Barriers to health care service utilization among HIV infected Hijra sex workers: Findings from Pakistan

Background: HIV/AIDS carries stigma in many societies and people living with HIV/AIDS are known to be discriminated against by societies. This discrimination extends to even provision of care in hospitals to these infected... [ view full abstract ]

Background: HIV/AIDS carries stigma in many societies and people living with HIV/AIDS are known to be discriminated against by societies. This discrimination extends to even provision of care in hospitals to these infected patients by caregivers. Existing studies suggest that HIV-infected individuals from marginalized populations who know their status do not seek health services because they are unaware of available treatment and care options, may not understand how to access services, or have poor access to and utilization of health care services. Additionally these individuals often face structural, financial and personal and cultural barriers to health care. A better understanding of factors that facilitate or hinder health services utilization can be used to design effective interventions and inform policies to increase utilization, particularly among HIV-infected individuals from vulnerable and under-served populations.
Objective: This study examined factors associated with health service utilization in a sample of under-served recently diagnosed HIV-positive hijra sex workers with sexual risk behaviors.
Setting: Service Delivery Points offered by Sindh AIDS Control & Prevention Program. The data were collected between June 2015 and November 2015.
Outcomes: Utilization of any health services since learning of HIV status at 3- and 6-month follow-up assessments.
Results: Denial of HIV status may be a barrier to care leading study participants to avoid utilizing health services specific to their disease. In multivariate analyses, reduced self-respect, reduced confidence, prior experience of use of health services, financially supporting gurus, and sex dealing as a main mean of bread and butter were strongly associated with health service use at follow-up assessments.
Conclusion: As a preliminary step in examining the issue of health services utilization by this marginalized group in Pakistan, the findings suggest an urgent need to promote HIV prevention and early testing, to strengthen long-term HIV care services, and to increase access to services.