 1.49; 95 % CI = 1.12–1.98) and had high-risk perception (Adjusted OR = 1.68; 95 % CI = 1.32–2.14) were more likely than others to test for HIV. Compared to those with no programme exposure, IDUs who received counselling, or counselling and needle/syringe services, were more likely to test for HIV. Conclusions: HIV testing uptake among IDUs is low in Manipur and Nagaland, and a critical group of HIV-positive IDUs who have never tested for HIV are being missed by current programmes. This study identifies key sub-groups—including early initiators, short duration and less frequent injectors, perceived to be at low risk—for promoting HIV testing. Providing needles/syringes alone is not adequate to increase HIV testing; additionally, interventions must provide counselling services to inform all IDUs about HIV testing benefits, facilitate visits to testing centres and link those testing positive to timely treatment and care

Shaping Demand and Practices to Improve Family Health Outcomes: Designing a Behavior Change Communication Strategy in India, Volume 2: Bihar

Maternal and child-health indicators have remained poor in northern India, with various factors contributing to continued mortality and morbidity. Communication strategies play a powerful role in addressing the barriers to, and shaping demand for, the adoption of preventive health practices. This volume, covering Bihar, provides information on family dynamics that could be used to develop a comprehensive behavior change communication (BCC) strategy on family health in northern India. The study focuses on increasing the adoption of eight family-health behaviors that have a significant bearing on Millennium Development Goals. Funded by the Bill and Melinda Gates Foundation, this BCC study has been designed on a comprehensive scale, based on evidence generated from large, formative studies to identify the barriers and factors facilitating the adoption of family-health behaviors. Unlike most BCC studies that are based on cognitive theories of behavior change, this study, which integrates the broader social context, media choices, program structure, and audience interaction that influences the target behaviors, is a valuable resource for policymakers, program implementers, researchers, and field-level individuals alike

Relationship between mobility, violence and major depression among female sex workers: A cross-sectional study in southern India

Background: The relationship between mobility, violence and mental health has largely been unexplored in developing countries. This study screens for signs of major depression, and assesses its association with mobility and violence among female sex workers (FSWs) in southern India. Methods: Data (N=2400) for this study were used from a cross-sectional Behavioral Tracking Survey (BTS-2014) conducted among FSWs from a southern state of India as part of the Avahan programme. Major depression of FSWs was assessed using the Patient Health Questionnaire-2 depression scale. Descriptive statistics, frequency, bivariate, interaction effect and multivariate logistic regression techniques were used for the analysis. Results: More than one-fourth of FSWs (29%) screened positive for major depression. The likelihood of screening positive for major depression was 6 times higher among FSWs who were both mobile for sex work outside their district of residence and had experienced any violence (combined association) during the past 1 year (62% vs 19%, adjusted OR 6.1, 95% CI 4.4 to 8.6) compared with those who reported neither. The individual association results show that FSWs who reported being mobile outside the district, and FSWs who were beaten or raped in the past 1 year, were 3 times more likely to screen positive for major depression. Conclusions: The findings indicate that violence and mobility are independently associated with major depression among FSWs. The combined association of mobility and violence poses a greater risk to the mental health of FSWs than their independent association. These results point to the need for creating an enabling environment for FSWs to enhance existing efforts to reduce the spread of HIV and mental health problems. The study highlights that HIV prevention efforts among FSWs in India require evidence-based research and integrated programme approaches to address mental health issues