Geospatial analysis of HIV-related social stigma in Andhra Pradesh

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Geospatial analysis of HIV-related social stigma: a study of tested females

across mandals of Andhra Pradesh in India

In Geographical Information Systems issues of scale are of an increasing

interest in storing health data and using these in policy support.

National and international policies on treating HIV (Human Immunodeficiency

Virus) positive women in India are based on case counts at Voluntary Counseling

and Testing Centers (VCTCs).

In this study, carried out in the Indian state of Andhra Pradesh, these centers

are located in subdistricts called mandals, serving for both registration and

health facility policies. This study hypothesizes that people may move to a

mandal different than their place of residence for being tested for reasons of

stigma.

Counts of a single mandal therefore may include cases from inside and outside a

mandal. HIV counts were analyzed on the presence of outside cases and the most

likely explanations for movement.

Counts of women being tested on a practitioners'referral (REFs) and those

directly walking-in at testing centers (DWs) were compared and with counts of

pregnant women.

Results: At the mandal level incidence among REFs is on the average higher than

among DWs. For bothgroups incidence is higher in the South-Eastern coastal

zones, being an area with a dense highway network and active port business.

A pattern on the incidence maps was statistically confirmed by a cluster

analysis. A spatial regression analysis to explain the differences in incidence

among pregnant women and REFs shows a negative relation with the number of

facilities and a positive relation with the number of roads in a mandal.

Differences in incidence among pregnant women and DWs are explained by the same

variables, and by a negative relation with the number of neighboring mandals.

Based on the assumption that pregnant women are tested in their home mandal,

this provides a clear indication that women move for testing as well as clues

for explanations why.

Conclusions: The spatial analysis shows that women in India move towards a

different mandal for getting tested on HIV.

Given the scale of study and different types of movements involved, it is

difficult to say where they move to and what the precise effect is on HIV

registration. Better recording the addresses of tested women may help to relate

HIV incidence to population present within a mandal.

This in turn may lead to a better incidence count and therefore add to more

reliable policy making, e.g. for locating or expanding health facilities.

Author: Rashmi KandwalEllen-Wien Augustijn Alfred SteinGian luca Miscione

Pradeep GargRahul Garg

International Journal of Health Geographics 2010, 9:18