Why are people getting tested? Self-reported reasons for seeking voluntary counseling and testing at a clinic in Chennai, India.

VCT has been shown to be an important HIV risk reduction strategy; however, little is known about who attends VCT or why people seek VCT. A retrospective analysis was performed on charts of 6330 clients who attended VCT between 1994 and 2002 at Y.R. Gaitonde Centre for AIDS Research and Education, a non-governmental organization in Chennai, Tamil Nadu, India. Most clients reported more than one reason for attending VCT, and the most commonly reported reasons were risk behavior, having symptoms, having a current HIV-positive partner, and reconfirming a previous positive HIV test. Reasons varied by gender and over time, and the likelihood of testing positive for HIV varied by reason reported. Understanding why people seek VCT informs an understanding of knowledge and attitudes about HIV and HIV testing, which has implications for the development of education, outreach and other HIV prevention services.

Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study.

Antiretroviral therapy (ART) for HIV is increasingly being introduced and utilized in diverse areas of the world. However, little research exists on adherence to ART in different cultural settings, particularly in developing countries such as India. This formative qualitative study examined barriers and facilitators of ART adherence among 60 (49 men, 11 women; 33 taking ART, 27 not currently taking ART) patients receiving HIV primary care at YRG CARE, a nongovernmental organization, in Chennai, India. The average participant reported becoming HIV infected through heterosexual transmission, was between 31 and 40 years old, had over ninth class standard education, was married, and generally had access to medical care; however, we obtained some qualitative data from various other risk categories. Trained ethnographers at the study site conducted in-depth interviews in the local language. These interviews were analyzed for content and ethnographic data. Almost all of the participants discussed the cost of ART as a barrier, with many reporting extended drug holidays, turning to family and/or friends, or taking drastic measures (i.e., selling family jewels, property) for financial assistance. Other barriers centered on privacy and stigma issues, such as disclosure of HIV inhibiting pill-taking and social support. Frequently discussed facilitators of adherence included perceived benefits of ART and proper adherence, perceptions about the consequences of nonadherence, and social support, if available. These data highlight the importance of reducing the cost of antiretroviral medications, involving family members in HIV care, and addressing privacy issues and stigma in counseling interventions in this setting.