Knowledge about reproductive tract infections and sex work among female textile workers in Surat, India.

In this qualitative study, we investigated knowledge about reproductive tract infections (RTIs) and commercial sex work among female textile workers of Surat, India. We analyzed data from three focus groups conducted with 18 women using content analysis. Participants had some knowledge about the symptoms of RTIs; however, they had limited knowledge about RTI prevention, transmission, and treatment. None used condoms consistently for RTI prevention. The women attributed economic hardship as one of the main reasons for engaging in commercial sex work. Our study is one of the first to evaluate sexual and reproductive health among female textile workers in India.

"My husband says this: If you are alive, you can be someone ": Facilitators and barriers to cervical cancer screening among women living with HIV in India.

PURPOSE: Women living with human immunodeficiency virus (WLWH) have a higher risk of cervical cancer than women without HIV. In addition, women in India experience a high burden of death from cervical cancer. This qualitative study evaluated individual and interpersonal factors influencing cervical cancer screening among WLWH in Surat, India. METHODS: In-depth interviews were conducted with 25 WLWH and 15 stakeholders in Surat, India. Data were analyzed using directed content analysis to identify individual and intrapersonal barriers and facilitators. RESULTS: WLWH lacked knowledge and reported being afraid of cervical cancer and cervical cancer screening but were interested in learning more about it. Interpersonal factors influencing cervical cancer screening included receipt or lack of instrumental and emotional family support, interactions with healthcare providers, and receipt or lack of information about cervical cancer and the Pap test from healthcare providers. CONCLUSION: Widespread public education is necessary to increase awareness of cervical cancer and cervical cancer screening and to encourage family members to support women who wish to obtain screening. Patient- and provider-focused interventions may facilitate the process of providing cervical cancer care to WLWH who are obtaining care in busy public healthcare systems in India.

"HIV is not an easily acceptable disease": the role of HIV-related stigma in obtaining cervical cancer screening in India.

Women living with HIV (WLWH) are at high risk for cervical cancer (CC); however, many WLWH in India do not obtain regular CC screening. Little is known about facilitators and barriers of CC screening in this population. This qualitative study examined the relation of HIV-related stigma to obtaining CC screening among women in Surat, India. Semi-structured individual in-depth interviews were conducted between April 2015 and July 2015 with 25 WLWH at the New Civil Hospital Anti-Retroviral Centre and 15 stakeholders providing health care to WLWH. HIV-related stigma emerged as a considerable barrier to gynecologic care and CC screening among WLWH. Two major subthemes were identified: (1) perceptions of HIV-related normative stigma and enacted discrimination; and (2) HIV status disclosure in the context of health care and CC screening. Stakeholders described a general awareness of HIV-related stigma as a barrier to care for WLWH, while WLWH focused on experiences of enacted discrimination. Both patients and stakeholders described that concerns about disclosure and fear of stigma hinder WLWH in India from obtaining health care and CC screening. Findings suggest that interventions to increase cancer screening among WLWH in India should address the role of HIV-related stigma to be maximally effective.

"My Life is Spoiled Because of Him " A Qualitative Study of Human Immunodeficiency Virus Disclosure and Male Involvement in Prevention of Mother-to-Child Transmission Program.

BACKGROUND: India has the third largest human immunodeficiency virus (HIV) epidemic in the world, with 15,000 newborns infected every year. Prevention of mother-to-child transmission (PMTCT) services can eliminate new HIV infections. Nondisclosure of positive HIV status and nonoptimal uptake of PMTCT are related. Therefore, understanding different aspects of HIV disclosure are necessary for program managers and careproviders for prevention and support. OBJECTIVE: The present research explores HIV disclosure narratives, the family's perspective, and theoretical framework in the context of PMTCT. METHODS: A qualitative study was conducted among 31 (16 mothers and 15 fathers) utilizers of PMTCT at an urban antiretroviral therapy center. A semi-structured in-depth interview guide based on disclosure process model (DPM) was used to explore HIV disclosure goals and outcomes by both members of parental dyad. The recorded interviews were transcribed verbatim, translated into English, and analyzed with Atlas.ti software. Directed content analysis was used to code data according to "a priori" and emerging themes. Demographic data were analyzed using descriptive statistics. RESULTS: Limited disclosure is a necessity for pregnant women and their male partners for approach coping with HIV diagnosis and pursuing positive support for PMTCT adherence. Interpersonal, society, and community contextual outcomes affect the care uptake and future likelihood of disclosure. CONCLUSIONS: DPM suggestions from the present study can be used to facilitate a goal-directed process that allows parents/PLWHA to selectively disclose their HIV status to family members and acquaintances for obtaining maximum support to eliminate newborn HIV infections while minimizing distress, stigma, and discrimination.

Development of the Sexually Transmitted Infection Service Evaluation Tool: Use of Delphi Approach.

BACKGROUND: With the wide variation in sexually transmitted infection (STI) services, it is a challenge to devise strategies for ensuring effective service delivery. The objectives of this study were to develop a standard tool for STI services evaluation and use the Delphi method to derive a weighted factor for each parameter of the tool. METHODS: A review of existing guidelines for quality care STI services were conducted, and parameters were selected to form the content of the measurement tool. Delphi technique was used to derive weighted factor for each STI service delivery parameter by using the Likert scale of 0-7. A heterogeneous group of 18 anonymous experts was invited to rate the parameters. All the responses were collected online. Cronbach's alpha level ≥0.8 was selected to define consensus the experts. RESULTS: The STI service evaluation tool (SSET) was created including ten parameters to evaluate the performance of clinic with the help of standard National guidelines. The SSET was standardized by deriving weighted factor for each evaluation parameter. Three rounds of Delphi were required to achieve consistency. Response rates for each Delphi round were 77.78%, 100%, and 78.57%, respectively. Each parameter, such as workforce, materials, consumables, consultation, counseling, coverage, referral, records, information education and communication, and supervision, was assigned weighted factor derived by converting the final score into the total standard score of 100. CONCLUSION: The Delphi method represents a novel approach to develop standardized tools to evaluate the performance of service delivery.

Rape: Is it a lifestyle or behavioral problem?

INTRODUCTION: In India, girl is raped every 20 min. The majority of reports reveals youth is vulnerable group for rape victimization. A set of prejudicial, stereotyped, or false beliefs about rape, rape victims, and rapist exist in the community. AIMS/OBJECTIVES: To study the attitude and myths toward rape among college going students of Surat City. MATERIALS AND METHODS: College students of various streams were participated in the study based on attitude toward rape scale (21 items) and updated Illinois Rape Myth Acceptance Scale (22 items). A total of 332 participants from three different colleges of the city took part in the survey. Data analysis was done with the SPSS version 19. RESULTS: Among the responders, 61.75% were female. Mean age of participants was 20.22 ± 1.27 years. Almost two-third (73%) of female participants and 42% of the male participants disagreed with the myth that "When a woman says 'no' she really means 'yes'." Around 30% of the participants were uncertain about the myth that "A woman cannot be raped by someone she previously knew or had sex with." While almost 35% of participants believed that "Most rapes are carried out by strangers." Strong sexual desire of guys, drunkenness, and girl's clothes were reported to be factors that provoke rape by 50%, 40%, and 33% of respondents, respectively, around 95% of female and 92% of male participants think that 7-year imprisonment for rape is not enough. CONCLUSIONS: Rape myths are found to be highly prevalent among youth and higher among males.

Diagnostic accuracy of self-reported symptomatic assessment versus per speculum/per vaginal examination for the diagnosis of vaginal/cervical discharge and lower abdominal pain syndromes among female sex workers.

BACKGROUND: National AIDS Control Organization guidelines on enhanced syndromic case management of sexually transmitted infections (STIs) and reproductive tract infections (RTIs) require per speculum (P/S) and per vaginal (P/V) examinations for diagnosis of STIs. However, it is not known if the addition of P/S and P/V examinations to self-reported symptomatic assessment adds any value for the diagnosis of STI/RTI. OBJECTIVE: To assess the diagnostic accuracy of P/S and P/V examinations compared with self-reported symptomatic assessment in a cohort of female sex workers (FSWs). METHODS: We performed a cross-sectional study from August 2009 to June 2010, among 519 FSWs in Surat city, Gujarat, India. Symptomatic assessment for the presence or absence of vaginal/cervical discharge (VCD) or lower abdominal pain (LAP) was done using a self-administered questionnaire. After completion of the questionnaire, all participants underwent P/S and P/V examinations. Summary diagnostic accuracy measures were calculated. RESULTS: Five hundred and nineteen FSWs between the ages of 18-49 years participated in the study. The median age of participants was 31 years. The prevalence of VCD and LAP syndromes based on vaginal discharge, LAP, or both was 56%, 5,-10%, respectively. The sensitivity of P/S and P/V examinations depending on symptomatic assessment ranged from 47% to 76%. The specificity ranged from 73% to 93%. The positive predictive value ranged from 25% to 83%, and the negative predictive value ranged from 56% to 98%. CONCLUSION: Symptomatic assessment alone is not adequate for the diagnosis of VCD and LAP syndromes and can lead to a significant number of missed cases (36%). A P/S and P/V examinations is critical for assessment of VCD and LAP syndromes and subsequent treatment.

HIV and STI prevalence and determinants among male migrant workers in India.

BACKGROUND: Our objective was to estimate for the first time the prevalence and determinants of human immunodeficiency virus type 1 (HIV-1) and sexually transmitted infections (STIs) among male migrants in India. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a multi-stage stratified probability sample survey of migrant (defined as not born in Surat city) men aged 18 to 49 years working in the diamond and textile industries in Surat city. Behavioural and biological data were collected. Biological data included laboratory diagnosed herpes simplex virus type 2 (HSV-2), syphilis, chlamydia, gonorrhoea, Trichomonas vaginalis (together defined as 'any STI') and HIV-1. Likely recently acquired STIs included chlamydia, gonorrhoea, T. vaginalis and syphilis with rapid plasma reagin ≥1:8. The response rate was 77% (845/1099). Among 841 participants, HIV-1 prevalence was 1.0%, 'any STI' prevalence was 9.5% and 38.9% of these STIs were likely to have been recently acquired. Being a diamond worker, Surat resident for 10+ years and recent antibiotic use were each associated with higher odds of 'any STI' (aORs 1.83 (95% CI 1.09-3.09), 1.98 (95% CI 1.22-3.22) and 2.57 (95% CI 1 .17-5.64), respectively) after adjusting for the other two factors and age. The main study limitation was social desirability bias for self-reported sexual behaviour; STIs were diagnosed in some self-reported virgins. CONCLUSIONS/SIGNIFICANCE: HIV and STI prevalence were lower than expected, but prevention interventions remain necessary in Surat since almost 40% of STIs among participants were probably recently acquired and sentinel surveillance HIV prevalence remains high. The participants had a similar HIV prevalence to Surat antenatal clinic attendees, a proxy for the general population. This suggests migrants are not always at higher risk of HIV compared to the general population in their migration destination. Our findings highlight the need to contextualise research findings from a specific setting with other local information to guide HIV/STI prevention interventions.