Examining sex differentials in the uptake and process of HIV testing in three high prevalence districts of India

Abstract

Sex differentials in the uptake of HIV testing have been reported in a range of settings, however, men's and women's testing patterns are not consistent across these settings, suggesting the need to set sex differentials against gender norms in patient testing behaviour and provider practices. A community-based, cross-sectional survey among 347 people living with HIV in three HIV high prevalence districts of India examined reasons for undergoing an HIV test, location of testing and conditions under which individuals were tested. HIV testing was almost always provider-initiated for men. Men were more likely to be advised to test by a private practitioner and to test in the private sector. Women were more likely to be advised to test by a family member, and to test in the public sector. Men were more likely to receive pre-test information than women, when tested in the private sector. Men were also more likely to receive direct disclosure of their HIV positive status by a health provider, regardless of the sector in which they tested. More women than men were repeatedly tested for HIV, regardless of sector. These sex differentials in the uptake and process of HIV testing are partially explained through differences in public and private sector testing practices. However, they also reflect women's lack of awareness and agency in HIV care seeking and differential treatment by providers. Examining gender dynamics that underpin sex differentials in HIV testing patterns and practices is essential for a realistic assessment of the challenges and implications of scaling-up HIV testing and mainstreaming gender in HIV/AIDS programmes.

Keywords:

• HIV
• testing
• gender
• India

Acknowledgements

We are especially grateful to Solomon Salve for his assistance in coordinating data collection and helping in analysis. Our sincere thanks to all the study participants for spending their valuable time and sharing their experiences and insights with us. We thank the directors, project coordinators and counsellors of the NGOs, and PLHIV networks for their cooperation and support. We are indebted to the field investigators who helped conduct the interviews in the local language. We thank all our colleagues at MAAS-CHRD for their help and support. Special thanks to Dr. Tom Philip and his team from the Resource Centre for Sexual Health and HIV/AIDS (RCSHA) for their support and guidance. The study on which the paper is based, was conducted with funds received from RCSHA, DFID TB Knowledge Programme (Contract-HPD KP9) and DFID Communicable Diseases Research Programme Consortium-TARGETS (Contract-HD205).

Notes

1. The private medical sector comprises practitioners from different systems of medicine (western biomedicine, homeopathy and Indian systems including Ayurveda, Unani and Siddha medicine) working in a spectrum of institutional organisation ranging from individual practices to state-of-the-art hospitals (Baru, 1998).

2. Inclusion criteria of PLHIV was based on age (≥18 years of age), knowledge of HIV positive status, residence in the study district and willingness to participate in the study.