Search

The burden of avoidable illness, accidents and impairments can be estimated by understanding the quality of life, and it can also offer important new insights into the connections between risk factors and the quality of life. This study assessed the quality of life of people living with HIV during the COVID-19 pandemic which would have caused substantial difficulties for such individuals. Data were collected using WHOQOL-BREF SCALE and FGD Semi-Structured Questionnaire. People living with HIV enrolled under TANSACS were included. Chi-square analysis was used to evaluate the association between the demographic variables and the domains of the quality of life. The quality of life was determined using 4 domains. The average score for each domain includes physical health, 54.39, psychological, 44.85, social relationships, 48.48 and environment 57.69. The average overall score for the quality of life was 51.35. The occupation variable is significant with all the domains; physical health (P = 0.030), psychological (P = 0.046), social relationships (P = 0.027) and environment (P = 0.023) and the gender variable is significant with physical health (P = 0.026), social relationship (P = 0.007) domains. COVID-19 worsened quality of life for HIV patients, impacting healthcare, support, jobs, and stigma. The employment status also significantly impacted. [ABSTRACT FROM AUTHOR]

World AIDS Day observed on 1st December 2024 aims for the right to health by addressing the inequalities that hinder progress in ending AIDS. India has a large number of people living with HIV and factors like socioeconomic strata, stigma and lack of awareness, are till hurdles to cross even though the National AIDS Control Organisation (NACO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) organisation have made significant strides. Here we discuss the HIV prevalence and burden, evolving anti-retroviral therapies, and improvement in life expectancy over the last decade. [ABSTRACT FROM AUTHOR]

Introduction: India has the second largest HIV epidemic in the world. Despite successes in epidemic control at the population level, a concentrated epidemic persists among gay and other men who have sex with men (MSM). However, India lags in implementation of biomedical prevention technologies, such as HIV pre-exposure prophylaxis (PrEP). In order to inform scale-up of new HIV prevention technologies, including those in the development pipeline, we assessed willingness to use oral PrEP, rectal microbicides, and HIV vaccines, and choices among product characteristics, among MSM in two major Indian cities. Methods: A cross-sectional survey was conducted with a discrete choice experiment (DCE), an established methodology for quantitively estimating end-user preferences in healthcare. Survey participants were randomly assigned to one of three questionnaire versions, each of which included a DCE for one prevention technology. Participants were recruited using chain-referral sampling by peer outreach workers, beginning with seeds in community-based organizations and public sex environments, in Chennai and Mumbai. DCE data were analyzed using random-parameters (mixed) logit (RPL) models. Results: Among participants (n = 600), median age was 25 years, with median monthly income of INR 9,000 (~US$125). Nearly one-third (32%) had completed a college degree and 82% were single/never married. A majority of participants (63%) reported condomless anal sex in the past month. The acceptability of all three products was universally high (≥90%). Across all three products, four attributes were significant predictors of acceptability—with efficacy consistently the most important attribute, and in decreasing order of preference, side-effects, dosing schedule, and venue. MSM varied in their preferences for product attributes in relation to their levels of education and income, and engagement in sex work and HIV risk behavior. Conclusion: This study provides empirical evidence to facilitate the integration of end users' preferences throughout design, testing, and dissemination phases of HIV prevention technologies. The findings also suggest action points and targets for interventions for diverse subgroups to support the effectiveness of combination HIV prevention among MSM in India. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Blood banks are responsible for notification and counseling of the reactive donors besides screening for transfusion-transmitted infections (TTIs). Donor notification and counseling is essential to protect the health of the donor by early clinical intervention and to prevent secondary transmission of infection. AIM: The aim of this study was to determine the effectiveness of human immunodeficiency virus (HIV)-reactive donor notification and counseling in a tertiary care center. MATERIALS AND METHODS: An audit of the records of HIV-reactive donors over 2 years was conducted. The response rate of HIV-reactive donors on notification about reactive HIV status for one-to-one counseling was evaluated. Their attendance at an integrated counseling and testing center (ICTC) and compliance at an antiretroviral therapy (ART) clinic were also assessed. RESULTS: Out of 60,907 total donations, 124 (0.2%) donors were HIV reactive. One hundred and eleven were informed about their reactive status and the rest 13 could not be informed due to wrong demographic details in donor registration form. Eighty-seven (78%) reactive donors were informed by phone and the rest 24 (22%) were informed by confidential letter. Of the 111 informed donors, 62 (55.8%) came for one-to-one counseling (responders). Fifty-one (82.2%) responders visited ICTC after postdonation counseling. Over 6-month follow-up, 20/62 (32.2%) reactive donors were undergoing ART. CONCLUSION: The response rate of the donors to the notification and further receiving treatment is low in developing countries. Predonation screening and counseling by a trained counselor should be strengthened upon. Education of the donors about the TTIs can improve their knowledge and allay their anxiety. [ABSTRACT FROM AUTHOR]

In Surat city of Gujarat, India, female sex workers (FSW)-based targeted interventions (TI) and community-based organizations (CBO) have been functioning since 1998. To document the impact of the COVID-19 lockdown (March–May 2020) on FSWs and STI/RTI/HIV preventive measures provided through TI/CBOs in Surat city, sequential, explanatory mixed-methods design was used. We conducted a desk review of quarterly programmatic data (2018–2020) of four TIs and CBOs and interviewed of 221 FSWs to study pre- and post-lockdown socioeconomic conditions, engagement in sex work, health services during COVID-19 lockdown and coping strategies, followed by five focus group discussions of FSWs and TI/CBO project staff. Study identified four major themes: reasons for working as a FSW during COVID-19 lockdown, entry to sex work during or as a consequence of lockdown, exploitation of FSWs during lockdown, and challenges of TI and CBOs in service provision in pandemic situation. Number of new registrations and STI/RTI detection increased immediately after lockdown. TI/CBO and other NGOs working for women welfare must build financial independence by training them in microeconomics, savings, and entrepreneurship. TI/CBO staff must also include experts in finance or business, trained in emergency response. The presence of strong TI/CBO network facilitated prompt delivery of essential commodities and financial aid to FSWs. However, laboratory and screening services were hampered, which warrants need of introducing self-test kits. In backdrop of decrease in condom distribution, continuation of sex work during lockdown and disruption of routine HIV/STI/RTI screening facilities, our study also recommends intensified HIV/STI/RTI screening among FSWs. [ABSTRACT FROM AUTHOR]

The article discusses research by Arpit Parmar, Radhika Chakraborty, and Yatan P. S. Balhara, reported in the April 2024 issue of the Indian Journal of Psychiatry, focusing on the current status of harm reduction initiatives in India. Topics include the history of harm reduction in India, the Indian status of harm reduction compared to global standards, and the strategies of harm reduction services in the country, highlighting the need for improved support and funding for these services.

Background and aims: Network centrality, an indicator of an individual's importance and potential to drive behavioral change, is rarely used to select peer educators. Individual‐level predictors of network centrality might be useful to identify people who inject drugs (PWID) for potential roles as peer navigators or change agents in network‐based interventions in settings where sociometric data are unavailable. We assessed the relationship between network centrality and HIV prevention service engagement to determine whether centrally‐positioned PWID share measurable commonalities. Design: Observational study and survey using baseline data from a sociometric network cohort of PWID, enumerated using network software and biometric data (2017‐2020). Network ties corresponded to direct injection partnerships in the prior month. Setting: New Delhi, India. Participants: A total of 2512 PWID who were ≥18 years, provided written informed consent, and reported illicit injection drug use within the 24 months before study enrollment. Measurements Interviewer‐administered questionnaires measured demographics and substance use behaviors. Central versus peripheral network position was categorized using betweenness centrality 75th%ile. Logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) between network position and HIV testing, medication for opioid use disorder (MOUD), or syringe service use. Lasso models selected predictors of central network position among 20 covariates detailing demographic, biologic, and substance use information. Predictive accuracy was evaluated using model performance metrics. Findings Overall, median age was 26 years (interquartile range 22–34); 99% were male; 628 were classified as central. Compared with PWID at the periphery, central PWID were more likely to use MOUD (aOR: 1.59, 95%CI: 1.30–1.94) and syringe services (aOR: 2.91, 95%CI: 2.25, 3.76) in the prior six months. Findings for HIV testing were inconclusive (aOR: 1.30, 95%CI: 1.00–1.69). The lasso variable selector identified several predictors of network centrality: HIV and hepatitis C infection, number of PWID seen in the prior month, injecting heroin and buprenorphine (vs. heroin only) six months prior, sharing injection equipment six months prior, experiencing drug overdose in the past year, and moderate/severe depression (vs. none/mild). Average agreement between model‐predicted vs. observed values was 0.75; area under the receiver operator curve was 0.69. Conclusions: In a socioeconomic network of people who inject drugs (PWID) in New Delhi, India, there are common characteristics among individuals based on their network position (central vs. peripheral) but individual‐level predictors have only moderate predictive accuracy. Although central network members appear to be more likely to use HIV prevention services than peripheral network members, their potential as change agents may be limited by other factors that impede their ability to adopt or promote HIV prevention service use. [ABSTRACT FROM AUTHOR]

In this article, we examine how two emerging economies, Brazil and India, initially responded to the COVID-19 pandemic. Historically, to build their international reputation and soft power influence in health, both countries implement effective prevention and treatment programs in response to global pandemics, such as HIV/AIDS. However, this did not occur in response to COVID-19. Why? Building on the global health diplomacy and soft power literature, we introduce a new concept, soft power extremes, to explain Brazil and India's delayed and lackluster policy response to COVID-19. Soft power extremes emerge when presidents either prioritize building their international reputation in health at the expense of meeting domestic healthcare needs, or conversely, when they are apathetic towards international reputation building through policy innovations. At the same time, we argue that the absence of a strong state-civil societal partnership in response to COVID-19 in both countries facilitated the emergence of these soft power extremes, in turn revealing the importance of combining a focus on elite-centered foreign health policymaking with analysis of governance and social accountability. [ABSTRACT FROM AUTHOR]

India continues to grapple with a significant burden of HIV infections. Despite notable progress in prevention and treatment efforts, multiple challenges, such as high-risk populations, inadequate testing facilities, and limited access to healthcare in remote areas, persist. Though the Government of India offers HIV-1 plasma viral load testing at various medical centers, aiding treatment decisions and monitoring antiretroviral therapy effectiveness, enhancing care for individuals living with HIV under the National AIDS Control Program (NACP), the nation's large population and diverse demographics further complicate its outreach and response. Hence, strategic interventions and alternative methods of testing remain crucial to curbing HIV transmission and improving the quality of life for those affected. Dried blood spot (DBS) sampling has emerged as a convenient and cost-effective alternative for HIV-1 viral load testing, revolutionizing the landscape of diagnostic and monitoring strategies for HIV infection. Though the plasma-based viral load remains the gold standard for monitoring HIV-1, DBS-based HIV-1 viral load testing holds immense promise for improving access to care, particularly in resource-limited settings where traditional plasma-based methods may be logistically challenging. DBS entails the collection of a small volume of blood onto filter paper, followed by drying and storage. This approach offers numerous advantages, including simplified sample collection, transportation, and storage, reducing the need for cold-chain logistics. Recent studies have demonstrated the feasibility and accuracy of DBS-based HIV-1 viral load testing, revealing a strong correlation between DBS and plasma measurements. Its implementation can enhance the early detection of treatment failure, guide therapeutic decisions, and ultimately contribute to better clinical outcomes for HIV-infected individuals. Hence, this review explores the principles, advancements, feasibility, and implications of DBS-based HIV-1 viral load testing. [ABSTRACT FROM AUTHOR]

Background: Meaningful community engagement (CE) in HIV prevention research is crucial for successful and ethically robust study implementation. We conducted a qualitative study to understand the current CE practices in HIV prevention research and to identify expressed and implicit reasons behind translational gaps highlighted by communities and researchers. Methods: For this exploratory qualitative study, we recruited a purposive sample of participants from Indian government-recognised key populations such as men who have sex with men, transgender women, people who inject drugs and female sex workers; general population adults and adolescents/youth; and researchers. We conducted 13 virtual focus groups (n = 86) between July and October 2021. Data were explored from a critical realist perspective and framing analysis (i.e., examining how the participants framed the narratives). Results: Participants reported that study communities, especially those from key populations, were primarily involved in data collection, but not necessarily with optimal training. Involvement of communities before the start of the study (e.g., obtaining feedback on the study's purpose/design) or once the study is completed (e.g., sharing of findings) were highlighted as priorities for meaningful engagement. Participants suggested meaningful CE in all stages of the study: (1) before the study—to get inputs in finalising the study design, drafting comprehensible informed consent forms and culturally-appropriate data collection tools, and deciding on appropriate monetary compensation; (2) during the study—adequate training of community field research staff; and (3) after the study—sharing the draft findings to get community inputs, and involving communities in advocacy activities towards converting evidence into action, policy or programs. Timely and transparent communications with communities were explicitly stated as critical for gaining and maintaining trust. Mutual respect, reciprocity (e.g., appropriate monetary compensation) and robust community feedback mechanisms were considered critical for meaningful CE. Conclusions: The findings highlighted the translational gaps and priority areas for capacity building to strengthen CE in HIV prevention research. It is not only important to engage communities at various stages of research but to understand that trust, dignity, respect, and reciprocity are fundamentally preferred ways of meaningful community engagement. Plain English summary: Engaging communities in HIV prevention research enhances the rigour and impact of research. We sought to understand the current community engagement practices and to identify how communities preferred to get involved in research. We explored these topics with key and general populations and researchers, by conducting 13 focus group discussions with 86 participants. We found that there was limited involvement of communities before the start of the study and after its completion, although trained community members were involved in data collection. Participants strongly suggested that the community should be involved throughout—before initiation, during the study and after study completion. Participants' preferred ways of engaging communities reflected that mutual respect, reciprocity and transparent communications are critical for meaningful and successful community engagement. [ABSTRACT FROM AUTHOR]

Introduction: Effective educational interventions to knowledge, attitude, and prevention of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) may limit the spread of the disease. However, the relevance of HIV knowledge to followers of religions is unknown. We assessed the 2015-2016 Demographic and Health Survey (DHS) data from India to investigate the levels of knowledge of HIV/AIDS among Hindus, Muslims, Sikhs, Christians, and Buddhists in relation to standard sociodemographic variables in India. Methods: We used the individual and household level data from the internationally and temporally harmonized cross-sectional DHS. These data were representative of the national population and were collected from January 2015 to December 2016. Results: The age range of the population was 15-54 years (n = 224,531). We found the highest level of knowledge of HIV/AIDS among Sikh men (than the followers of other religions (80.4%-92.7%). Conversely, Muslims and Hindus were least knowledgeable of HIV/ AIDS (80.4% and 81.2%). Younger participants (82.5%), residents of urban areas (90.6%), more educated (98.6%), never married (84.9%), wealthier (95.5%), and having more access to mass media (90.4%-96.7%) were more aware of HIV/AIDS-related knowledge. Among various religions, Sikhs were more educated (16.1% with higher education), wealthier (59.5% in the top quintile), with higher exposure to communication means than Muslims, Hindus, and Christians. Conclusion: We report that Sikh men are most knowledgeable of HIV compared to Sikh women and followers of other religions. Our findings may help formulate public health strategies targeting various religious groups to reduce the incidence of HIV/AIDS. [ABSTRACT FROM AUTHOR]

Unlike prevailing research methodologies in the interdisciplinary field of global health, feminist methodologies allow researchers to unsettle the premises and assumptions of the field. This paper describes how we mobilize transnational feminist ethnography in our research on HIV in India and postabortion care in Senegal. Transnational feminist perspectives enable us to re-embed HIV prevention and post-abortion care in the politics of gender and sexuality and in postcolonial histories of health governance. They consider the role of gender and sexuality not just in terms of gendered health inequalities, but also in terms of how global health problems are defined, managed, measured, and contested. We outline how our projects put this lens into practice by pushing the methodological boundaries of time, scale, and scope and through a historicized, multisited, and multiscalar approach that triangulates multiple sources of data. Feminist ethnography requires that we turn the critical gaze upon ourselves, reflecting on multiple and shifting personal and professional positionalities during and after fieldwork and our ethical commitments to our interlocutors. While acknowledging the significant personal, institutional, and professional challenges of using feminist methodologies, especially given the dominant modes of research in global health, we urge greater consideration, among both advanced and early scholars, of the possibilities they offer for studying global health problems. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic posed unprecedented challenges to HIV services globally. We evaluated the impact of the COVID-19 pandemic on the uptake of HIV testing in the Targeted Intervention (TI) program in Maharashtra—a high HIV burden state in India. Annual HIV testing was sustained during the pandemic year (2020–2021), at levels similar to the pre-pandemic year (2019–2020), among Female Sex Workers (FSW), Men having Sex with Men (MSM), Transgender (TG), and Truckers; but not among Migrants and Intravenous Drug Users (IDU). There was an acute decline during the lockdown across all typologies. Sharp recovery was seen among FSW, MSM, and TG during the early months of the un-lockdown. The community-based screening (CBS) approach primarily contributed to this recovery. Among migrants and truckers, recovery was delayed. There was an overall reduction of 58% in annual HIV-positive registrations. The community-based networks, participatory structures, and processes of HIV programs played an essential role in reaching the community during the pandemic. [ABSTRACT FROM AUTHOR]

Background: India has successfully reduced Human Immuno-deficiency Virus (HIV) incidence, with a 66% decline since the year 2000 has been seen; however, control among Men having sex with Men (MSM) and transgender women (TGW) remains a critical challenge. Oral Pre-Exposure Prophylaxis (PrEP) may help close a critical HIV prevention gap for MSM and TGW in India; however, no studies to date have evaluated the feasibility of oral PrEP among MSM and TGW in India. Methods: The proposed study aims at understanding the implementation of the provision of daily oral-Tenofovir (TDF) containing PrEP among MSM and TGW through the clinic and community-based delivery models in Pune, Maharashtra, and Jalandhar, Punjab respectively in India. The study aims at estimating PrEP adherence, facilitators, and barriers to PrEP use, retention, acceptability, and willingness to pay for PrEP. After the screening, eligible participants (n = 600) will receive PrEP medicines and will be monitored quarterly for HIV, STIs, and renal and liver toxicity for 12 months as per the schedule of events. The primary outcomes of interest are PrEP acceptability, PrEP adherence, retention rate, adverse medical events, and sexual behavioural changes with PrEP use and breakthrough infections while on PrEP. The study will assess the feasibility of two service delivery models; however, the data from the two service delivery models will be analyzed independently and will not be compared for feasibility and other outcome indicators. The study has been initiated after obtaining appropriate regulatory approvals. Discussion: PrEP is efficacious in preventing HIV among high-risk population however there are scarce data on providing PrEP to MSM and TGW. The study will provide critical evidence to programs and policymakers on the implementation of PrEP in a "real world" setting, among MSM and TGW in India including identifying populations that can benefit most from this additional HIV prevention intervention along with acceptable delivery strategies and means of support for adherence. Trial registration: Not applicable being a demonstration project. Efficacy is already proven. [ABSTRACT FROM AUTHOR]

This article aims to analyse the role of dual challenges in the HIV epidemic in India, especially in the context of the criticality of the emerging epidemic, in altering the HIV discordance among couples. Analysis of the evidence from two rounds of community-based HIV testing (NFHS-3&4) portrays that coverage of HIV testing in India has remarkably increased (91%) over the last decade. Although the overall prevalence of HIV in the country has declined, a noticeable decline can be found only among the males. The percentage of HIV concordant among couples in India remains unchanged (0.11%). Whereas, HIV prevalence among the couples where only the male partner is HIV positive has declined to 0.17% in NFHS-4 from 0.32% in NFHS-3. On the other hand, among couples where only the woman is HIV positive, the prevalence has increased. This shows that Indian women are in a disadvantageous position, and the gender difference in new infections is narrowing down. Thus, it can be said that the emerging HIV epidemic is altering the HIV discordance among couples in India, which poses the need to effectively and rapidly refine the HIV prevention strategies to target the sub-typologies and vulnerabilities. [ABSTRACT FROM AUTHOR]

Transgender women (TGW) in India, especially those who engage in sex work, are at high risk for HIV. Guided by the information-motivation-behavioral skills model and qualitative formative research findings, Sakhi (girlfriend), a 3-week smartphone-based pilot intervention consisting of short videos (one/week) and text messages (two/week), was implemented using a one-group pre- and post-test design to test its efficacy in promoting condom use and HIV testing among TGW (n = 50) who engage in sex work in Chennai. Changes in outcomes were assessed by conducting multivariable analyses using generalized estimating equations. Participants' mean age was 26 years, and the mean monthly income was INR 21700 (USD 292). About one-third completed college, and 96% were HIV-negative. Significant changes in the desired direction were observed in the primary outcomes: condom use – decrease in the engagement of condomless anal sex with male partners (12% to 2%, p < 0.05) and HIV testing – increase in intentions to undergo HIV testing every 6 months (34% to 86%, p < 0.001); and in some of the secondary outcomes: decrease in alcohol use before sex, increase in intentions to use condoms consistently and increase in the well-being score. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the Sakhi intervention and warrants a larger randomized trial among diverse subgroups in diverse settings. [ABSTRACT FROM AUTHOR]

This paper presents the cost-effectiveness of a WHO-recommended harm-reduction programme implemented among a cohort of persons who inject drugs in Delhi, India. We estimate the number of infections averted using Bernoulli process model and calculate cost-effectiveness ratio as the total programme cost per infection averted. The intervention averted 996 HIV infections over 36 months, with a cost-effectiveness ratio of INR 24,763 (US$ 476) per infection averted per year. The first phase, when HIV testing and counselling were initiated, was more cost-effective than the second phase when full intervention package, including needle-syringe exchange, condom distribution, harm-reduction education, etc., was implemented. [ABSTRACT FROM AUTHOR]

Background: Global evidence suggests that Pre-Exposure Prophylaxis (PrEP) plays a pivotal role in reducing new HIV-infections among key populations (KP). However, the acceptability of PrEP differs across different geographical and cultural settings and among different KP typologies. Men who have sex with men (MSM) and transgender (TG) communities in India have around 15–17 times higher prevalence of human immunodeficiency virus (HIV) than the general population. The low rates of consistent condom use and poor coverage of HIV testing and treatment among the MSM and transgender communities highlight the need for alternative HIV prevention options. Methods: We used data from 20 in-depth interviews and 24 focused group discussions involving 143 MSM and 97 transgender individuals from the two metropolitan cities (Bengaluru and Delhi) in India to qualitatively explore their acceptability of PrEP as a HIV prevention tool. We coded data in NVivo and conducted extensive thematic content analysis. Results: Awareness and use of PrEP were minimal among the MSM and transgender communities in both cities. However, on being provided with information on PrEP, both MSM and transgender communities expressed willingness to use PrEP as an additional HIV-prevention tool, to complement inability to consistently use condoms. PrEP was also perceived as a tool that could enhance the uptake of HIV-testing and counseling services. PrEP awareness, availability, accessibility and affordability were identified as determining factors that could influence its acceptability. Challenges such as stigma and discrimination, interrupted supply of drugs and non-community-friendly drug dispensing sites were identified barriers to continuing PrEP. Conclusions: Using qualitative data from two Indian settings, this study provides community perspectives and recommendations to stakeholders and policymakers for introduction of PrEP into programs as a prevention tool among MSM and transgender communities in India. [ABSTRACT FROM AUTHOR]

Background & objectives: Transgender women (TGW) in India are at high risk of HIV infection. Despite behavioural interventions aimed at reducing HIV risk, no literature synthesis exists so far to evaluate their potential for reducing HIV incidence in India This review was aimed to identify and evaluate HIV-focussed behaviour change interventions for TGW in India. Methods: Literature from three databases were reviewed up to June 2, 2021, for studies describing behavioural interventions for HIV prevention among TGW in India. The inclusion criteria were studies that included TGW and reported intervention effects on HIV prevention-related behaviour. Data were analyzed descriptively. Results: Of the 146 articles screened, only three met the inclusion criteria. All three interventions were at the open pilot trial stage and included other high-risk groups (e.g. men who have sex with men). The interventions used behavioural counselling, increased sexually transmitted infection screening and sexual healthcare visits and leveraged community-based organizations to improve the outcomes. All these interventions showed modest improvements in health-seeking behaviour and access to services. However, none specifically targeted TGW. Interpretation & conclusions: The scoping review highlights the need for behavioural interventions for HIV prevention tailored to TGW in India. This study emphasizes the need for research to move to the next stage of intervention development and testing utilizing more rigorous evaluation methods, such as a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Background & objectives: HIV sentinel surveillance (HSS) among antenatal women in India has been used to track the epidemic for many years. However, reliable tracking at the local level is not possible as ANC sentinel sites are limited in number and cover a smaller sample size at each site. Prevention of parent-to-child-transmission (PPTCT) programme data has a potential advantage due to better geographical coverage, which could provide more precise HIV case estimates; therefore, we compared HSS ANC data with PPTCT programme data for HIV tracking. Methods: Out of the 499 surveillance sites, where HSS and PPTCT programme was being conducted in 2015, 210 sites (140 urban and 70 rural) were selected using a stratified random sampling method. HSS (n=72,981) and PPTCT (n=112,832) data records were linked confidentially. The sociodemographic characteristics of HSS and PPTCT attendees were compared. HIV prevalence from HSS ANC was compared with the PPTCT programme data using Chi-square test. State- and site-level correlation of HIV prevalence was also done. Concordance between HSS and PPTCT HIV positivity was estimated using kappa statistics. Results: The age distribution of HSS and PPTCT attendees was similar (range: 23 to 27 yr); however, HSS ANC participants were better educated, whereas PPTCT recorded a higher proportion of homemakers. The correlation of HIV prevalence between HSS and PPTCT was high (r=0.9) at the State level and moderate at the site level (r=0.7). The HIV positivity agreement between HSS ANC and PPTCT was good (kappa=0.633). A similar prevalence was reported across 26 States, whereas PPTCT had a significantly lower prevalence than HSS in three States where PPTCT coverage was low. Overall HIV prevalence was 0.31 per cent in HSS and 0.22 per cent in PPTCT (P<0.001). Interpretation & conclusions: High-quality PPTCT programme data can provide reliable HIV trends in India. An operational framework for PPTCT-based surveillance should be pilot-tested in a phased manner before replacing HSS with PPTCT. [ABSTRACT FROM AUTHOR]

Background: Current programs to engage marginalized populations such as gay and bisexual individuals and other men who have sex with men (MSM) in HIV prevention interventions do not often reach all MSM who may benefit from them. To reduce the global burden of HIV, far-reaching strategies are needed to engage MSM in HIV prevention and treatment. Globally, including low- and middle-income countries, MSM are now widely using internet-based social and mobile technologies (SMTs; eg, dating apps, social media, and WhatsApp [Meta]), which provides an unprecedented opportunity to engage unreached and underserved groups, such as MSM for HIV prevention and care., Objective: This study aimed to assess the effectiveness of a multilevel mobile health (mHealth)-based intervention to improve HIV testing uptake and status neutral linkage-to-care among sexually active MSM reached through internet-based platforms in Mumbai, India., Methods: In this randomized controlled trial, we will determine whether CHALO! 2.0 (a theory-based multilevel intervention delivered in part through WhatsApp) results in increased HIV testing and linkage-to-care (prevention or treatment). This study is being conducted among 1000 sexually active MSM who are unaware of their HIV status (never tested or tested >6 months ago) and are recruited through SMTs in Mumbai, India. We will conduct a 12-week, 3-arm randomized trial comparing CHALO! 2.0 to 2 control conditions-an attention-matched SMT-based control (also including a digital coupon for free HIV testing) and a digital coupon-only control. The primary outcomes will be HIV testing and status neutral linkage-to-care by 6 months post enrollment. Participants will be followed up for a total of 18 months to evaluate the long-term impact., Results: The study was funded in 2020, with recruitment having started in April 2022 due to delays from the COVID-19 pandemic. Baseline survey data collection began in April 2022, with follow-up surveys starting in July 2022. As of April 2022, we enrolled 1004 participants in the study. The completion of follow-up data collection is expected in January 2025, with results to be published thereafter., Conclusions: While global health agencies have called for internet-based interventions to engage populations vulnerable to HIV who are not being reached, few proven effective and scalable models exist and none is in India, which has one of the world's largest HIV epidemics. This study will address this gap by testing a multicomponent mHealth intervention to reach and engage MSM at high priority for HIV interventions and link them to HIV testing and prevention or treatment., Trial Registration: ClinicalTrials.gov NCT04814654; https://clinicaltrials.gov/study/NCT04814654. Clinical Trial Registry of India CTRI/2021/03/032280., International Registered Report Identifier (irrid): DERR1-10.2196/59873., (©Jatin Chaudary, Shruta Rawat, Alpana Dange, Sarit A Golub, Ryung S Kim, Venkatesan Chakrapani, Kenneth H Mayer, Julia Arnsten, Viraj V Patel. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.11.2024.)

In India, male sex workers (MSW) are among the most vulnerable populations at higher risk for HIV and other sexually transmitted infections (STIs) and may seek health care services less frequently. A community-based sample of 100 MSW in Chennai, India, completed a baseline assessment as part of a behavioral intervention to reduce the acquisition and transmission of HIV. MSW reported an average of 12.2 (SD = 17.7) condomless anal sex acts with male clients in the past month, yet only 48% accessed health care services in the past 3 months. In a multivariable model adjusted for relevant covariates, MSW who accessed health care services in the past 3 months were more likely to be tested for HIV/STIs and report routine HIV testing over the past 12 months. Future HIV prevention efforts among MSW in India should incorporate referrals for accessing general health care services and identify specific barriers to health care engagement among this group. [ABSTRACT FROM AUTHOR]

Breastfeeding is a natural act, but it is also a learned behaviour. This year’s theme for World Breastfeeding Week 2022 is ‘Step up for breastfeeding: Educate and support.’ Organizations like Mumbai Breastfeeding Promotion Committee (MBPC) Mumbai Obstetric & Gynecological Society (MOGS) and Federation of Obstetrics & Gynecologic Societies of India (FOGSI) have been holding activities, webinars and competitions to focus on this important topic. This has been a wonderful way to partner with neonatologists, pediatricians, community medicine and mother support groups. The aim of all these activities is to highlight the physiological importance of breastfeeding, promote exclusive breastfeeding, and make the general population aware about its multiple benefits. This article provides a few key points for practicing physicians to impart knowledge of the evidence-based advantages of breastfeeding to their patients, friends and relatives. [ABSTRACT FROM AUTHOR]

Background: The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-prevalence ratio (IPR) and incidence-mortality ratio (IMR) to measure the progress in HIV epidemic control. In this paper, we describe the status of epidemic control in India and in various states in terms of UNAIDS's recommended metrices. Method: The National AIDS Control Programme (NACP) of India spearheads work on mathematical modelling to estimate HIV burden based on periodically conducted sentinel surveillance for providing guidance to program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2019, IPR and IMR were calculated. Results: National level IPR was 0.029 [0.022–0.037] in 2019 and ranged from 0.01 to 0.15 in various States and Union Territories (UTs). Corresponding Incidence-Mortality Ratio was at 0.881 [0.754–1.014] nationally and ranged between 0.20 and 12.90 across the States/UTs. Conclusions: Based on UNAIDS recommended indicators for HIV epidemic control, namely IPR and IMR; national AIDS response in India appears on track. However, the program success is not uniform and significant heterogeneity as well as expanding epidemic was observed at the level of States or UTs. Reinforcing States/UTs specific and focused HIV prevention, testing and treatment initiatives may help in the attainment of 2030 Sustainable Development Goals of ending AIDS as a public health threat by 2030. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has threatened to diminish gains in HIV epidemic control and impacts are likely most profound among key populations in resource‐limited settings. We aimed to understand the pandemic's impact on HIV‐related service utilization among men who have sex with men (MSM) and people who inject drugs (PWID) across India. Methods: Beginning in 2013, we established integrated care centres (ICCs) which provide HIV preventive and treatment services to MSM and PWID across 15 Indian sites. We examined utilization patterns for an 18‐month period covering 2 months preceding the pandemic (January–February 2020) and over the first and second COVID‐19 waves in India (March 2020–June 2021). We assessed: (1) unique clients accessing any ICC service, (2) ICC services provided, (3) unique clients tested for HIV and (4) HIV diagnoses and test positivity. Among an established cohort of PWID/MSM living with HIV (PLHIV), we administered a survey on the pandemic's impact on HIV care and treatment (June–August 2020). Results: Overall, 13,854 unique clients visited an ICC from January 2020 to June 2021. In January/February 2020, the average monthly number of clients was 3761. Compared to pre‐pandemic levels, the number of clients receiving services declined sharply in March 2020, dropping to 25% of pre‐pandemic levels in April/May 2020 (first wave), followed by a slow rebound until April/May 2021 (second wave), when there was a 57% decline. HIV testing followed a similar trajectory. HIV test positivity changed over time, declining in the first wave and reaching its nadir around July 2020 at ∼50% of pre‐pandemic levels. Positivity then increased steadily, eventually becoming higher than pre‐pandemic periods. The second wave was associated with a decline in positivity for MSM but was relatively unchanged for PWID. Among 1650 PLHIV surveyed, 52% of PWID and 45% of MSM reported the pandemic impacted their ability to see an HIV provider. MSM had barriers accessing sexually transmitted infection testing and partner HIV testing. Conclusions: The COVID‐19 pandemic led to significant decreases in HIV‐related service utilization among key populations in India. This presents an opportunity for increased transmission and patients presenting with advanced disease among groups already disproportionately impacted by HIV. [ABSTRACT FROM AUTHOR]

Timely HIV testing and diagnosis are necessary to prevent the development of AIDS and interrupt its transmission in society. We collected the data on HIV testing and diagnosis in 2020 and compared it with preceding years to examine how COVID-19 pandemic-related restrictions impacted HIV services. The number of people who underwent HIV testing at the apex tertiary referral hospital of India in 2020 reduced by 57% compared to 2019 or the average/year during 2019-2016. Hence, the diagnosis of new HIV infections decreased by 52% compared to 2019 and 54% compared to the average/year during 2019-2016. Provider-initiated testing and diagnosis were more affected than client-initiated. There was a non-significant change in the rate of HIV detection among tested individuals. The male testing saw a more notable drop than female testing. HIV testing between ≥50 years and ≤14 years was more affected than other age groups. The transmission via regular partner/spouse increased, whereas it decreased via heterosexual commercial sex workers. [ABSTRACT FROM AUTHOR]

HIV pre-exposure prophylaxis (PrEP) is not yet included in India's national AIDS program, with demonstration projects for MSM in planning stages. In order to support PrEP roll-out for MSM, we assessed: (1) associations between guideline-informed PrEP eligibility, HIV risk perception, and perceived PrEP benefits and costs, with willingness to use PrEP (WTUP); and (2) correlates of non-WTUP among PrEP-eligible MSM. Data were collected from MSM (n = 197) sampled from cruising sites in Mumbai and Chennai. More than half (58.4%) reported inconsistent condom use with male partners, 88.3% >1 male partner, and 48.6% engaging in sex work (all past month). Overall, 76.6% reported they would "definitely use" PrEP. Among 92.9% deemed PrEP-eligible, 79.2% reported WTUP. In adjusted analyses, PrEP eligibility (aOR = 5.31, 95% CI 1.11, 25.45), medium (aOR = 2.41, 95% CI 1.03, 5.63) or high (aOR = 13.08, 95% CI 1.29, 132.27) perceived HIV risk, and greater perceived benefits (aOR = 1.13, 95% CI 1.03, 1.24) were associated with higher odds of WTUP. Among PrEP-eligible MSM, non-WTUP was associated with low HIV risk perception and lower perceived benefits. Facilitating accurate risk assessment and promoting awareness of PrEP benefits and eligibility criteria may increase PrEP uptake among MSM in India. [ABSTRACT FROM AUTHOR]

Community mobilisation improves outcomes from HIV to maternal and child health. Yet, little health research has explored why some community groups are better able to mobilise than others. We address this gap by considering the case of Avahan, the India AIDS Initiative, which sought to foster community mobilisation, including the creation of community-based groups serving men who have sex with men (MSM), female sex workers (FSWs), and injection drug users (IDUs). Using quantitative and qualitative data collected from 58 community-based groups from 2009–2012 across six Indian states, we analyse variation in groups' action on behalf of their members. Based on a mixed effects logistic regression, we find that older groups and those with bank accounts, crisis committees, or strategic relationships were most likely to take action on behalf of members by demanding rights or confronting gatekeepers and opinion leaders. Analysis of qualitative data reveals the types of action organisations took on behalf of members (mediation, removal of community members from harm, and advocacy), but also that sometimes organisations refused to take action, or community members declined their assistance. These findings indicate that organisations formalising, creating structures for social action, and building networks are important strategies to foster community mobilisation. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) programs are planned for key populations in India. We examined PrEP awareness and willingness to use PrEP in order to support products and services for MSM. From December 2016 to March 2017, we conducted a survey and discrete choice experiment (DCE)—a technique to quantify the strength of participants' trade-off preferences among various product attributes—to assess willingness to use PrEP and related preferences. MSM were recruited from cruising sites and HIV prevention services in Mumbai and Chennai. DCE data were analyzed using mixed logit regression models and estimated marginal willingness-to-pay, the relative value participants' place on different PrEP attributes. Overall, 76.6% indicated willingness to use PrEP. Efficacy had the greatest effect on choice (high vs. moderate, aOR = 19.9; 95% CI 13.0–30.4), followed by dosing frequency (intermittent vs. daily regimen, aOR = 2.02; 95% CI 1.8–2.2). Participants preferred no (vs. minor) side-effects, subsidized (vs. market) price, and government (vs. private) hospitals. Findings suggest that educational and social marketing interventions should emphasize PrEP's high efficacy and minimal side effects, and programs should provide government-subsidized PrEP with choices of intermittent or daily dosing delivered by government and private hospitals/clinics in order to optimize PrEP uptake among MSM in India. [ABSTRACT FROM AUTHOR]

Background: Empowering female sex workers (FSWs) through women controlled HIV prevention option has been in focus globally. FSWs are important target for oral pre exposure prophylaxis (PrEP). A multi-centric qualitative study was conducted to explore the FSWs' willingness to use oral PrEP in India.Methods: Seventy three interviews and 02 focus group discussions were conducted at 3 high HIV prevalent states in India during 2013-14. Study explored issues around willingness to use oral PrEP. The study was approved by the respective institutional ethics committee of the study sites. Thematic analysis using grounded theory approach was used to analyze the data in N-VIVO version 8.0.Results: Thematic analysis showed events of forced condom-less sex. FSWs believed that oral PrEP could provide independence, financial gains, and privacy and therefore hoped to use it as an alternative to male condom. However, any impact on physical/ aesthetic attributes and reproductive system were not acceptable and could become a barrier. Provider initiated oral PrEP was not preferred. Providers voiced safety monitoring concerns. Adherence emerged as a challenge because of: (1) alcohol use; (2) taking PrEP tablet each day being boring; (3) Stigma because Oral PrEP is ARV based. Alcohol use and dread of repetitive dose brings forth the need for long acting oral PrEP.Conclusion: Oral PrEP is acceptable among FSWs; it should be rolled out alongside strong messages on STI protection and PrEP as compliment to condoms. PrEP roll out requires educating communities about HIV treatment versus prevention. Long-acting oral PrEP could address both 'boredom' and alcoholism and sustain adherence. [ABSTRACT FROM AUTHOR]

The "AIDS industry" has been a contested topic for scholars of sex work and sexuality in India. Predictions of an AIDS crisis in India in the 1990s led to an influx of global funding for HIV prevention programs targeted toward sex workers, sexual minorities, and transgender people. These programs were managed by a state agency, the National AIDS Control Organization, but implemented through non-governmental and community-based organizations (NGOs and CBOs). Existing scholarship shows that this incorporation of civil society into state programs both furthered epidemiological surveillance into intimate life and created openings for activist claims on the state. In this article, I argue that HIV prevention programs, as mediators of state public health imperatives and the everyday lives of "at-risk" targets, became sites for cultivating new ways of naming, embodying, and practicing sexuality. Drawing on ethnographic and in-depth interview fieldwork in Bangalore, I show how HIV prevention workers cultivated respectable ways of dressing, speaking, soliciting clients, and moving through public space, while learning how to speak openly in the right contexts and at the right times. HIV drop-in centers became a route to respectable sexuality, an index of class and caste, that enabled new individual and collective engagements with the state while generating room for collective care. As sociologists increasingly turn to the state's production of legible subjects, HIV prevention programs in India provide an instructive site for demonstrating how, at the interface of state and civil society, sexual respectability was central to both surveillance and the formation of collective demands. [ABSTRACT FROM AUTHOR]

• Knowledge about HIV/AIDs among adolescents is a major determining factor for the control of the disease. • A systematic analysis of evidence around research on HIV/AIDS among adolescents will explain the research gaps, scope and policy perspective. • Present scoping review of ninety eligible studies provides the pattern of HIV/AIDS research among adolescents in India in the last 20 years. • The finding of the review shows a sparse nature of knowledge, wrong beliefs and therefore insufficient and ineffective practices towards HIV/AIDS control. • We also understand that there is significant scope for research toward improving HIV/AIDS-related health among adolescents. HIV/AIDS remains a significant global health concern among adolescents (10–19 years) with a burden of 1.65 million individuals by the year 2022; adolescents account for about 4 % of the overall HIV burden while 10 % of new adult cases are converted from the adolescent group only. In India, adolescents often lack adequate knowledge about HIV/AIDS, influenced by various factors. This scoping review aims to comprehensively synthesize and assess existing evidence on the knowledge, beliefs, and practices related to HIV/AIDS among adolescents in India. Literature searches were conducted in various databases with search limitations from January 2000 to December 2021. Ninety articles met our inclusion criteria. Data extraction was conducted, which followed a narrative summarization. A gap analysis was undertaken to highlight future research needs. A brief on government policies for creating awareness and preventing contraction among adolescents was presented for a better understanding. A total of seventy-four studies during the period of 2011–2021 were included in this analysis. More than 80% of the studies were cross-sectional (84.44%) prioritising urban settings (37.77%). Geographically, nearly one-third (26.66%) of the studies were reported from the northern region of the country. Knowledge among both the gender and the entire adolescent group was assessed by 58.9% and 15.5% of studies respectively. Key areas including knowledge regarding HIV/AIDS, sources of knowledge, attitude towards PLWH, and beliefs of adolescents regarding HIV/AIDS were prioritized. The findings indicated that males and urban adolescents exhibited higher levels of awareness about HIV/AIDS. However, several major research gaps around selected aspects of HIV/AIDS in India were identified. This scoping review provides a comprehensive overview of existing literature around attitude and beliefs among Indian adolescents regarding HIV/AIDS and emphasizes the importance and scope of further research. The study provides important perspectives for future policies and interventions. [ABSTRACT FROM AUTHOR]

Purpose: The Hijra community is a cultural and gender grouping in South Asia broadly similar to western transgender communities, but with literature suggesting some differences in gender experience and patterns of psychosocial adversity. The present study aims to describe patterns of mental illness and psychoactive substance use in Hijra subjects and study their association with gender experience and psychosocial adversity. Methods: Fifty self-identified Hijras availing HIV-prevention services in New Delhi, India, were interviewed. Data on mental disorders, psychoactive substance use, quality of life, discrimination, empowerment, violence and gender identity were assessed using structured instruments. Results: Subjects were mostly in their mid-twenties, and had joined the Hijra community in their mid-teens. More subjects (46%) were involved in begging than in traditional Hijra roles (38%). Sex work was reported by 28% subjects. The rates of lifetime mental illness was 38%, most commonly alcohol abuse (26%); others had anxiety or depressive disorders (8% each), somatoform disorders (6%) and bulimia nervosa (n = 1). Disempowerment was mostly experienced in domains of autonomy and community participation; 52% had experienced sexual or psychological violence. Discrimination was attributed to gender (100%), appearance (28%) or sexual orientation (28%). There were negative correlations between the physical domain of WHO-QOL and physical violence and depression scores; and between discrimination and WHO-QOL environmental, physical and psychological domains. Conclusions: This Hijra group showed high rates of mental disorder and substance involvement, related to QOL domains and experiences of discrimination and disempowerment. [ABSTRACT FROM AUTHOR]

Gowri Vijayakumar's book, "At Risk: Indian Sexual Politics and the Global AIDS Crisis," provides an ethnographic account of the HIV/AIDS epidemic in India and its impact on sex workers, queer individuals, and transgender activists. The book explores how AIDS and ideas of sexuality arrived in India during globalization and became a focal point for constructing differences based on race, caste, gender, and class. It examines the experiences of the sexually marginalized and the ways in which HIV prevention programs reshaped their lives. The book also discusses the shift in India's response to the crisis from criminalization and marginalization to inclusion and engagement with high-risk groups. The author highlights the influence of colonial and postcolonial policies on containing deviant sexuality and the unintended outcomes of these policies. The book also explores the collaboration between India and Africa in managing the epidemic and how it helped India gain recognition in the global AIDS field. Overall, the book offers valuable insights into the intersection of sexual politics, public health, and social inequality in India. [Extracted from the article]

Purpose: Men who have sex with men (MSM) is a vulnerable group, who have been neglected and discriminated. Such discrimination decreases their access to health care and increases the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Aims and Objective: The objective is to evaluate the effectiveness of "self-care interventional package" on the promotion of sexual health, among MSM. Materials and Methods: A randomized controlled trial was conducted on MSM from two nongovernmental organization centers of Chandigarh, which were randomized by simple random sampling into a control and experimental group. Over a period of 1 month, a total of 115 MSM were found eligible; 55 in control group and 60 in experimental group. Data were collected by a personal interview, after taking consent, in a comfortable and private environment. The Self-Care Interventional Package on the promotion of sexual health was developed in the form of flash book and booklet, and delivered by one-to-one interaction. Three follow-ups were done weekly for motivation in both the groups. Postintervention assessment was conducted after 1 month. Results: There was a statistically significant (P < 0.01) improvement in knowledge about prevention and management of STIs and HIV, getting vaccinated for Hepatitis B and regular self check-up. Statistically significant reduction in unsafe sexual practices was noted among the MSM of experimental group. Conclusion: The self-care interventional package for the promotion of sexual health was effective in improving the sexual heath of the MSM population. [ABSTRACT FROM AUTHOR]

This study is concerned with Injecting Drug Users (IDUs) who weren't able to follow up with the existing HIV prevention program due to the existence of stigma. These IDUs are living in Chennai city of South India, which is a large, cosmopolitan city. Objective: The primary objective of this study was to identify the influential injecting drug user who plays an active role in carrying out different activities like buying and sharing of illicit drugs, seeking information and advising about HIV prevention, using Social Network Analysis. Methods: This quantitative cross-sectional study was conducted among 46 IDUs undergoing Opioid Substitution Therapy (OST) during the study period (April 2015-March 2016). As all the 46 IDUs were recruited as participants of this study, this network is considered as full network method, in which the existing relationships (ties) among the IDUs was studied. The open source software Node XL was used to analyze the social network data. Centrality metrics of social network analysis like Degree, Closeness, Betweenness, Eigen Vector and Page Rank were used to identify the influential IDUs (nodal persons) within the IDU networks. Results: SNA had identified the IDU-64 as one of the influential IDUs (node) who is well known for his illicit drug dealings. He is well-connected with other IDUs in the network, because he communicates with the majority of the members for the purpose of distributing illicit drugs, directly and through other nodal persons. This analysis also identified IDU-39 as a resource person who has provided HIV-related information to the maximum number of IDUs both directly and indirectly, and IDU-67 had motivated a maximum number of IDUs in the network to engage in HIV testing and to enroll in the OST program. It is surprising to know that these three influential nodal persons had themselves had not enrolled in the OST Program and were Ex-users. Conclusion: Social network analysis of IDUs identified the key nodal individuals who could be utilized for effectively imparting essential HIV prevention information and implementing behavioral communication. The study findings highlighted the possibilities of utilizing centrality metrics of the social network as a tool for effective follow-up of IDUs for HIV prevention. [ABSTRACT FROM AUTHOR]

Background: The sexual behaviour of adolescents is of importance due to the engagement in risky sexual activity at a too early age, which may be associated with the adverse outcomes. The study aims to understand the transitions in adolescent boys and young men's high-risk sexual behaviour in India using two rounds of Indian demographic health survey, NFHS-3 (2005-06) and NFHS-4 (2015-16).Methods: A total of 25,538 in NFHS-3 (2005-06) and 35,112 in NFHS-4 (2015-16) men were considered for the analysis. Men have been divided into two age groups as 15-19 years (adolescent) and 20-24 (young men) for comparison purposes. Descriptive and multivariate statistics have been used.Results: Overall, high-risk sexual behaviour has increased among adolescent boys (64 to 70%) and young men (18 to 27%) from 2005-06 to 2015-16. The trend of live-in relationship has increased among adolescent boys of rural areas (0.6 to 6.0%) as well as in urban areas (3.1 to 10.9%) over the last 10 years. Adolescent boys having 10th and above years of schooling (AOR = 1.98; p < 0.01), residing in urban areas (AOR = 2.23; p < 0.01), and belonging to the affluent class of households (AOR = 1.41; p < 0.05) were more likely to engage in high-risk sexual activity than the young men in India. The odds of high-risk sexual behaviour was higher among alcohol-using adolescent boys (AOR = 1.82; p < 0.01) and young men (AOR = 2.38; p < 0.01) in 2015-16.Conclusions: The study concludes that early sexual debut, lower prevalence of condom use at first sexual experience, tendency of live-in-relationship, and alcohol consumption indicate the hazardous interconnection between such behaviours among adolescent boys over the last decade which placed them at higher-risky sexual behaviour as compared to young men. Adolescent' sexual behaviours have both short-term and long-term consequences, and interventions that focus on multiple domains of risk may be the most effective in helping to promote broad reproductive health among young adults. [ABSTRACT FROM AUTHOR]

To inform PrEP roll out, Ashodaya Samithi, a sex workers' collective, conducted a community-led prospective demonstration project among female sex workers in Mysore and Mandya, India. Following a community preparedness phase and pre-screening, participants were recruited for clinical screening and enrolment, provided PrEP as part of combination HIV prevention, and followed for 16 months. Adherence was measured by self-reported pill intake and by tenofovir blood level testing among a subset of participants. Of the 647 participants enrolled, 640 completed follow-up. Condom use remained stable and no HIV seroconversions occurred. Self-reported daily PrEP intake over the last month was 97.97% at the end of the study. Tenofovir blood levels >40 ng/mL (consistent with steady state dosing) were detected among 80% (n = 68/85) and 90.48% (n = 76/84) of participants at month 3 and 6, respectively. Our study holds important insights for rolling out PrEP in community settings as part of targeted HIV prevention interventions. [ABSTRACT FROM AUTHOR]

Background: A cluster-randomized trial recently demonstrated that an integrated behavioral and mobile technology intervention improved uptake of key components of a Prevention of Mother to Child Transmission (PMTCT) Option B+ program, among HIV- infected pregnant/breastfeeding women in India. To guide scale-up and optimize programmatic implementation, we conducted a mixed-methods evaluation of the feasibility and acceptability of this intervention.Methods: The COMmunity Home Based INDia (COMBIND) study, was conducted in four districts of Maharashtra, India and randomized 119 integrated counseling and testing centers (ICTC) and their outreach workers (ORWs) to the COMBIND intervention, an integrated mHealth application that allowed digital data capture, PMTCT educational videos, SMS alerts for missed visits and reminder for visits, combined with personal empowerment and motivational interviewing training for ORWs. This qualitative evaluation was done through 15 in-depth interviews (IDIs) with ORWs and 15 IDIs with HIV-infected pregnant/breastfeeding women from the intervention arm. Utilizing a concurrent nested mixed-method evaluation approach, we assess the feasibility and acceptability of the study intervention.Results: All 30 participants reported that the PMTCT videos were essential in providing easy to understand information on critical aspects of HIV and necessary care related to PMTCT practices. A majority of the ORWs reported that the personal empowerment training with motivational interviewing skills training increased their confidence, motivation and gave them the tools for effectively supporting their clients. The mHealth application improved their working style as it facilitated targeted PMTCT information support, systemized data capture, streamlined their health education delivery practice and provided a sense of work satisfaction. The SMS appointment alerts improved retention in HIV care for mother and baby to the smaller proportion that had access to their phones. Despite reported improvements in knowledge and communication, few ORWs reported that structural challenges such as limited drug stocks, lack of HIV kits or unavailability of trained staff at ICTC, may hamper the uptake of PMTCT services, thus resulting in limited significant impacts of COMBIND on PMTCT outcomes.Conclusion: This study found that COMBIND intervention is scalable, feasible, beneficial and very well accepted by ORWs and patients, however structural challenges in goods and services remain. [ABSTRACT FROM AUTHOR]

Background The human immunodeficiency virus (HIV) epidemic in India is concentrated among 3.1 million men who have sex with men (MSM) and 1.1 million people who inject drugs (PWID), with a mean incidence of 0.9–1.4 per 100 person-years. We examined the cost-effectiveness of both preexposure prophylaxis (PrEP) and HIV testing strategies for MSM and PWID in India. Methods We populated an HIV microsimulation model with India-specific data and projected clinical and economic outcomes of 7 strategies for MSM/PWID, including status quo; a 1-time HIV test; routine HIV testing every 3, 6, or 12 months; and PrEP with HIV testing every 3 or 6 months. We used a willingness-to-pay threshold of US$1950, the 2017 Indian per capita gross domestic product, to define cost-effectiveness. Results HIV testing alone increased life expectancy by 0.07–0.30 years in MSM; PrEP added approximately 0.90 life-years to status quo. Results were similar in PWID. PrEP with 6-month testing was cost-effective for both MSM (incremental cost-effectiveness ratio [ICER], $1000/year of life saved [YLS]) and PWID (ICER, $500/YLS). Results were most sensitive to HIV incidence. PrEP with 6-month testing would increase HIV-related expenditures by US$708 million (MSM) and US$218 million (PWID) over 5 years compared to status quo. Conclusions While the World Health Organization recommends PrEP with quarterly HIV testing, our analysis identifies PrEP with semiannual testing as the cost-effective HIV prevention strategy for Indian MSM and PWID. Since nationwide scale-up would require a substantial fiscal investment, areas of highest HIV incidence may be the appropriate initial targets for PrEP scale-up. [ABSTRACT FROM AUTHOR]

Despite high HIV prevalence among transgender women (TGW) in India, there is limited exploration of pre-exposure prophylaxis (PrEP) acceptability. With PrEP licensure pending, we conducted six focus group discussions (FGDs) with diverse TGW (n = 36), and eight key informant interviews with community leaders and physicians, in Mumbai and Chennai. Data were explored using framework analysis guided by the Theoretical Framework of Acceptability. FGD participants' mean age was 26.1 years (SD = 4.8); two-thirds engaged in sex work. TGW reported low PrEP awareness, with moderate acceptability once PrEP was explained. Population-specific facilitators of PrEP acceptability included its perceived effectiveness in the context of challenges to condom use in serodiscordant relationships and forced sex encounters. PrEP was considered especially appropriate for TGW sex workers; however, barriers were anticipated in the context of hierarchical hijra (indigenous trans identity) kinship networks and gurus' (masters) potential negative reactions to PrEP use by their chelas (disciples). Positive attitudes toward high efficacy and potential covert use were tempered by TGW's concerns about high costs and adherence challenges living with parents or primary partners, and TGW sex workers' unpredictable schedules. Anticipated interactions with feminizing hormones, visible side effects, and PrEP-related stigma within TGW communities emerged as opportunity costs. PrEP implementation for TGW in India should promote comprehensive information on side effects and potential interactions with feminizing hormones, provide free or subsidized PrEP, and highlight the advantages of added protection in sex work and forced sexual encounters. Meaningful engagement with TGW kinship networks can encourage positive transgender community norms on PrEP use and mitigate multifaceted stigma. [ABSTRACT FROM AUTHOR]

Background: Acquired Immunodeficiency Syndrome (AIDS) continues to pose a significant public health threat worldwide, with India experiencing a substantial burden. Integrated Counseling and Testing Centers (ICTCs) play a pivotal role in addressing HIV/AIDS by providing crucial healthcare access and dispelling misconceptions surrounding the disease. Objectives: To study the profile of PLHIV patients attending ICTC centre. Methodology: This descriptive record-based study was conducted at the ICTC of Kasturba Medical College Hospital, Mangalore, aiming to profile HIV-positive attendees. Data on sociodemographic characteristics, mode of transmission, referrals, and counseling practices were collected from records of 137 seropositive attendees using convenient sampling. Statistical analysis was conducted using SPSS version 11.5. Results: The study revealed that most attendees were male (63.5%), married (78.8%), and aged 40 and above (40.1%). Heterosexual contact was identified as the primary mode of transmission (95.6%), with no cases attributed to blood transfusion. Private health facilities were the primary referrers (72.9%), and ICTC mainly referred patients to Antiretroviral Therapy (ART) centers (72.3%). Post-test counseling included spousal testing (33.6%) and condom counseling (90.5%), with limited condom uptake (18.9%) and follow-up of seropositive attendees (35.8%). Conclusion: The study underscores the critical role of ICTCs in HIV/AIDS management, highlighting trends in attendee profiles, transmission modes, referrals, and counseling practices. It emphasizes the necessity for targeted interventions to enhance follow-up and promote condom usage, alongside continued efforts to mitigate HIV transmission. [ABSTRACT FROM AUTHOR]

The article provides a list of international conferences scheduled for March 2024 in various locations around the world.

Background Little is known about the impact of psychosocial factors and substance use on viral suppression among human immunodeficiency virus (HIV)–infected key populations in resource-limited settings. Accordingly, we examined the association and interactions between depression, alcohol use, and recreational drug use on viral suppression among men who have sex with men (MSM) and people who inject drugs (PWID) in India. Methods MSM and PWID were recruited across India using respondent-driven sampling (RDS). Correlates of viral suppression were determined using Poisson regression models incorporating RDS-II weights. Two-way multiplicative interactions were assessed with separate models of all combinations of the 3 variables of interest using interaction terms; 3-way interactions were evaluated by stratifying 2-way interactions by the third variable. Results Among 1454 treatment-eligible HIV-infected MSM and 1939 PWID, older age (adjusted prevalence ratio [aPR], 1.14 for MSM; 1.41 for PWID) and higher HIV treatment literacy (aPR, 1.58 for MSM; 3.04 for PWID) were positively associated with viral suppression. Among MSM, there was evidence of a synergistic negative association between severe depression and recreational drug use (aPR, 0.37 [95% confidence interval {CI},.16–.84]), alcohol dependence and recreational drug use (aPR, 0.45 [95% CI,.20–.99]), and severe depression, alcohol dependence, and recreational drug use (aPR, 0.23 [95% CI,.09–.57]). Among PWID, daily injection (aPR, 0.51 [95% CI,.31–.82]) was the primary barrier to suppression. Conclusions Incorporating psychosocial and harm-reduction services into differentiated care models targeting MSM and PWID in low-resource settings is critical to achieving the 90-90-90 HIV/AIDS targets. [ABSTRACT FROM AUTHOR]

Introduction: The global revolution of online social media and connectivity had a tremendous effect on sexual behavior in both developed and developing countries. This global change is influencing the societal structure and existing social principles. Moreover, it has a significant impact on the epidemiology of different infectious diseases, especially HIV. Discussion: India is one of the most diverse democratic countries that has undergone a social-cultural transition in the last decade. However, having the second-highest HIV infection rate in the world, India does not have any other new prevention tools in their national HIV prevention strategy. Pre-Exposure Prophylaxis (PrEP), a boon of HIV prevention widely used in different countries, is still not implemented in India. The concept of "Digital India" by the Government of India is giving wide access of internet to the people of India. Furthermore, people are exposed to social media, and that is impacting their sex seeking behavior. Interestingly, recent legal changes in India promotes sex positivity. It also calls for introspection on existing HIV preventive strategies. Conclusion: Given the current scenario of PrEP and other existing preventive measurements of HIV, further research is needed to determine the acceptance and efficacy of PrEP and improve engagement in care for individuals in India. Various international studies recommend effective implication of PrEP to reduce the rate and economic burden of HIV infection. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Non-fatal opioid overdose (NFOO) predicts future fatal opioid overdose and is associated with significant morbidity. There is limited literature on the rates and risk factors for NFOO in people who inject drugs (PWID) from India. We aimed to study the rates of NFOO and documented risk factors for NFOO, as well as knowledge-level of NFOO among PWID from India.Design and Methods: Community-based, cross-sectional and observational study. We interviewed 104 adult male participants receiving HIV prevention services. Drug use patterns, rates of NFOO and opioid overdose risk factors, knowledge about opioid overdose and its management were assessed.Results: The mean age of the participants was 27.9 years. The most common opioid used for injecting was heroin followed by buprenorphine. About 45% (n = 47) participants had experienced an opioid overdose at least once in their lifetime. Around 25% (n = 26) participants had overdosed in the past year, while 21% (n = 22) participants had overdosed within the past 3 months. The majority had risk factors that could predispose them to NFOO. No participant was aware of the use of naloxone for opioid overdose.Discussion and Conclusion: The rates of NFOO as well as risk factors for overdose among PWID from India are high, with poor knowledge on overdose management. There is urgent need for a program to prevent and manage opioid overdose among PWID in India. [ABSTRACT FROM AUTHOR]

There is some evidence that female sex workers (FSWs) receive greater earnings for providing unprotected sex. In 2003, the landscape of the fight against HIV/AIDS dramatically changed in India with the introduction of Avahan, the largest HIV prevention programme implemented globally. Using a unique, cross-sectional bio-behavioural dataset from 3591 FSWs located in the four Indian states where Avahan was implemented, we estimate the economic loss faced by FSWs who always use condoms. We estimate the causal effect of condom use on the price charged during the last paid sexual intercourse using the random targeting of Avahan as an instrumental variable. Results indicate that FSWs who always use condoms face an income loss of 65% (INR125, US$2.60) per sex act compared to peers providing unprotected sex, consistent with our expectations. The main finding confirms that clients have a preference for unprotected sex and that policies aiming at changing clients' preferences and at improving the bargaining power of FSWs are required to limit the spread of HIV. [ABSTRACT FROM AUTHOR]

Community-led organizations (COs) have been an integral part of HIV prevention programs to address the socio-economic and structural vulnerabilities faced by female sex workers (FSWs). The current study examines whether strengthening of community-led organizations and community collectivization have been instrumental in reducing the financial vulnerability and empowering FSWs in terms of their self-efficacy, confidence, and individual agency in India. This study used a panel data of 2085 FSWs selected from 38 COs across five states of India. Two rounds of data (Round 1 in 2015 and Round 2 in 2017) were collected among FSWs. Data were collected both at CO and individual level. CO level data was used to assess the CO strength. Individual level data was used to measure financial security, community collectivization, and individual empowerment. There was a significant improvement in CO strength and community collectivization from Round 1 to Round 2. High CO strength has led to improved financial security among FSWs (R2: 85% vs. R1: 51%, AOR: 2.5; 95% CI: 1.5–4.1) from Round 1 to Round 2. High collective efficacy and community ownership have improved the financial security of FSWs during the inter-survey period. Further, the improvement in financial security in the inter-survey period led to increased or sustained individual empowerment (in terms of self-confidence, self-efficacy, and individual agency) among FSWs. Institutional strengthening and community mobilization programs are key to address the structural issues and the decrease of financial vulnerability among FSWs. In addition, enhanced financial security is very important to sustain or improve the individual empowerment of FSWs. Further attention is needed to sustain the existing community advocacy and engagement systems to address the vulnerabilities faced by marginalized populations and build their empowerment. [ABSTRACT FROM AUTHOR]

Objectives: The key to newer therapeutic and eradication approaches often lies in understanding slow disease progression in HIV infection. The paediatric population has been poorly studied in this regard. We aimed to describe a cohort of perinatally infected long‐term nonprogressor (LTNP) children living with HIV in India and to evaluate the immune biomarkers of disease progression. Methods: LTNPs (ART‐naïve, with a CD4 count ≥ 500 cells/μL at age ≥ 7 years) among the cohort of HIV‐infected children were identified and monitored longitudinally, and their CD4 T‐cell counts and plasma viral loads were measured every 6 months. The plasma monocyte/macrophage activation markers, namely soluble CD14 (sCD14), soluble CD163 (sCD163) and interferon‐inducible protein‐10 (IP‐10) were measured by enzyme‐linked immunosorbent assay (ELISA) in LTNPs and progressors. The Mann–Whitney U‐test was used to compare the two groups and P values < 0.05 were considered statistically significant. Spearman's rank or Pearson's correlation coefficient (r) was calculated to determine the associations between variables. Results: Among 378 children living with HIV‐1 surveyed in our cohort, 40 (10.6%) were LTNPs. Longitudinal analysis of the LTNP data showed that both CD4 count and viral load declined significantly with age (P < 0.0001 for both). Plasma sCD14 levels were significantly (P < 0.005) higher in progressors and sCD163 levels were significantly (P < 0.0001) higher in LTNPs. Conclusions: The prevalence of LTNPs in our cohort of perinatally infected children living with HIV was 10.6%. We observed a trend for associations between the increasing sCD163 monocyte/macrophage activation marker levels, declining CD4 counts and the gradual loss of nonprogressor status with age in the LTNPs. These findings underscore the need for early antiretroviral therapy in those children with proven slow disease progression. [ABSTRACT FROM AUTHOR]