Barriers to Free ART Access for Female Sex workers in Chennai

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Barriers to Free Antiretroviral Treatment Access for Female Sex Workers in

Chennai, India

Venkatesan Chakrapani, A. Newman, Murali Shunmugam, Abraham K. Kurian,

Dubrow. AIDS Patient Care and STDs. November 2009, 23(11): 973-980.

doi:10.1089/apc.2009.0035.

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Published in Volume: 23 Issue 11: November 20, 2009

Online Ahead of Print: October 12, 2009

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Abstract

India's National AIDS Control Organization (NACO) provides free first-line

antiretroviral treatment (ART) at government centers for people living with HIV.

To assist in developing policies and programs to ensure equity in ART access, we

explored barriers to ART access among female sex workers (FSWs) living with HIV

in Chennai.

Between August and November 2007, we conducted three focus group discussions and

two key informant interviews. Data were explored using framework analysis to

identify categories and derive themes. We found interrelated barriers at the

family/social, health care system/programmatic, and individual levels.

Major barriers included fear of adverse consequences of disclosure of HIV status

due to stigma and discrimination associated with HIV and sex work, lack of

family support, negative experiences with health care providers, lack of

adequate counseling services at government centers and by outreach workers

employed by nongovernmental organizations (NGOs), perceived biased treatment of

FSWs who are not referred by NGOs, lack of adequate knowledge about ART, and

fatalism.

Barriers can be addressed by: creating effective measures to reduce stigma

associated with HIV/AIDS and sex work at the familial, societal, and health care

system levels; incorporating information about ART into targeted interventions

among FSWs; training counselors at government hospitals and NGO outreach workers

on treatment issues; improving infrastructure and staffing levels at government

centers to allow adequate time and privacy for counseling; and implementing

government mass media campaigns on ART availability.

Finally, it is crucial that NACO begin monitoring ART coverage of FSWs and other

marginalized populations to ensure equitable ART access.