Uncovering the Complexities of HIV Care: A Qualitative Study on Adherence and Prevention in Urban South Gujarat, India

Background: The perception of HIV within the scientific community and the public has evolved from considering it a "life-threatening fatal disease" to viewing it as a "chronic manageable disease." This study examined the evolving landscape of HIV treatment and prevention within the framework of the Test and Treat Policy. It explored factors contributing to HIV infection and the challenges related to treatment adherence among newly infected patients living with HIV (PLHIV) and PLHIV who have been lost to follow-up (LFU) in an urban setting. Methods: This qualitative study was conducted at an ART Centre in a tertiary care hospital in South Gujarat. The participants included 20 male PLHIV, 10 newly infected individuals and 10 who had been LFU. Purposive sampling was employed to select participants based on specific criteria, including enrolment at the ART Centre after April 2017 and a willingness to provide informed consent. In-depth interviews (IDIs) were conducted, and audio recordings were translated, coded, and analyzed using thematic analysis in Atlas Ti software to identify key themes related to HIV infection and challenges in treatment adherence. Results: Thematic analysis identified several key themes. Among newly infected participants, long-term high-risk sexual behaviors and isolated incidents of unprotected sex were significant contributors to HIV acquisition. In the LFU group, economic constraints such as wage loss and lack of financial support, were major reasons for missed ART visits. Fear of discrimination in workplace and within the family, compounded by insufficient family support, further hindered adherence. Some participants expressed feelings of hopelessness, leading to ART discontinuation. Conclusion: Addressing high-risk behaviours, socio-economic challenges, and stigma is crucial to improving HIV prevention, treatment adherence, and overall health outcomes among newly infected PLHIV in urban areas.