Initial Commitment to Pre-Exposure Prophylaxis and Circumcision for HIV Prevention amongst Indian Truck Drivers

Studies of HIV prevention interventions such as pre-exposure prophylaxis (PREP) and circumcision in India are limited. The present study sought to investigate Indian truck-drivers initial commitment to PREP and circumcision utilizing the AIDS Risk Reduction Model. Ninety truck-drivers completed an in-depth qualitative interview and provided a blood sample for HIV and HSV-2 testing. Truck-drivers exhibited low levels of initial commitment towards PREP and even lower for circumcision. However, potential leverage points for increasing commitment were realized in fear of infecting family rather than self, self-perceptions of risk, and for PREP focusing on cultural beliefs towards medication and physicians. Cost was a major barrier to both HIV prevention interventions. Despite these barriers, our findings suggest that the ARRM may be useful in identifying several leverage points that may be used by peers, health care providers and public health field workers to enhance initial commitment to novel HIV prevention interventions in India

A 'snip' in time: what is the best age to circumcise?

<p>Abstract</p> <p>Background</p> <p>Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves.</p> <p>Discussion</p> <p>We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used.</p> <p>Summary</p> <p>Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.</p

Induced abortion and concurrent adoption of contraception in the rural areas of India (an ICMR task force study)

BACKGROUND: Despite a liberal Medical Termination of Pregnancy (MTP) act and awareness of family planning, maternal mortality attributable to induced abortion is high. AIMS: Assess attitude, behavior, practices and utilization of services by rural women for induced abortion and concurrent acceptance of contraception. SETTINGS AND DESIGN: Cross sectional survey of eligible married women in 13 states in India over one year. MATERIAL AND METHODS: A total of 1851 women who had an induced abortion during the previous 3 years were interviewed. STATISTICAL ANALYSIS USED: Includes proportions, rates and chi-square test. RESULTS: The main reason for seeking abortion was "don't need any more children" (42%), and in 12.4 per cent they specifically mentioned that they "don't need any more daughters". Around 46% of women accessed abortion services from private clinics as compared to government hospital (37.1%) and Primary Health Centre/Community Health Centre (14.0%). The decision to terminate the pregnancy and place of abortion was made by the husband in 42.8% and 52.5% respectively. Regret for abortion was expressed by 29.6% of the women. However, only 7.2% said they would not advice others for induced abortion. Nearly one half of the women undergoing abortion accepted a family planning method concurrently; of these Intra Uterine Device/oral contraceptives and a permanent method was adopted by 37.2% and 49.1% respectively. Acceptance of vasectomy by male partner was found to be low (1.3%). "Husband objected" (32.3%) was the main reason for not accepting post abortal contraception. Majority of the acceptors said they would recommend to others the same place where they had undergone abortion, thus indicating their satisfaction with the source and services received. CONCLUSIONS: Counselling for post-abortal contraceptive should be provided to the couple so that they can make an informed choice

Acceptability of oral and topical HIV chemoprophylaxis in India: implications for at-risk women and men who have sex with men

With reducing HIV prevalence, India has made gains in containing the epidemic. Yet, unprotected sex and commercial sex work, unprotected anal sex between men and needle sharing among intravenous drug users continue to drive the epidemic. Development of effective, safe and acceptable topical (microbicides) and oral (pre-exposure prophylaxis (PrEP)) chemoprophylaxis could augment the already available tools for HIV prevention. This paper reviews the acceptability of topical microbicides and oral PrEP, in the context of the nature of the HIV epidemic, the sociocultural norms and the acceptability data obtained from studies carried out in India. Overall, men and women have a positive attitude towards the concept and use of microbicide products. Self-perceptions of HIV risk, product attributes, ease and convenience of use during sex, gender norms, the sociocultural context and the potential for undisclosed use were important factors influencing acceptability. A multipurpose product that would simultaneously address women’s contraceptive and disease prevention needs would be devoid of the stigma attached to an anti-HIV product and may be more acceptable. Limited information on the acceptability of oral PrEP amongst high-risk groups merits further research, including carrying out demonstration projects for program introduction. </jats:p

Cost-effectiveness of a repeat HIV test in pregnancy in India

OBJECTIVE: To evaluate cost-effectiveness of second HIV test in pregnancy. BACKGROUND: Current strategy of single HIV test during pregnancy in India can miss new HIV infections acquired after the first test or those HIV infections that were missed in the first test due to a false-negative HIV test. METHODS: Between August 2011 and April 2013, 9097 pregnant HIV uninfected women were offered a second HIV test near term (34 weeks or beyond) or within 4 weeks of postpartum period. A decision analysis model was used to evaluate cost-effectiveness of a second HIV test in pregnant women near term. PRIMARY AND SECONDARY OUTCOME: Our key outcome measures include programme cost with addition of second HIV test in pregnant women and quality-adjusted life years (QALYs) gained. RESULTS: We detected 4 new HIV infections in the second test. Thus HIV incidence among pregnant women was 0.12 (95% 0.032 to 0.297) per 100 person women years (PWY). Current strategy of a single HIV test is 8.2 times costlier for less QALYs gained as compared to proposed repeat HIV testing of pregnant women who test negative during the first test. CONCLUSIONS: Our results warrant consideration at the national level for including a second HIV test of all pregnant women in the national programme. However prior to allocation of resources for a second HIV test in pregnancy, appropriate strategies will have to be planned for improving compliance for prevention of mother-to-child transmission of HIV and reducing loss-to-follow-up of those women detected with HIV. TRIAL REGISTRATION NUMBER: CTRI/2013/12/004183