Health Workers' Experiences in Service Delivery to Women Living with HIV in India

Background and Purpose

India has witnessed a 32% decline in new HIV infections between 2007 and 2015. Yet, the decreased rate of HIV is greater among men (3.23%) than women (2.02%) and women’s access to HIV health care services is consistently lower. Women’s poorer access to and low usage of health services is attributed to their lack of education, HIV-related stigma and discrimination, poor access to health information, and challenges including long distances to hospitals, safety and economic costs while traveling.

Despite evidence of the difficulties women face in accessing services, there is very limited research exploring health workers’ experiences in delivering services to women as a population. This study fills this gap by exploring health workers’ perspectives, experiences and challenges in providing health services to women living with HIV in a north Indian state with poor health and development indicators.

Methods

 In-depth interviews were conducted with fifteen health workers (M-9, F-6), recruited through two non-profit agencies in Uttar Pradesh, India. Health workers included 2 project coordinators, 5 outreach workers, and 8 medical and peer counselors. Interview questions explored the following domains, 1) health workers’ perceptions about the everyday lives and challenges of women living with HIV, and 2) health workers’ experiences in connecting women with primary health services or with government welfare programs. Data were transcribed, translated from Hindi into English, coded in ATLAS.ti qualitative software and analyzed inductively, using an interpretive phenomenological approach. Member checking and an audit trail were employed to enhance rigor.

Results

Three major themes emerged. First, health workers viewed women as ‘sacrificial beings’ who made consistent sacrifices at the cost of their personal health and resources to care for their families. Health workers accepted women’s sacrificing role as their normative role and therefore did not offer women assistance in coping with gender-related power dynamics within their families. Second, health workers viewed women as a ‘burdensome’ population in need of extra services that created challenges for them including: 1) health workers allocated extra time and human resources to intervene in situations where women faced discrimination based on their gender, health and poverty status, while accessing public benefits; and 2) health workers escorted women to welfare offices and assisted with documentation and paper work to access public benefits because women had lower literacy compared to men and needed extra assistance. Third, despite allocating extra time and effort while working with women, health workers felt overwhelmed and helpless in assisting female clients and saw fewer improvements in women’s health and well-being as compared to men, which they took as a personal reflection of their failure.

Implications and Conclusions  

This study has implications for determining the training needs of HIV health workers to enable them to serve women living with HIV in resource constrained settings. Health workers need to be provided with support, resources and gender sensitive training to meet the needs of female clients while maintaining their own well-being and efficacy in their professional roles.