Utilization of HIV testing services among men who have sex with men inNew Delhi, India: A qualitative study on barriers and facilitators

Abstract Background & objectives: In India, the prevalence of HIV among men who have sex with men (MSM), a core risk group for HIV was estimated to be 4.3%, 16 times higher than the national average. In Delhi, the estimated prevalence among MSM was 1.8%. Despite free HIV testing services being available across the public health systems, for over two decades, MSM did not avail themselves, these services optimally. The objective of this study was to understand the barriers to and facilitators of the utilisation of standard HIV testing among MSM. Methods: A qualitative study was conducted among MSM who were registered with the selected targeted intervention sites (TIs) in New Delhi, India. MSM were recruited for focus group discussions (FGDs) between January and May 2021. A total of six FGDs were conducted using a prepared FGD guide that covered questions on issues, challenges faced during and facilitators of the utilization of standard HIV testing. The data were manually coded and entered into NVivo release 1.5 and themes were identified. Results: A total of 67 MSM participated in the FGDs. Major barriers reported with utilization of standard HIV testing were rude behavior of health care workers (HCWs), long queues, sexual stigma - disclosure of one’s identity on being spotted in queues by acquaintances, discomfort with the too many questions on sexual behavior being asked by HCWs and HIV related stigma- fear of turning out positive. The facilitators identified were knowledge about and perceived risk of HIV/AIDS and exclusive MSM NGOs/ TI sites. Interpretation & Conclusions: We identified factors within the individual as well as the environment that acted as barriers and facilitators to the utilization of standard HIV testing by MSM.