Abstract
Background: The national HIV scenario in India has improved impressively during past two decades. Contrastingly, the State-level HIV sentinel surveil-lance and routine programme data from various testing facilities indicated an increasing HIV prevalence among antenatal clinic attendees and female sex workers (FSWs) in three districts of Assam. Objectives: 1) To explore the reasons behind increasing adult HIV prevalence and 2) To understand the role of FSW and Migrants/long distance truckers as drivers of the HIV epi-demic in these districts. Methodology: Three sources of data were utilized in this concurrent mixed methods study—1) existing programme data for past three years; 2) questionnaire-based data for a case-control study, where dur-ing past six months at designated testing facilities HIV(+) married women were “cases” and age-matched HIV(?) women from the same district were “controls”. Spouses of these women were also interviewed separately; and 3) a qualitative study, where focus group discussions were conducted among FSWs, outgoing male migrant labourers and long-distance truckers. Results: The study revealed high levels of unsafe sexual practices among the FSWs. Sometimes in poverty-struck areas, women, not identifying themselves as sex workers, sold sex on a part-time basis to earn extra money for financial sup-port and often remained invisible to the programme. The clients of the sex workers, male migrants and truckers also revealed various risk behaviours for contracting and transmitting HIV infection. Conclusion: Population and context specific programme strategies are required to halt the rising trend of HIV infection in the general population in Assam.
Highlights
The adult HIV prevalence at the national level in India has declined steadily from an estimated peak of 0.38% in 2001-03 through 0.34% in 2007 and to 0.26% in 2015
Number (%) HIV Positive of Assam and even from other States visited these Integrated Counselling & Testing Centres (ICTCs) and they often had higher prevalence of HIV infection. Among those who visited from different districts of Assam, attendees belonging to Karimganj district showed the highest HIV positivity (7.41%)
The purpose of collecting and analyzing qualitative data was to supplement the findings from the above-mentioned quantitative data, in order to enhance our understanding about the possible reasons of increasing HIV prevalence among general population in the three study districts
Summary
The adult HIV prevalence at the national level in India has declined steadily from an estimated peak of 0.38% in 2001-03 through 0.34% in 2007 and to 0.26% in 2015. Methodology: Three sources of data were utilized in this concurrent mixed methods study—1) existing programme data for past three years; 2) questionnaire-based data for a case-control study, where during past six months at designated testing facilities HIV(+) married women were “cases” and age-matched HIV(−) women from the same district were “controls”. Spouses of these women were interviewed separately; and 3) a qualitative study, where focus group discussions were conducted among FSWs, outgoing male migrant labourers and long-distance truckers.
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