Abstract
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.
Highlights
South/Southeast Asia is the second-most HIV affected region in the world, and India continues to have the highest numbers of HIV infected in Asia [1]
Participant willingness to pay for pre-exposure prophylaxis (PREP) was based upon the response to the following question: How much would you be willing to pay for PREP each month on to prevent HIV infection? Participant willingness to pay for circumcision was based upon the response to the following question: How much would you be willing to pay for a one time circumcision to prevent HIV infection? To determine social acceptability and norms of the interventions in those who were not interested in circumcision and/or PREP for personal use, study participants who were not willing to use the prevention interventions based upon previous initial commitment questioning were asked to indicate what a peer who was ready to use these interventions might pay
Converging stories reflected in these analyses show that overall initial commitment to circumcision and PREP is low in a general Indian truck-driver population
Summary
South/Southeast Asia is the second-most HIV affected region in the world, and India continues to have the highest numbers of HIV infected in Asia [1]. It is anticipated that these new HIV prevention strategies and technologies will need to be carefully assessed in specific populations because 1) these advances are unlikely to provide full protection against HIV [21]; 2) the possibility of risk compensation (adjustment in behavior due to perceived changes in risk) or behavioral disinhibition (failure to inhibit behavior when aversive consequences are likely) could mitigate the benefits [22]; 3) strategies using medication will require ongoing adherence [22]; 4) they may offer little or no protection against other sexually transmitted infections [16]; 5) they likely will provide either variable protection against unintended pregnancies or limit the ability to become pregnant and 6) each intervention has to be introduced carefully into local environment paying special attention to local cultural beliefs, customs and community opinions [23] Warnings by the former UNAIDS director that Hindus in India may be more likely to become HIV infected because of uncircumcised status created significant controversy and may have resulted in increasing negative attitudes towards circumcision [23,24]. In this study using a mixed methods approach, we applied the ARRM framework to assess proximate factors that might affect future uptake of circumcision or PREP
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