Predictors of Bisexual Behaviour among MSM Attending Intervention Sites May Help in Prevention Interventions for This Bridge to the Heterosexual Epidemic in India: Data from HIV Sentinel Surveillance

Abstract

BackgroundIndian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM.MethodsBetween March-May 2011, 4682 men (15–49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites.ResultsOf 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, ‘being bisexual’ was found to be independently associated with ‘older age’: 26–30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; ‘reporting penetrative behaviour alone’ with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and ‘reporting both penetrative and receptive behaviour’ [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual.ConclusionsA substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population.

Sexual identity and behavior in an online sample of Indian men who have sex with men

“…Mostly missing from these discussions about emerging sexual identities is the effect of relationship dynamics of MSM with their female partners, which is understood only within the scope of marriage or MSM as a bridge population for HIV infection (Asthana & Oostvogels, 2001; Dodge et al, 2016; Godbole et al, 2014; Kumta et al, 2010; Ramakrishnan et al, 2015; Setia et al, 2006; Thomas, 2009a; Thomas et al, 2009b). Heterosexual marriages are attributed to pressure on MSM stemming from the cultural emphasis on marriage (Asthana & Oostvogels, 2001; Kumta et al, 2010).…”

“…Heterosexual marriages are attributed to pressure on MSM stemming from the cultural emphasis on marriage (Asthana & Oostvogels, 2001; Kumta et al, 2010). These married MSM lead dual lives, and their sexual identities and acknowledgement of risky sexual behaviors vary as per circumstances (Asthana & Oostvogels, 2001; Dodge et al, 2016; Godbole et al, 2014). Different identities adopted by Indian MSM in different familial and sexual scenarios, their extent of closetedness, and the influence of these behaviors on safe-sex practices remain inadequately investigated.…”

Unsafe sexual behavior of currently married men having sex with men in Thane, Maharashtra: a challenge for ensuring ZERO HIV transmission

“…The participants for the present study belong to Thane district of Maharashtra, while interestingly both of the previous studies also have representation of participants from Maharashtra. 11,14 Considering the high-risk behavior among CM-MSM reported in the present study, in the context of HIV prevalence reported in the earlier studies, there is a need to understand the impact of these high-risk behaviors among MSM, including CM-MSM and their male and female sexual partners in Thane, Maharashtra.…”

“…11,14 Nevertheless, both the studies could not find any significant difference in the HIV prevalence between the MSM having sex with only men and MSM having sex with men and women. The participants for the present study belong to Thane district of Maharashtra, while interestingly both of the previous studies also have representation of participants from Maharashtra.…”

“…[7][8][9] Similarly, the importance of reaching out to the spouses of married MSM with HIV prevention interventions is being discussed and debated at different levels. 10,11 There were very limited studies outside India indicating the vulnerability for HIV of female sex partners of bisexual HIV infected MSM, who were not aware of their partner"s bisexual behaviour. 12,13 In India, although the HIV prevalence among MSM is declining, there have been regions showing mixed trends of HIV prevalence among this community.…”