Targeted interventions in HIV/AIDS and gender disparities among HIV infected in Delhi-NCR, India

Background: In India 2.5 million people live with HIV/AIDS (PLHIV) with higher prevalence among men than women. Targeted interventions disproportionately cater to “high risk group” such as ‘men who have sex with men' (MSM) despite limited evidence of success of this strategy. Not all individuals identify as male-female; alternative gender/sexual identities, other than MSM, are common. In context of targeted intervention strategy and presence of alternative gender identities in India we examined gender disparities in HIV/AIDS healthcare services utilization by PLHIVs who are male, female, or ‘other' in Delhi-NCR, India. Methodology: Data from a cross-sectional study for a disproportionate convenience sample of 355 adult PLHIVs who became positive before Jan 2009 were analyzed. Chi-square, ANOVA, and multivariable logistic regression analyses were done to determine odds of lower utilization of HIV/AIDS healthcare services by male or female PLHIVs compared to ‘other' PLHIVs. Results: HIV/AIDS healthcare services utilization varied by gender. Male PLHIVs were less likely to use pre-test counseling (ORa=0.18, 95% CI: 0.03, 0.96, p<0.05), free condoms (ORa=0.24, 95% CI: 0.07, 0.80, p<0.05), and treatment for any STI (ORa=0.30, 95% CI: 0.12, 0.73, p<0.05), than ‘other' PLHIVs. Female PLHIVs were less likely to utilize free condoms (ORa: 0.06, 95% CI: 0.01, 0.25, p<0.05) and pre-test counseling (ORa: 0.16, 95% CI: 0.03, 0.70, p<0.05) than ‘other' PLHIVs. Conclusions: PLHIVs of Delhi-NCR missed by targeted interventions were less likely to utilize HIV/AIDS healthcare services. Targeted intervention strategy augments gender disparities in HIV/AIDS healthcare.