Ensuring It Works: A Community-Based Approach to HIV Prevention Intervention Development for Men Who Have Sex with Men in Chennai, India

Abstract

Men who have sex with men (MSM) in India have an HIV seroprevalence 22 times greater than the country’s general population and face unique challenges that may hinder the effectiveness of current HIV prevention efforts. To obtain an understanding of the logistical and sociocultural barriers MSM experience while accessing HIV prevention services, focus groups and key informant interviews were conducted with 55 MSM in Chennai, India. Qualitative data were analyzed using descriptive qualitative content analysis. Sixty-five percent of participants identified as kothi (receptive partners), 9% as panthi (insertive partners), 22% as double decker (receptive and insertive), and 4% did not disclose. Themes included: (a) fatigue with current HIV risk reduction messages; (b) increased need for non-judgmental and confidential services; and (c) inclusion of content that acknowledges individual and structural-level determinants of risk such as low self-esteem, depression, and social discrimination. MSM interventions may benefit from approaches that address multilevel psychosocial factors, including skills building and strategies to foster self-acceptance and increased social support.

HIV Prevention Fatigue and HIV Treatment Optimism Among Young Men Who Have Sex With Men

“…For example, Keep it Up!, an interactive online program focused on healthy sexuality, relationships, and preventing HIV was recently found to be feasible and acceptable among diverse YMSM, and produced a significantly lower rate of condomless sex relative to controls (Mustanski et al, 2013a). As MSM report that HIV prevention messages are important but overlook other psychosocial and contextual issues related to HIV transmission among gay and bisexual men (Thomas et al, 2012), tailoring messages to youth’s unique risk factors may better resonate with that individual, reduce risk of fatigue, and increase likelihood of adherence to HIV prevention behaviors (Flowers et al, 2001). …”

The other side of the bridge: exploring the sexual relationships of men who have sex with men and their female partners in Mumbai, India

“…The variability of sexual preferences and sexual arrangements across sub-groups of men who have sex with men suggests that it may not be appropriate to develop HIV prevention programming according to sexual identity (i.e., kothi, panthi , double-decker, and bisexual) (Thomas et al 2012). Anthropological research with Indian men who have sex with men has emphasised the fluidity and situational nature of gendered and sexual identities (Boyce 2007; Lorway et al 2009; Boyce and Khanna 2011).…”

A Pilot RCT of an Intervention to Reduce HIV Sexual Risk and Increase Self-acceptance Among MSM in Chennai, India

“…Accordingly, we developed a model of self-acceptance as a key factor in promoting psychological resilience in MSM, as well as asked questions about their acceptability of format and content of the proposed intervention [14,18]. Additionally, prior to this pilot RCT, we conducted an open-pilot of the intervention in one group of MSM and made additional refinements to the intervention based on their exit interview feedback.…”

“…The current study is part of a program of research to develop and initially test a culturally relevant, resilience-based HIV prevention intervention for MSM in India that addressed both sexual risk as well as a key resilience variable for this population, self-acceptance [14,18]. We hypothesize that the intervention would be feasible to deliver, and that MSM who were assigned to the intervention condition would reduce condomless sex in greater magnitude compared to MSM assigned to enhanced standard of care (ESOC) alone.…”