Men having sex with men and people who inject drugs (PWID) lag behind other HIV-infected persons in availing HIV care services, new data by National AIDS Control Organization, Johns Hopkins University and YRG Care, Chennai has shown.
The overall HIV prevalence has shot down but the decline has not been as apparent in these key populations of MSM and PWID. Published in the peer reviewed Clinical Infectious Diseases Journal, findings of a large community-based study of MSM and PWID across India showed that the major barrier to successful engagement in HIV care was diagnosis.
As many as 12,022 MSM and 14,481 PWID were recruited across 26 cities from September 2012 to December 2013 as part of an trial by National AIDS Control Organisation,Johns Hopkins University, YRG Care, Chennai and others. A total of 1146 (7%) of MSM and 2906 (21%) of PWID were HIV-infected during the trial .
Of 643 MSM not aware of their HIV-positive status, 357 (51%) reported being tested previously. Of these 357, 167 (43%) were tested >1 year earlier, and 25 (14%) reported never receiving their results. Of 286 never tested, primary reasons for never being tested were low perceived risk (48%), not knowing where to go (24%), no time (14%), and being afraid of a positive diagnosis (8%).
Of 1682 PWID not aware of their HIV-positive status, 693 (34%) reported being tested previously. Of these 693 individuals, 344 (52%) reported being tested >1 year earlier and 232 (31%) reported never receiving their results. Of 989 never tested, primary reasons for not being tested were low perceived risk (42%), not knowing where to go (25%), no time (15%), and being afraid of a positive diagnosis
The trial led the National AIDS Control Organisation (NACO) along with Johns Hopkins university and YRG Care, Chennai to set up a joint research project across 22 cities to improve access to HIV services for these two vulnerable high risk groups.
Dr Sunil Solomon, in charge at the YRG Care, Chennai and who is also an assistant professor at the Department of Medicine at Johns Hopkins University told The Indian Express that to achieve the ambitious UNAIDS (Joint United Nations Programme on HIV/AIDS) target of “90-90-90” by 2020 – there is a requirement that 90% of persons infected with human immunodeficiency virus should be aware of their status, 90 per cent of those who are aware of their status should receive ART and 90% of those receiving ART achieve viral suppression.
“As part of the trial in each city a local partner was identified that maintained a MSM/PWID drop-in center and provided some HIV prevention services. This is the first such trial that used a combination of prevention/treatment approach focused on MSM and PWID populations,” Solomon said.
MSM and PWID share commonalities that make HIV service delivery challenging, Solomon said. This trial had sought to evaluate whether single-venue, integrated delivery of core services to vulnerable high-risk populations (MSM and PWID) improves service utilization and consequently HIV testing and other outcomes along the HIV care continuum.
According to NACO, India has estimated there are 2.35 million ‘high-risk’ MSM living in India. However, estimates of prevalence of same-sex behavior among men range from 9-12%, translating to as many as 45 million MSM(,most MSM remain hidden and frequently marry women to conceal their MSM behavior) . The National Integrated Bio-behavioural surveillance (IBBS) 2014-15 showed that the HIV prevalence among MSM was 4.3 per cent while that among IDUs was 9 percent.
These interventions can improve awareness of HIV status, reduce injection- related and same-sex risk behavior, reduce sexual transmission to ‘bridge’ populations (wives, other injection and sexual partners), improve health, reduce mortality, and decrease the infectiousness of HIV-infected persons in the community through effective viral suppression, experts have stressed.