Assessment of attitudes and practices of providers of services for individuals at high risk of HIV and sexually transmitted infections in Karnataka, south India

Background A key component of prevention programmes aimed at reducing the risk of HIV and sexually transmitted infections (STI) among high-risk groups such as female sex workers (FSW) is the provision of quality STI services. The attitudes and practices of care providers are critical factors in the provision of services and in achieving better participation of high-risk individuals in accessing services. Objectives To assess the attitudes and practices of STI care providers towards FSW, and the perceptions of FSW towards STI services, following training. Methodology After an intensive physician capacity building programme, 393 exit interviews of FSW were conducted following clinical encounters, and discussions were held with 131 STI care providers (physicians) across several districts in Karnataka. Focus group discussions were held among FSW to understand the perceptions of non-users of services. Results 60% of women reported that the clinics were accessible. 76% of the women who visited clinics for STI consultations were offered a speculum examination. 85% received a condom demonstration, but only 52% were advised for partner treatment. 69% of women were referred for HIV testing. 79% of physicians felt that sex workers were responsible for spreading HIV in the community, and 47% believed that sex work should be banned to control HIV. Conclusions Following physician training, quality of care appears to be generally acceptable, but it is important to improve further the attitudes of providers towards sex work, and improve practices such as speculum examination and partner referral that can enhance quality of care.