HIV/AIDS, Social Stigma and Treatment Needs of MARPs in India: Can Bio-Medical Prevention Methods Help?

Introduction: UNGASS (2010) has identified three most-at-risk populations (MARPs) in India: MSM, Female Sex Workers (FSWs) and IDUs, who are more susceptible to engage in different health risk behaviours. Moreover, social stigma and criminalization of homosexuality complicates the issue, depriving them of opportunities to seek, obtain and maintain adequate health. With a population estimate of IDUs (9.2%), MSMs (7.3%) and FSWs (4.3%), southern, western and north-eastern region are considered as regions with high concentration of risk population. However, recent increases of HIV cases in Punjab, Bihar, U.P. and Orissa accompanied with challenges of surveillance due to several socio-cultural reasons are complicating the healthcare provision. At present, 36-55% of HIV infected individuals are on ART. With substantial issues raised on lack of availability of ART 2ndline drugs MSM/Transgender health is perceived to be one of the most challenging.

Methods: Considering challenges and need for adequate treatment and intensified prevention efforts, recent biomedical preventions methods are considered to be helpful. Hence, a survey was conducted and 120 healthcare professionals participated. We explored: i) Perception on how ART program is being covered; ii) need/context assessment for advanced biomedical prevention strategies like Pre-Exposure Prophylaxis (PrEP); iii) Present knowledge base and prerequisites for its implementation; and iv) Potential challenges.

Results: Participants reported: i) Failures in successful implementation of ART and difficulties in access to baseline ART in several areas of India; ii) Mixed opinion on the potential effectiveness of PrEP and rectal micro-bicides; iii) lack of considerable knowledge on recent advances in bio-medical prevention methods; iv) Resource (material and human) constraints are felt to be a challenge in implementation.

Discussion: This ongoing survey helps to understand and assess challenges in implementation of prevention efforts like surveillance of MARPs due to social stigma and discrimination. Hence, intensified Socio-structural interventions have to precede any bio-medical prevention.