HIV Care Continuum among Men Who Have Sex With Men and Persons Who Inject Drugs in India: Barriers to Successful Engagement
BACKGROUND:
We
characterize the human immunodeficiency virus (HIV) care continuum for men who
have sex with men (MSM) and persons who inject drugs (PWID) across India.
METHODS:
We
recruited 12 022 MSM and 14 481 PWID across 26 Indian cities, using respondent-driven
sampling (September 2012 to December 2013). Participants were aged ≥18 years
and either self-identified as male and reported sex with a man in the prior
year (MSM) or reported injection drug use in the prior 2 years (PWID).
Correlates of awareness of HIV-positive status were characterized using
multilevel logistic regression.
RESULTS:
A total
of 1146 MSM were HIV infected, of whom a median of 30% were aware of their
HIV-positive status, 23% were linked to care, 22% were retained before
antiretroviral therapy (ART), 16% had started ART, 16% were currently receiving
ART, and 10% had suppressed viral loads. There was site variability (awareness
range, 0%-90%; suppressed viral load range, 0%-58%). A total of 2906 PWID were
HIV infected, of whom a median of 41% were aware, 36% were linked to care, 31%
were retained before ART, 20% had started ART, 18% were currently receiving
ART, and 15% had suppressed viral loads. Similar site variability was observed
(awareness range: 2%-93%; suppressed viral load range: 0%-47%). Factors
significantly associated with awareness were region, older age, being married
(MSM) or female (PWID), use of other services (PWID), more lifetime sexual
partners (MSM), and needle sharing (PWID). Ongoing injection drug use (PWID) and
alcohol use (MSM) were associated with lower awareness.
CONCLUSIONS:
In
this large sample, the major barrier to HIV care engagement was awareness of
HIV-positive status. Efforts should focus on linking HIV testing to other
essential services.
- 1Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health.
- 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
- 3Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu.
- 4National AIDS Control Organisation, New Delhi, India.
- 5Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu.
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