Contextual influences on condom use among men who have sex with men in India: subjectivities, practices and risks

Abstract

Citation (published version)Chakrapani, V., et al. (2013) Contextual influences on condom use among men who have sex with men in India: subjectivities, practices and risks. Culture, Health & Sexuality 15(8) How to cite TSpace itemsAlways cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the TSpace version (original manuscript or accepted manuscript) because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.

Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study

“…Previous research on depression, with a focus on MSM both in India and in other settings, guided the development of a multivariable model [7, 15, 17, 20, 54–57]. Several variables associated with depression in prior research, including sex work [15], stigma [7], and experiences of violence [57, 58], have also been previously noted to be more prevalent among certain sexual identity groups in India [7, 9, 11, 24, 35–38]. Since sexual identity was a variable of interest, we examined the association between these variables and sexual identity to inform our final multivariable model.…”

“…Both qualitative and quantitative studies have identified significant psychosocial concerns among MSM in India, including high levels of psychological distress, depression, anxiety, suicidal ideation, and substance use [4, 5, 7, 8, 14–22]. These psychosocial factors are associated with increased HIV-risk behaviors and poorer HIV outcomes, including more frequent unprotected anal sex, lower testing rates, and reduced engagement in HIV care and treatment [4, 7, 9, 11, 19, 20, 23, 24]. Following the minority stress model [25], depression has been conceptualized as a co-occurring condition with HIV risk-behaviors, constituting a “syndemic” [5, 26].…”

“…Research has focused on three main Indian MSM sexual identities: kothi [more feminine in behavior and dress, who predominately engage in receptive anal intercourse (AI)], panthi or girya (more masculine in appearance, who predominately engage in insertive AI) and double deckers (may have masculine or feminine appearance, and engage in both receptive and insertive AI), alongside gay , bisexual , and MSM identities, which may be situationally fluid and change over time [12, 27–34]. Qualitative studies indicate that kothis may be particularly vulnerable to multiple levels of stigmatization, discrimination, and violence in their families and communities [8, 9, 11, 24]. Kothis are more likely to participate in transactional sex and sex work for economic support, which contributes to higher risk of violence and greater vulnerability to HIV [9, 11, 24, 35–37].…”

“…Qualitative studies indicate that kothis may be particularly vulnerable to multiple levels of stigmatization, discrimination, and violence in their families and communities [8, 9, 11, 24]. Kothis are more likely to participate in transactional sex and sex work for economic support, which contributes to higher risk of violence and greater vulnerability to HIV [9, 11, 24, 35–37]. Kothis’ feminine gender expression makes them recognizable [9, 11, 24], marking them as a visible target of stigmatization and discrimination [38].…”

“…Kothis are more likely to participate in transactional sex and sex work for economic support, which contributes to higher risk of violence and greater vulnerability to HIV [9, 11, 24, 35–37]. Kothis’ feminine gender expression makes them recognizable [9, 11, 24], marking them as a visible target of stigmatization and discrimination [38]. Beyond identified high depression rates among kothi [7, 15], data on depression across sexual identities remains limited [15].…”