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Barriers to Anti-Retroviral Therapy among Men who have sex with men in West Bengal, India

  • Author(s): PAL, DEBOTTAM
  • Advisor(s): Detels, Roger
  • et al.


To explore the challenges and barriers to the continuum of HIV care and services of Men who have sex with men (MSM) living with HIV through qualitative inquiries and to measure adherence to Anti-Retroviral Therapy (ART), and barriers that hinder ART access.


The study was conducted in Kolkata, India. During the qualitative phase, we conducted one Focus Group Discussion (FGD) with a MSM community-based organization (CBO) and 6 in-depth interviews (IDI) with MSM assigned to ART. In the quantitative phase, we recruited 104 seropositive MSM, who had been assigned to ART. We conducted a baseline Audio Computer-Assisted Self-Interview (ACASI) with the participants. A follow-up ACASI was conducted after 3months. We employed the Aids Clinical Trial Group questionnaire and Homosexuality Stigma Scale for collection of relevant information.


The FGD and IDIs with seropositive MSM’s, identified several barriers they have to overcome in order to access free HIV care services in India. Social discrimination and barriers to HIV testing as well as of ART adherence. Poor health system responsiveness emerged as a major theme. The baseline ACASI revealed that 36% (95%Cl: 26%, 45%) of the MSM’s were depressed. Depression was significantly associated with increased internalized stigma. An increase by 5units in the stigma scale was associated with an increment of 1unit on the depression scale (adjβ:0.2, 95%Cl: 0.1, 0.3). Self-reported adherence to ART reveals MSM’s were similarly adherent 67% (95%Cl: 57%, 77%) as the general adult population. Among those who missed ART pills (n=41), 44% of the MSM’s just had forgot to take their medications. Fearing stigma, 24% did not want it to be know he takes ART medications and thus skipped medications. Linear multivariate analysis revealed that depression among MSM’s lowered adherence score (adjβ: -3.2, 95%Cl: -4.9, -1.5). Alcoholics had a significantly lower score of adherence as compared to non-alcoholics (adjβ: -14.6, 95%Cl: -25.0, -4.2), after controlling for other variables. Being less confident to be able to take medications at baseline significantly decreased the adherence score by 26 units when compared to those who were confident at baseline. (adjβ: -27.1, 95%Cl: -39.2, -14.9), after controlling for other variables.


Our study findings will help fill some of the existing knowledge gaps regarding mental health status of MSM’s living with HIV in India and barriers of ART adherence among these socially marginalized population. We expect the findings to inform design and implementation of suitable and effective intervention strategies targeted to improve the quality of life of HIV infected MSM living in India.

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