Population Council Research that makes a difference

There are more than two and a half million people living with HIV (PLHIV) in India. In 2004, India’s Ministry of Health and Family Welfare initiated a national program to provide free antiretroviral treatment (ART) to PLHIV. A major challenge for the health system has been to increase utilization of ART services; as of March 2009, only 217,781 PLHIV were receiving ART through the national program.

The Population Council undertook a two-phase, multisite study in four high-HIV-prevalence and three low-HIV-prevalence states to understand the context and factors that influence the uptake of ART services and the sociodemographic characteristics of PLHIV registered for treatment at ART centers. Phase 1 involved analyzing secondary data collected from 30 integrated counseling and testing centers (ICTCs) and ten corresponding ART centers to understand and compare the sociodemographic characteristics of PLHIV diagnosed as HIV-positive at ICTCs and those who registered for treatment at ART centers. These findings informed Phase 2, which was conducted among newly diagnosed HIV-positive people tested at ICTCs, who were followed up until their registration at the referral ART center. Those who did not register were tracked for a follow-up interview. A total of 1,057 newly diagnosed HIV-positive people were recruited into the cohort and followed up for two months.

The study found that nearly three-quarters (73.5%; n=777) of newly diagnosed HIV-positive people in the cohort registered at ART centers within two months. Those who did not register indicated a variety of reasons, including a perception of good health, work and family engagements, fear of disclosure of their HIV status, being recognized and the resulting stigma, financial difficulties or travel expenses, family opposition, distance to ART centers, and severe illness preventing travel. Younger and single respondents, as well as those working in unskilled manual labor, were significantly less likely to register for treatment within two months. Those who had not disclosed their HIV status and those who knew of HIV-positive people in the community were also less likely to register, highlighting that disclosure and stigma continue to be important barriers to accessing services.

Respondents generally experienced high-quality services at ART centers, with the majority reporting short waiting times and sympathetic counselors and physicians. Inadequacies in service delivery included failure to inform the client about HIV testing for spouses/partners and children, to discuss CD4 tests to assess eligibility for ART, to underscore the importance of adherence and the need for regular follow-up for ART, or to focus on preventing HIV transmission.

Project impact

The study recommendations are being used by the national HIV/AIDS control program to develop strategies to increase enrollment in its expanding network of ART services, with the ultimate goal of better care for HIV-infected individuals.