Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India.

Among transgender women living with HIV (TGWLH) in India, little is understood about the mechanisms through which multiple intersecting stigmas impact HIV care engagement, or intervention strategies that might mitigate this impact. We conducted focus groups with TGWLH (N = 30) in three Indian cities and analysed data using theoretical frameworks related to HIV stigma, gender affirmation, and syndemics. Findings revealed that enacted and anticipated stigma due to transgender identity, HIV, or sex work status, and lack of gender affirmation (e.g., misgendering) in healthcare settings delayed ART initiation and promoted care disengagement. Having supportive physicians and counsellors within ART centres and peer outreach workers facilitated ART initiation, adherence, and retention. Findings also revealed that HIV stigma within TGW communities led to concealment of HIV status or syndemic conditions such as depression and alcohol use, thereby affecting care engagement. However, the TGW community itself was also described as a resilience resource, offering emotional, psychological and tangible support that decreased the impact of discrimination on care engagement. HIV care engagement efforts among Indian TGWLH could be strengthened by reducing intersecting stigmas in healthcare settings and within TGW communities, providing gender-affirming and culturally competent healthcare, addressing psychosocial syndemic conditions, and strengthening support within transgender communities.

Pilot Community Mental Health Awareness Campaign Improves Service Coverage in India.

PURPOSE: Low community awareness of mental health problems negatively impacts treatment-seeking for such problems. Despite a shortage of mental health providers, there is scope to improve coverage of mental health services in India. In this study, we examined the impact of a multi-state community-based awareness campaign on knowledge, attitude, treatment-seeking behavior and acceptability. METHODS: Campaign activities included educational materials, public meetings, musical announcements, quizzes, and street plays, followed by a mental health screening camp. A rapid, real-world evaluation was conducted using post-intervention surveys (n = 693), field notes and telephonic interviews in five states. RESULTS: The campaign, implemented as a public-private partnership between government service providers and community-based organizations, reached ~ 3000 people in 20 new locations across five states. As a result of the campaign, 1,176 persons sought treatment services for mental disorders and 66% received a preliminary diagnosis. Collectively, campaign activities were the first time that ~ 75% of participants reported learning about mental health problems. Participants expressed knowledge that mental disorders are treatable, listed common symptoms and location of available mental health services and attitudes supporting people with mental health problems. CONCLUSION: The campaign enabled improved coverage for mental health services, potentially by enhancing knowledge, attitude and treatment-seeking behavior. Future research may develop a quasi-experimental evaluation of the current campaign methodology.