Online Program

Prevalence of HIV and perceptions of risk among the hijra population in bangalore,India

Monday, November 4, 2013 : 1:15 p.m. - 1:30 p.m.

Mythili Ramakrishna, BDS, MscPh(Lond), Magee -Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
Dayaprasad Kulkarni, MBBS, Msc(UK), Madhyama Prasaran Scientific and Research Foundation, Bangalore, India
Anand Bhat, MD, Msc(Lond), Medicine, Case Western Reserve University Metro Health Medical Centre, Cleveland, OH
Srilatha Thotappa, BDS, MDS, Pedodontics, JSS Dental College and Mysore, Mysore, India
Elizabeth Miller, MD, PhD, Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
Jessica Burke, PhD, MHS, Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
Background* 75% of people living with HIV/AIDS in South Asia live in India, making up about 15% of the world HIV/AIDS population. Current understanding of sexual risk behaviours of transgenders is limited in Indian AIDS research. This study was designed to estimate HIV prevalence, measure condom usage, and study sexual behaviour among Hijras in Bangalore, India

Methods A total of 109 Hijras were approached randomly at traffic signals in Bangalore. 102 consented to participate in the study. A structured interview was used that contained socio-demographic characteristics, sexual practices and partner preferences. In addition, HIV risk perception and consistency of condom use were assessed. The study participants were divided into regular and non-regular condom users based on the data collected. HIV screening was conducted among 93 who consented. All of them also received pre and post test counseling services.

Results* The data revealed 39% having more than five partners during the last six months. 71% had never used condoms. The overall prevalence of HIV was 26.98%; Seroprevalence of HIV among non-regular condom users was 27% while 3% HIV prevalence was reported among regular condom users. About 58% had never perceived any risk of acquiring HIV by their sexual practices. The prospective interviews with the non-condom users revealed that usage increased from 33% to about 75% after 6 months.

Conclusion* Correct and consistent use of condoms during anal penetrative intercourse appears to reduce HIV transmission in hijras. Low or no risk perception and poor knowledge of HIV resulted in unsafe sexual practices.

Learning Areas:

Biostatistics, economics
Clinical medicine applied in public health
Diversity and culture
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify the Hijra community which has been marginalized and stigmatized for centuries needs to be uplifted and made a part of mainstream society. This will pave ways to improve their existing educational, health and socio-economic status. They are a potential reservoir of HIV infection and contribute to spread of HIV in the general population through their clients who act as a bridging population. This makes them the prime target for HIV control activities. Sensitization of Physicians, Paramedical staff and outreach workers to the needs of Hijras (kothis, panthis and other MSM) with additional stress on anal intercourse, partners of MSM, confidentiality and gender identities is the need of the hour. Special stress needs to be laid on imparting knowledge about condom use. There is also a need to formulate strategies by which condoms can be made readily and cheaply available. Interventions should also be directed at training Hijras to negotiate with partners in order to use condoms and also means of coping with partner pressure. There is also a need to sensitize the law enforcement agencies, medical fraternity and the public at large towards this community and its specific needs. It is therefore logical to make sure that this group is targeted to significant and substantial intervention programmes by the government, NGO’s, CBO’s, private donors and researchers on a national level. Future research focus and programmatic responses should aim at reduction of HIV and STI transmission among hijra communities in India. This could very well be the key step in controlling the spread of HIV in our country.

Keyword(s): HIV Risk Behavior, Sexual Risk Behavior

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have initiated and managed various programs on HIV/STI identification and management amongst rural and highly vulnerable populations such as the LGBT community, commercial sex workers, migrant labourers and street children. As a Project officer and researcher for Madhyama Prasaran and Scientific Research Foundation I was involved in the design, development, and implementation of various projects in the area of sexual health and gender based violence involving transgender individuals and women.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.