Int J Health Geogr - Geospatial analysis of HIV-Related social stigma: a study of tested females across mandals of Andhra Pradesh in India.


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CKGROUND: In Geographical Information Systems issues of scale are of an increasing interest in storing health data and using these in policy support. National and international policies on treating HIV (Human Immunodeficiency Virus) positive women in India are based on case counts at Voluntary Counseling and Testing Centers (VCTCs). In this study, carried out in the Indian state of Andhra Pradesh, these centers are located in subdistricts called mandals, serving for both registration and health facility policies. This study hypothesizes that people may move to a mandal different than their place of residence for being tested for reasons of stigma. Counts of a single mandal therefore may include cases from inside and outside a mandal. HIV counts were analyzed on the presence of outside cases and the most likely explanations for movement. Counts of women being tested on a practitioners' referral (REFs) and those directly walking-in at testing centers (DWs) were compared and with counts of pregnant women.RESULTS: At the mandal level incidence among REFs is on the average higher than among DWs. For both groups incidence is higher in the South-Eastern coastal zones, being an area with a dense highway network and active port business. A pattern on the incidence maps was statistically confirmed by a cluster analysis. A spatial regression analysis to explain the differences in incidence among pregnant women and REFs shows a negative relation with the number of facilities and a positive relation with the number of roads in a mandal. Differences in incidence among pregnant women and DWs are explained by the same variables, and by a negative relation with the number of neighboring mandals. Based on the assumption that pregnant women are tested in their home mandal, this provides a clear indication that women move for testing as well as clues for explanations why.CONCLUSIONS: The spatial analysis shows that women in India move towards a different mandal for getting tested on HIV. Given the scale of study and different types of movements involved, it is difficult to say where they move to and what the precise effect is on HIV registration. Better recording the addresses of tested women may help to relate HIV incidence to population present within a mandal. This in turn may lead to a better incidence count and therefore add to more reliable policy making, e.g. for locating or expanding health facilities.

Resumo Limpo

ckground geograph inform system issu scale increas interest store health data use polici support nation intern polici treat hiv human immunodefici virus posit women india base case count voluntari counsel test center vctcs studi carri indian state andhra pradesh center locat subdistrict call mandal serv registr health facil polici studi hypothes peopl may move mandal differ place resid test reason stigma count singl mandal therefor may includ case insid outsid mandal hiv count analyz presenc outsid case like explan movement count women test practition referr ref direct walkingin test center dws compar count pregnant womenresult mandal level incid among ref averag higher among dws group incid higher southeastern coastal zone area dens highway network activ port busi pattern incid map statist confirm cluster analysi spatial regress analysi explain differ incid among pregnant women ref show negat relat number facil posit relat number road mandal differ incid among pregnant women dws explain variabl negat relat number neighbor mandal base assumpt pregnant women test home mandal provid clear indic women move test well clue explan whyconclus spatial analysi show women india move toward differ mandal get test hiv given scale studi differ type movement involv difficult say move precis effect hiv registr better record address test women may help relat hiv incid popul present within mandal turn may lead better incid count therefor add reliabl polici make eg locat expand health facil

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