Emerging HIV Epidemic in the North-Eastern State of Assam, India: An Exploratory Study Using Mixed-Methods Approach

Abstract

Background: The national HIV scenario in India has improved impressively during past two decades. Contrastingly, the State-level HIV sentinel surveillance and routine programme data from various testing facilities indicated an increasing HIV prevalence among antenatal clinic attendees and female sex workers (FSWs) in three districts of Assam. Objectives: a) To explore the reasons behind increasing adult HIV prevalence and b) To understand the role of FSW and Migrants/long distance truckers as drivers of the HIV epidemic in these districts. Methodology: Three sources of data were utilized in this concurrent mixed methods study—a) existing programme data for past three years; b) questionnaire-based data for a case-control study, where during past six months at designated testing facilities HIV(+) married women were “cases” and age-matched HIV(−) women from the same district were “controls”. Spouses of these women were also interviewed separately; and c) a qualitative study, where focus group discussions were conducted among FSWs, outgoing male migrant labourers and long-distance truckers. Results: The study revealed high levels of unsafe sexual practices among the FSWs. Sometimes in poverty-struck areas, women, not identifying themselves as sex workers, sold sex on a part-time basis to earn extra money for financial support and often remained invisible to the programme. The clients of the sex workers, male migrants and truckers also revealed various risk behaviours for contracting and transmitting HIV infection. Conclusion: Population and context specific programme strategies are required to halt the rising trend of HIV infection in the general population in Assam.