Primary prevention lessons learned from those with HIV in Chennai, India.

BACKGROUND: As each HIV-infected individual represents a breakdown of HIV primary prevention measures, formative data from representative individuals living with HIV can help shape future primary prevention interventions. Little is known about sexual behaviours and other transmission risk factors of high-risk group members who are already HIV-infected in Chennai, India. METHODS: Semi-structured qualitative interviews were conducted with 27 HIV-infected individuals representing each high-risk group in Chennai (five men who have sex with men (MSM), five female commercial sex workers (CSW), four truckers and other men who travel for business, four injecting drug users (IDU), five married male clients of CSW, and four wives of CSW clients, MSM, truckers, and IDU). RESULTS: Themes relevant to HIV primary prevention included: (1) HIV diagnosis as the entry into HIV education and risk reduction, (2) reluctance to undergo voluntary counselling and testing, (3) gender and sexual roles as determinants of condom use, (4) misconceptions about HIV transmission, and (5) framing and accessibility of HIV education messages. CONCLUSIONS: These qualitative data can be used to develop hypotheses about sexual risk taking in HIV-infected individuals in South India, inform primary prevention intervention programs, and improve primary prevention efforts overall.

Sexual behaviors of individuals with HIV living in South India: a qualitative study.

Formative data on the sexual behaviors of HIV-infected individuals in regions disproportionately affected by the epidemic can help generate hypotheses about sexual risk taking in HIV-infected individuals and shape interventions to prevent further transmission. India is home to the highest number of HIV-infected individuals in the world, and very little information is available about the sexual behaviors of HIV-infected Indians. The present qualitative study presents themes from individual in-depth interviews with 30 HIV-infected individuals in South India. The sample included individuals from demographic groups that may experience different risk factors (five individuals each: from men who have sex with men, sex workers, married men, married women, injection drug users, and truck drivers ormen who travel for work). Across the groups, the three most frequently discussed themes involved (a) sexual behavior change (sexual risk reduction after HIV diagnosis, sexual behavior remaining safe after initiation of ART treatment), (b) motivations to reduce risk (motivation to protect one's self against further infection, to protect others from infection), and (c) barriers to reduce risk (complexity and stigma associated with condom negotiation, perception of HIV-infected peers being less concerned about protecting others, condom use as linked to gender and sexual roles, condom use as inconvenient or unappealing). This qualitative data can be used to generate hypotheses about sexual risk taking in HIV-infected individuals in South India, to inform models of risky behaviors of HIV-infected individuals for quantitative studies, and to lay the groundwork for secondary prevention intervention efforts that enhance facilitators and reduce barriers of safer sex articulated by the interviewees.