Knowledge, Beliefs, and Health Care Practices Relating to Treatment of HIV in Vellore, India

Abstract

In India, little is known about health care-seeking behavior among HIV-infected individuals. Similarly, little is known about how HIV is being treated in the community, in particular by Indian Systems of Medicine (ISM) providers. Therefore, while ART implementation programs continue to expand, it is important to determine whether the knowledge, attitudes, and treatment practices of HIV-infected individuals and their health care providers are aligned with current treatment recommendations. We conducted in-depth qualitative interviews with persons with HIV (n = 9 men and 17 women), family members of persons with HIV (n = 14 men and 3 women), and ISM providers (n = 7). Many of the patients we studied turned at some point to ISM providers because they believed that such practitioners offer a cure for HIV. ISM treatments sometimes had negative impacts including side effects, unchecked progression of an underlying illness, and financial depletion. Indian women tended to be less knowledgeable about HIV and HIV treatments, and had less access to financial and other resources, than men. Finally, most of the ISM providers reported dangerous misconceptions about HIV transmission, diagnosis, and treatment. While the existence of ART in India is potentially of great benefit to those with HIV infection, this study shows that a variety of social, cultural and governmental barriers may interfere with the effective use of these therapies. Partnerships between the allopathic and traditional/complementary health sectors in research, policy, and practice are essential in building comprehensive HIV/AIDS treatment strategies.

Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD<350 cells/μL) in eastern Uganda

“…The finding however supports previous studies from Africa, South America and Asia where misconceptions about drugs or other care were vital for health seeking behavior [22,23,29,[55][56][57]. The concept of negative perceptions and dangerous misconceptions affecting HIV diagnosis and ARV treatment has similarly been established by other studies in resource-poor settings [23,36,[58][59][60].…”

Complex routes into HIV care for migrant workers: a qualitative study from north India

“…The dominance of private health care is partly attributed to its reputation as more efficient, convenient and confidential than public sector services (Bhat, 1999; Sheikh, Porter, Kielmann, & Rangan, 2006). However, the medical mismanagement respondents faced whereby they were treated for many other conditions before HIV was diagnosed echoes previous research where private practitioners were frequently found not following current HIV guidelines (Chomat et al, 2009; Datye et al, 2006; Kielmann et al, 2005). …”

Predictors of HIV positivity among pregnant women presenting for obstetric care in South India – a case-control study

“…This specifically translated into three times higher likelihood of being infected with HIV-1 if presenting for care late in the (Cohen et al, 2008;Kupka et al, 2009;Lemos et al, 2009;Pai et al, 2008). It is unknown, if this phenomenon is due to a prior knowledge of HIV status and stigma and discrimination related to that , versus a general lack of health seeking behavior among HIV-positive women (Chomat et al, 2009). We think it is the latter, as a higher percentage of HIV-positive women were primigravida, with little probability of having HIV testing outside of antenatal care.…”

“…Rogers et al, 2006;Samuel et al, 2007;Shrotri et al, 2003;Sinha et al, 2008;Solomon et al, 2003). It has been shown that their main sources of information on AIDS are health workers and television (Chatterjee, 1999a;Chomat et al, 2009;Kunte et al, 1999), both of which are amenable to targeted interventions and uptake regardless of the educational level of the women. Since marriage and motherhood are important in the Indian cultural context, male spouses should be included in riskreduction programs (M.C.…”