Bisexuality, Sexual Risk Taking, and HIV Prevalence Among Men Who Have Sex With Men Accessing Voluntary Counseling and Testing Services in Mumbai, India

Abstract

Objectives To describe sociodemographics, sexual risk behavior, and estimate HIV and sexually transmitted infection (STI) prevalence among men who have sex with men (MSM) in Mumbai, India. Methods Eight hundred thirty-one MSM attending voluntary counseling and testing (VCT) services at the Humsafar Trust, answered a behavioral questionnaire and consented for Venereal Disease Research Laboratory and HIV testing from January 2003 through December 2004. Multivariate logistic regression was performed for sociodemographics, sexual risk behavior, and STIs with HIV result as an outcome. Results HIV prevalence among MSM was 12.5%. MSM who were illiterate [adjusted odds ratio (AOR) 2.28; 95% confidence interval (CI): 1.08 to 4.84], married (AOR 2.70; 95% CI: 1,56 to 4.76), preferred male partners (AOR 4.68; 95% CI: 1.90 to 11.51), had partners of both genders (AOR 2.73; 95% CI: 1.03 to 7.23), presented with an STI (AOR 3.31; 95% CI: 1.96 to 5.61); or presented with a reactive venereal disease research laboratory test (AOR 4.92; 95% CI: 2.55 to 9.53) at their VCT visit were more likely to be HIV infected. Conclusions MSM accessing VCT services in Mumbai have a high risk of STI and HIV acquisition. Culturally appropriate interventions that focus on sexual risk behavior and promote condom use among MSM, particularly the bridge population of bisexual men, are needed to slow the urban Indian AIDS epidemic.

Sociobehavioral Correlates of HIV Risk among Men Who Have Sex with Men in Chhattisgarh, India: Analysis of Sentinel Surveillance Data

“…This discrepancy suggests that MSM with a lower literacy level in Chhattisgarh might be less aware of the available services and programs; it is also likely that their participation is more affected by stigma and discrimination. This study also revealed that illiterates subjects were likely to be at a higher risk of HIV, which is consistent with previous findings (14,(19)(20)(21). Therefore, these data suggest that the reach of intervention programs among MSM with a higher risk of HIV and lower or no education is probably less.…”

Re-Emergence of HIV Infection and Syphilis Among Men Who Have Sex with Men

“…In particular, high risk sexual behaviours reported in Africa and in India among MSM and high levels of bisexual activity are of grave concern. Most worrisome is that condom use messages for preventing HIV and STDs do not appear to have penetrated this population given the low proportion of MSM using condom ; three most often repeated reasons for not using condoms with regular partners include non availability, feeling the partner is safe and feeling that condoms do not give sexual pleasure (Kumta et al, 2010). Interestingly, a study carried out in the south-eastern part of India (Andhra Pradesh) showed that one of the primary reasons for low condom usage was that many married MSM did not disclose their sexual orientation to their wives and therefore struggled to explain the necessity of condom use (Gutierrez et al, 2010).…”

“…Protecting India's large population of FSW and MSM from infection is a critical priority and it is also an effective way to protect the remaining population from infection (UNAIDS, 2009, as cited in Gutierrez et al, 2010). A study carried out in Mumbai (formerly known as Bombay) found high rates of unprotected sex, bisexuality and HIV among urban Indian MSM (Kumta et al, 2010); another study conducted in Andhra Pradesh (AP) also found that MSM reported high rates of unprotected anal sex with other men and women. Andhra Pradesh (total population of 76.2 million) is among the six states in India with the highest HIV prevalence; about 10% of all AIDS cases in India are in AP (Dandona et al, 2005).…”

Syphilis and Herpes Simplex Virus Type 2 Sero-Prevalence Among Female Sex Workers and Men Who Have Sex with Men in Ecuador and Andhra Pradesh (India)

“…In relation to MSM, there is a lot less reported regarding STIs; however some of the studies report a syphilis prevalence between 6 and 17% (Brahmam et al, 2008;Gupta et al, 2006;Kumta et al, 2010;Setia et al, 2006;Solomon et al, 2010). Just as for FSW population, one study show that in a ten years time, syphilis prevalence significantly dropped in a MSM sample group (Gupta et al, 2006).…”

“…According to the last UNAIDS report, in 2009 there were 2,300,000 people of 15 and up, living with HIV in India, in contrast with 2,500,000 in 2001; the HIV general prevalence among the adult population in 2009 is 0.3% (UNAIDS, 2010). An HIV prevalence of 5 to 13% specially among FSW has been reported (Pal et al, 2004;Shethwala et al, 2009;Uma et al, 2005), whereas MSM report a prevalence of 9 to 18% (Brahmam et al, 2008;Kumta et al, 2010;Solomon et al, 2010).…”