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

Abstract

Indian men who have sex with men are disproportionately impacted by HIV. While prevention efforts to date have focused on men who visit drop-in centers or physical cruising sites, little is known about men who are meeting sexual partners on virtual platforms. This paper explores issues related to sexual identity and sexual behaviors in an online sample of men who identified as gay (n=279) or bisexual (n=123). There were significant differences in outedness between the two groups, with 48% of bisexually-identified men reporting that they were out to “no one” and 82% stating that they present themselves as heterosexual to family and friends. Corresponding rates for gay-identified men were 15% and 41%, respectively (both p <0.001). Twenty-nine percent of bisexually-identified men reported being married, compared to only 3% of the gay-identified men (p< 0.001). Bisexually-identified men were also more likely to report having exclusively insertive anal sex (49% vs 30% p< 0.001), while gay-identified men were more likely to report exclusively receptive anal sex (41% vs 13% p< 0.0001). Rates of unprotected anal sex in the two groups was similar, however married men were significantly more li kely to report unprotected vaginal sex (76% vs 35%, p <0.012). Positive attitudes toward unprotected anal sex and lower self-efficacy were associated with sexual risk in both groups, however, substance use was associated with sexual risk only among bisexually-identified men. These findings show that a large proportion of Indian bisexually-identified men lead closeted lives, especially in their interactions with friends and family, with the vast majority presenting as heterosexual. The lower condom use with wives may be due to societal pressures to have children. The results suggest that bisexually-identified men may benefit from targeted programs and non-directive, non-judgmental individual or couples counseling which emphasizes condom use with both male and female partners.

Barriers to HIV Testing Among Men Who Have Sex With Men in India Reached Online: Implications for Interventions

“…Prior national or multi-city samples of Indian MSM were recruited through physical venue-based approaches, and demonstrated similar or higher rates of HIV testing, ranging from 51–82%. 1,16 While the HIV testing prevalence we observed is comparable to smaller studies of Indian MSM recruited online, 5,6 prior studies have not examined correlates of HIV testing. Additionally, prior studies have not provided country-wide data needed to guide testing interventions for Indian MSM.…”

“…Though SNS disrupt traditional face-to-face outreach, SNS also provide access to hard-to-reach populations. Studies among SNS-using Indian MSM have found that up to 50% are unaware of their HIV status, 5,6 but were limited to small localities or did not examine correlates of HIV testing.…”

What Do We Know About LGBTQIA+ Mental Health in India? A Review of Research From 2009 to 2019

“…65 Two studies noted that bisexually identified men were less likely to be out as compared to gay men, and many of them passed as heterosexual. 43, 66…”

“…A qualitative study with sexual minority women found that isolation, anxiety, high substance use, and suicidal thoughts were common themes in these women's experiences. 35 Prevalence rates for depression, substance abuse and dependence, anxiety, and other psychiatric conditions from varied studies [36][37][38][39][40][41][42][43][44][45][46][47][48][49] are described in Table 1. Badgett 25 stated that in the absence of studies providing a comparable estimate for non-LGBTQIA+ people in India, the population prevalence of a condition can be used as a benchmark.…”

“…65 Two studies noted that bisexually identified men were less likely to be out as compared to gay men, and many of them passed as heterosexual. 43,66 The most common reasons for coming out were found to be avoiding marriage pressure from family, desire to gain mental peace, and among bisexual respondents, sexual adventure with another partner of the same sex. 66 The most common practice with respect to coming out was disclosing to some female family members.…”