1
|
Sabri B, Budhathoki C, McFall AM, Mehta SH, Celentano DD, Solomon SS, Srikrishnan AK, Anand S, Vasudevan CK, Lucas GM. Cumulative violence exposures among men who have sex with men living with HIV in India: Psychosocial correlates of HIV care continuum outcomes. PLoS One 2023; 18:e0295225. [PMID: 38039322 PMCID: PMC10691715 DOI: 10.1371/journal.pone.0295225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/17/2023] [Indexed: 12/03/2023] Open
Abstract
Lifetime exposures to violence among men who have sex with men (MSM) are associated with multiple psychosocial health risks and can affect engagement and outcomes of HIV treatment. This study a) explored relationships between levels of exposures to violence and HIV care continuum outcomes among MSM living with HIV in India, and b) identified psychosocial correlates of HIV care continuum outcomes among MSM living with HIV and those with lifetime cumulative exposures to violence (CVE). CVE referred to exposures to violence in both childhood and adulthood. This cross-sectional analysis used survey data collected between August 2016 and May 2017 from 1763 men who have sex with men living with HIV across 10 cities in India, using respondent-driven sampling. We found that higher levels of violence exposure were significantly associated with lower awareness of HIV positive status, and lower likelihood of initiating antiretroviral therapy. Compared with MSM living with HIV that had no CVE, those with CVE were more likely to report perpetration of interpersonal violence, alcohol misuse, depressive symptoms, and HIV transmission risk behaviors and to have two to four co-occurring psychosocial problems. In multivariable analysis with the subset of MSM with CVE, psychosocial correlates significantly associated with at least one HIV care continuum outcome were HIV transmission risk behaviors, perpetration of interpersonal violence, depression, and alcohol misuse. The findings highlight the need for integrating care for lifetime violence exposures and associated behavioral problems in HIV care settings for men who have sex with men living with HIV in India.
Collapse
Affiliation(s)
- Bushra Sabri
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Allison M. McFall
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Shruti H. Mehta
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - David D. Celentano
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Sunil S. Solomon
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | | | - Gregory M. Lucas
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| |
Collapse
|
2
|
Lodge Ii W, Biello K, Thomas B, Rawat S, Baruah D, Dange A, Anand V, Swaminathan S, Kumar S, Balu V, Menon S, O'Cleirigh C, Mayer KH, Safren SA, Mimiaga MJ. Longitudinal impact of stressful life events on HIV-related risk and psychosocial problems among MSM in Chennai and Mumbai, India. Int J STD AIDS 2023; 34:416-422. [PMID: 36825555 DOI: 10.1177/09564624231155998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Studies show that stressful life events (SLE) (e.g., discrimination, financial problems) can lead to psychosocial problems and exacerbate condomless anal sex (CAS) without protection via pre-exposure prophylaxis (PrEP) among men who have sex with men. However, few studies have examined this relationship among men who have sex with men in India, and none have examined this longitudinally. METHODS As a part of an HIV-prevention intervention, 608 MSM from Chennai and Mumbai, India, completed behavioral surveys at baseline, 4, 8, and 12 months. We used longitudinal generalized estimating equations (GEE) modeling to examine the relationship between SLE and its severity and subsequent psychosocial problems, CAS, and history of diagnosed sexually transmitted infection (STI). All models are adjusted for age, sexual identity, intervention arm, human immunodeficiency virus status, and recruitment city. RESULTS The number of SLE and their corresponding perceived impact score remained consistent at each time point. In multivariable GEE models, the number of SLE was predictive of CAS, depression, and harmful drinking. Similarly, the ratio of the impact of SLE was predictive of CAS, depression, and diagnosed STI. However, harmful drinking was not predictive in this model. CONCLUSIONS These findings provide evidence that can inform future interventions, which can be used to enhance self-acceptance, coping skills, and other forms of resiliency.
Collapse
Affiliation(s)
- William Lodge Ii
- Department of Behavioral and Social Health Sciences, 174610Brown University School of Public Health, Providence, RI, USA
| | - Katie Biello
- Department of Behavioral and Social Health Sciences, 174610Brown University School of Public Health, Providence, RI, USA.,Department of Epidemiology, 174610Brown University School of Public Health, Providence, RI, USA.,The Fenway Institute, 196148Fenway Health, Boston, MA, USA
| | - Beena Thomas
- 29888National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | | | | | | | | | - Soumya Swaminathan
- 29888National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Senthil Kumar
- 29888National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Vinoth Balu
- 29888National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | | | - Conall O'Cleirigh
- The Fenway Institute, 196148Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, 196148Fenway Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- The Fenway Institute, 196148Fenway Health, Boston, MA, USA.,Department of Psychology, Center for HIV and Research in Mental Health (CHARM), 5452University of Miami, Coral Gables, FL, USA
| | - Matthew J Mimiaga
- The Fenway Institute, 196148Fenway Health, Boston, MA, USA.,UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA.,Department of Epidemiology, 25808UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
3
|
Lodge W, Thomas B, Biello KB, Swaminathan S, Reddy BS, Navakodi P, Menon S, Mayer KH, Safren SA, Mimiaga MJ. General Health Care Utilization in the Past 3 Months Increased Recent and Routine HIV and STI Testing Among Male Sex Workers in Chennai, India. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:291-299. [PMID: 35994580 DOI: 10.1521/aeap.2022.34.4.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In India, male sex workers (MSW) are among the most vulnerable populations at higher risk for HIV and other sexually transmitted infections (STIs) and may seek health care services less frequently. A community-based sample of 100 MSW in Chennai, India, completed a baseline assessment as part of a behavioral intervention to reduce the acquisition and transmission of HIV. MSW reported an average of 12.2 (SD = 17.7) condomless anal sex acts with male clients in the past month, yet only 48% accessed health care services in the past 3 months. In a multivariable model adjusted for relevant covariates, MSW who accessed health care services in the past 3 months were more likely to be tested for HIV/STIs and report routine HIV testing over the past 12 months. Future HIV prevention efforts among MSW in India should incorporate referrals for accessing general health care services and identify specific barriers to health care engagement among this group.
Collapse
Affiliation(s)
- William Lodge
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island and the Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, Rhode Island
| | - Beena Thomas
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Katie B Biello
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island and the Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, Rhode Island
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | | | | | | | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Division of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts and the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, the Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, California, and UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, California
| |
Collapse
|
4
|
Srivastava A, Davis JP, Patel P, Daniel EE, Karkal S, Rice E. Polyvictimization, Sex Work, and Depressive Symptoms Among Transgender Women and Men Who Have Sex With Men. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP11089-NP11109. [PMID: 33530842 DOI: 10.1177/0886260521990840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This article examined the association among polyvictimization, sex work, and depressive symptomology among transgender women and men who have sex with men (MSM) in India. Data comes from a cross-sectional epidemiological study with 1,366 transgender women (from three states) and 2,182 MSM participants from five states of India. Multivariate regressions were used to examine how polyvictimization and sex work are associated with depressive symptoms. In total, 70% of transgender women and 44% of MSM participants in the sample reported being in sex work; 30% of transgender women and 17% of MSM reported at least one experience of abuse in last 6 months. In bivariate analysis, transgender women in sex work were more likely to report sexual abuse, and MSM in sex work more likely to report all types of abuse (physical, sexual, verbal, and property), compared to their peers. In multivariate models (with transgender women and MSM), increase in endorsement on types of abuses (polyvictimization) and being in sex work were associated with higher odds of reporting depressive symptoms. Both models controlled for age and marital status, while the model with transgender women also controlled for gender transitioning, and the model with MSM controlled for identity typology. National intervention program on HIV risk reduction must prioritize victimization screening and crisis management as part of their work. In addition, the interventions must be responsive to the diversity of the population, including those who engage in sex work, and address issues of access and support to gender transitioning services, and focus on psychosocial interventions to reduce stress due to gender-based stigma and discrimination among transgender women and MSM.
Collapse
Affiliation(s)
| | | | - Prachi Patel
- Catalyst Management Services, Bengaluru, Karnataka, India
| | | | | | - Eric Rice
- University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
5
|
Willingness to Use Pre-exposure Prophylaxis (PrEP) and Preferences Among Men Who have Sex with Men in Mumbai and Chennai, India: A Discrete Choice Experiment. AIDS Behav 2021; 25:3074-3084. [PMID: 33818643 DOI: 10.1007/s10461-021-03253-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 01/07/2023]
Abstract
Pre-exposure prophylaxis (PrEP) programs are planned for key populations in India. We examined PrEP awareness and willingness to use PrEP in order to support products and services for MSM. From December 2016 to March 2017, we conducted a survey and discrete choice experiment (DCE)-a technique to quantify the strength of participants' trade-off preferences among various product attributes-to assess willingness to use PrEP and related preferences. MSM were recruited from cruising sites and HIV prevention services in Mumbai and Chennai. DCE data were analyzed using mixed logit regression models and estimated marginal willingness-to-pay, the relative value participants' place on different PrEP attributes. Overall, 76.6% indicated willingness to use PrEP. Efficacy had the greatest effect on choice (high vs. moderate, aOR = 19.9; 95% CI 13.0-30.4), followed by dosing frequency (intermittent vs. daily regimen, aOR = 2.02; 95% CI 1.8-2.2). Participants preferred no (vs. minor) side-effects, subsidized (vs. market) price, and government (vs. private) hospitals. Findings suggest that educational and social marketing interventions should emphasize PrEP's high efficacy and minimal side effects, and programs should provide government-subsidized PrEP with choices of intermittent or daily dosing delivered by government and private hospitals/clinics in order to optimize PrEP uptake among MSM in India.
Collapse
|
6
|
Sharma A, Das K, Saini SK, Ghai S, Mittal S, Kaur M. Randomized Controlled Trial on the Promotion of Sexual Health Using "Self-Care Interventional Package" in Men Who have Sex with Men. Indian J Community Med 2021; 46:221-225. [PMID: 34321730 PMCID: PMC8281863 DOI: 10.4103/ijcm.ijcm_225_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 03/09/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose: Men who have sex with men (MSM) is a vulnerable group, who have been neglected and discriminated. Such discrimination decreases their access to health care and increases the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Aims and Objective: The objective is to evaluate the effectiveness of “self-care interventional package” on the promotion of sexual health, among MSM. Materials and Methods: A randomized controlled trial was conducted on MSM from two nongovernmental organization centers of Chandigarh, which were randomized by simple random sampling into a control and experimental group. Over a period of 1 month, a total of 115 MSM were found eligible; 55 in control group and 60 in experimental group. Data were collected by a personal interview, after taking consent, in a comfortable and private environment. The Self-Care Interventional Package on the promotion of sexual health was developed in the form of flash book and booklet, and delivered by one-to-one interaction. Three follow-ups were done weekly for motivation in both the groups. Postintervention assessment was conducted after 1 month. Results: There was a statistically significant (P < 0.01) improvement in knowledge about prevention and management of STIs and HIV, getting vaccinated for Hepatitis B and regular self check-up. Statistically significant reduction in unsafe sexual practices was noted among the MSM of experimental group. Conclusion: The self-care interventional package for the promotion of sexual health was effective in improving the sexual heath of the MSM population.
Collapse
Affiliation(s)
- Anjali Sharma
- Department of Community Health Nursing, Akal College of Nursing, Eternal University, Sirmaur, Himachal Pradesh, India
| | - Karobi Das
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushma Kumar Saini
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Ghai
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Mittal
- Deputy Director (Target Interventions), State AIDS Control Society, Chandigarh, India
| | - Manmeet Kaur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Logie CH, Wang Y, Marcus N, Lalor P, Williams D, Levermore K. Pathways from Police, Intimate Partner, and Client Violence to Condom Use Outcomes among Sex Workers in Jamaica. Int J Behav Med 2020; 27:378-388. [PMID: 32077049 DOI: 10.1007/s12529-020-09860-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Violence reduces sex workers' ability to enforce consistent condom use. Less is known of violence and condom use among gender diverse sex workers in Jamaica, where both sex work and same-sex practices are criminalized. We examined pathways from violence to consistent condom use among sex workers in Jamaica. METHODS We conducted a cross-sectional survey with a peer-driven sample of sex workers (n = 340: n = 124 cisgender men, n = 115 cisgender women, n = 101 transgender women) in Kingston, Ocho Rios, and Montego Bay, Jamaica. We conducted structural equation modeling using weighted least square estimation methods to test the direct effects of police harassment (ever), intimate partner violence (IPV) (ever), and recent (past 6-month) client violence on consistent condom use, and indirect effects via condom use self-efficacy, adjusting for socio-demographic factors. Moderation analysis was conducted to estimate the effect of binge drinking on condom use self-efficacy. We conducted a second SEM taking into consideration measurement invariance to test gender differences. RESULTS Over half of participants reported police harassment, half intimate partner violence, and one-third client violence. Overall, the direct path from police harassment to consistent condom use was significant. Condom use self-efficacy mediated associations between client violence and IPV with consistent condom use. Binge drinking moderated the association between client violence and condom use self-efficacy. There were gender differences in these pathways. CONCLUSIONS Violence has direct and indirect effects on condom use outcomes among sex workers in Jamaica. Multilevel, gender-tailored interventions at policy, police, and community levels can promote sex workers' health and human rights.
Collapse
Affiliation(s)
- Carmen H Logie
- Factor-Iwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada. .,Women's College Research Institute, Women's College Hospital, Toronto, Canada.
| | - Ying Wang
- Factor-Iwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Natania Marcus
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Canada
| | | | | | | |
Collapse
|
8
|
Seidu AA, Darteh EKM, Kumi-Kyereme A, Dickson KS, Ahinkorah BO. Paid sex among men in sub-Saharan Africa: Analysis of the demographic and health survey. SSM Popul Health 2019; 11:100459. [PMID: 32875050 PMCID: PMC7451820 DOI: 10.1016/j.ssmph.2019.100459] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 06/12/2019] [Accepted: 07/21/2019] [Indexed: 11/19/2022] Open
Abstract
Background Paying for sex is regarded as a risky sexual behavior (RSB) among heterosexual men. Men paying for sex are considered to be a bridging population for sexually transmitted infections (STIs). Despite the link between paid sex and sexual and reproductive health outcomes such as STIs, little is known about the prevalence and factors associated with paid sex among men in sub-Saharan Africa. This study examined the prevalence of paid sex and the socio-demographic factors associated with it among men in sub-Saharan Africa. Methods The study made use of pooled data from the Demographic and Health Surveys (DHS) conducted from January 1, 2010 to December 3, 2016 in 27 countries in sub-Saharan Africa. Binary and multivariable logistic regression models were used to investigate the relationship between the explanatory and the outcome variables. Results The results of the study showed that of the 139,427 men who participated in the study, 4.3% reported they had paid for sex in the 12 months preceding the survey. Men in Mozambique had the highest proportion (13.6%) of paying for sex in the 12 months preceding the survey. The results of the multivariable analysis indicated that men from DR Congo [AOR = 9.74; 95% CI = 7.45-12.73], men who had completed only primary level of education [AOR = 1.31; 95% CI = 1.18-1.45], men aged 25-34 years [AOR = 2.84; 95% CI = 2.26-3.56], men belonging to "other" religious groups [AOR = 1.20; 95% CI = 1.09-1.32] and men who were employed [AOR = 1.73; 95% CI = 1.58-1.90] had higher odds of paying for sex. Men who were divorced [AOR = 4.52; 95% = 3.89-5.25], men who read newspaper/magazine almost every day [AOR = 1.34; 95% CI = 1.12-1.63], men who listened to radio almost every day [AOR = 1.19; 95% CI = 1.05-1.36] and men who watched television at least once a week [AOR = 1.10; 95% CI = 1.01-1.19] also had higher odds of paying for sex. On the other hand, men in rural areas [AOR = 0.88; 95%CI = 0.82-0.95], men in the richest wealth quintile [AOR = 0.83; 95%CI = 0.74-0.93] and those with tertiary level of education [AOR = 0.77; 95% CI = 0.65-0.90] had lower odds of paying for sex. Conclusion The odds of paid sex were high among men with only primary level of education, men aged 25-34, men who professed 'other' religious affiliation, men who are employed and men who are divorced. However, paid sex was low among men in the richest wealth quintile, men with tertiary level of education and men living in rural areas. This means that the decision to pay for sex is influenced by several social and demographic factors. Hence, these factors should be taken into consideration for sexual and reproductive health interventions and services. Policy and interventional measures should aim at reducing high-risk behavior of men who pay for sex.
Collapse
Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Ghana
- Corresponding author.
| | | | | | | | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Australia
| |
Collapse
|
9
|
Chakrapani V, Kaur M, Newman PA, Mittal S, Kumar R. Syndemics and HIV-related sexual risk among men who have sex with men in India: influences of stigma and resilience. CULTURE, HEALTH & SEXUALITY 2019; 21:416-431. [PMID: 30025511 PMCID: PMC6430415 DOI: 10.1080/13691058.2018.1486458] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Using syndemics theory as a framework, we explored the experience of men who have sex with men in India in relation to four syndemic conditions (depression, alcohol use, internalised homonegativity and violence victimisation) and to understand their resilience resources. Five focus groups were conducted among a purposive sample of diverse men along with seven key informant interviews with HIV service providers. Participants' narratives suggested various pathways by which syndemic conditions interact with one another to sequentially or concurrently increase HIV risk. Experiences of discrimination and violence from a range of perpetrators (family, ruffians and police) contributed to internalised homonegativity and/or depression, which in turn led some men to use alcohol as a coping strategy. Stigma related to same-sex sexuality, gender non-conformity and sex work contributed to the production of one or more syndemic conditions. While rejection by family and male regular partners contributed to depression/alcohol use, support from family, regular partners and peers served as resources of resilience. In India, HIV prevention and health promotion efforts among men who have sex with men could be strengthened by multi-level multi-component interventions to reduce intersectional/intersecting stigma, address syndemic conditions and foster resilience - especially by promoting family acceptance and peer support.
Collapse
Affiliation(s)
- Venkatesan Chakrapani
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Corresponding Author: Manmeet Kaur
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
| | - Sandeep Mittal
- Chandigarh State AIDS Control Society, Chandigarh, India
| | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
10
|
Logie CH, Lacombe-Duncan A, Kenny KS, Levermore K, Jones N, Baral SD, Wang Y, Marshall A, Newman PA. Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey. Glob Health Action 2018; 11:1424614. [PMID: 29338660 PMCID: PMC5774420 DOI: 10.1080/16549716.2018.1424614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Globally, men who have sex with men (MSM) experience social marginalization and criminalization that increase HIV vulnerability by constraining access to HIV prevention and care. People who sell sex also experience criminalization, rights violations, and violence, which elevate HIV exposure. MSM who sell sex may experience intersectional stigma and intensified social marginalization, yet have largely been overlooked in epidemiological and social HIV research. In Jamaica, where same sex practices and sex work are criminalized, scant research has investigated sex selling among MSM, including associations with HIV vulnerability. OBJECTIVE We aimed to examine social ecological factors associated with selling sex among MSM in Jamaica, including exchanging sex for money, shelter, food, transportation, or drugs/alcohol (past 12 months). METHODS We conducted a cross-sectional survey with a peer-driven sample of MSM in Kingston, Ocho Rios, and Montego Bay. Multivariable logistic regression analyses were conducted to estimate intrapersonal/individual, interpersonal/social, and structural factors associated with selling sex. RESULTS Among 556 MSM, one-third (n = 182; 32.7%) reported selling sex. In the final multivariable model, correlates of selling sex included: individual/intrapersonal (lower safer sex self-efficacy [AOR: 0.85, 95% CI: 0.77, 0.94]), interpersonal/social (concurrent partnerships [AOR: 5.52, 95% CI: 1.56, 19.53], a higher need for social support [AOR: 1.08, 95% CI: 1.03, 1.12], lifetime forced sex [AOR: 2.74, 95% 1.65, 4.55]) and structural-level factors (sexual stigma [AOR: 1.09, 95% CI: 1.04, 1.15], food insecurity [AOR: 2.38, 95% CI: 1.41, 4.02], housing insecurity [AOR: 1.94, 95% CI: 1.16, 3.26], no regular healthcare provider [AOR: 2.72, 95% CI: 1.60, 4.64]). CONCLUSIONS This study highlights social ecological correlates of selling sex among MSM in Jamaica, in particular elevated stigma and economic insecurity. Findings suggest that MSM in Jamaica who sell sex experience intensified social and structural HIV vulnerabilities that should be addressed in multi-level interventions to promote health and human rights.
Collapse
Affiliation(s)
- Carmen H Logie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada.,b Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Ashley Lacombe-Duncan
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Kathleen S Kenny
- c Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | | | - Stefan D Baral
- e Johns Hopkins Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
| | - Ying Wang
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Annecka Marshall
- f Institute for Gender and Development Studies , Mona Campus, University of the West Indies , Kingston , Jamaica
| | - Peter A Newman
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| |
Collapse
|
11
|
Measurements of Sexuality-Based Stigma among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Resource-Poor Settings: A Review. AIDS Behav 2018; 22:1614-1638. [PMID: 29128941 DOI: 10.1007/s10461-017-1975-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) in resource-poor settings are disproportionately affected by the HIV/AIDS epidemic. GBMSM living in these settings may face unique barriers to HIV prevention, including legal barriers and increased sexuality-based stigma. It is therefore imperative to tailor HIV prevention and care resources to recognize the lived realities of GBMSM in these settings. Central to this is the accurate measurement of sexuality-based stigma. However, there is wide inconsistency in how sexuality-based stigma is measured among GBMSM in resource-poor settings. This paper reviews recent studies of sexuality-based stigma among GBMSM in resource-poor settings, finding great variability in measurements. The results of the review call for greater attention to the development of contextually and culturally specific measures of sexuality-based stigma for GBMSM living in resource-poor settings.
Collapse
|
12
|
Tomori C, Srikrishnan AK, Ridgeway K, Solomon SS, Mehta SH, Solomon S, Celentano DD. Perspectives on Sexual Identity Formation, Identity Practices, and Identity Transitions Among Men Who Have Sex With Men in India. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:235-244. [PMID: 27393039 PMCID: PMC5219953 DOI: 10.1007/s10508-016-0775-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 04/08/2016] [Accepted: 05/17/2016] [Indexed: 05/31/2023]
Abstract
Men who have sex with men (MSM) remain at high risk for HIV infection. Culturally specific sexual identities, encompassing sexual roles, behavior, and appearance, may shape MSM's experiences of stigmatization and discrimination, and affect their vulnerability to HIV. This multi-site qualitative study (n = 363) encompassing 31 focus group discussions (FGDs) and 121 in-depth interviews (IDIs) across 15 sites in India investigated sexual identity formation, identity practices, and transitions and their implications for HIV prevention. IDIs and FGDs were transcribed, translated, and underwent thematic analysis. Our findings document heterogeneous sexual identity formation, with MSM who have more gender nonconforming behaviors or appearance reporting greater family- and community-level disapproval, harassment, violence, and exclusion. Concealing feminine aspects of sexual identities was important in daily life, especially for married MSM. Some participants negotiated their identity practices in accordance with socioeconomic and cultural pressures, including taking on identity characteristics to suit consumer demand in sex work and on extended periods of joining communities of hijras (sometimes called TG or transgender women). Participants also reported that some MSM transition toward more feminine and hijra or transgender women identities, motivated by intersecting desires for feminine gender expression and by social exclusion and economic marginalization. Future studies should collect information on gender nonconformity stigma, and any changes in sexual identity practices or plans for transitions to other identities over time, in relation to HIV risk behaviors and outcomes.
Collapse
Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.
| | | | - Kathleen Ridgeway
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | - Suniti Solomon
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| |
Collapse
|
13
|
Srivastava A, Goldbach JT. Pathways to Male Transactional Sex in Mumbai, India. JOURNAL OF HOMOSEXUALITY 2017; 66:173-188. [PMID: 29077538 DOI: 10.1080/00918369.2017.1398018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The article explores pathways to male transactional sex, focusing on entering, soliciting practices, role of pimps, client characteristics, and negotiations. Little scientific literature exists regarding male transactional sex in India, who represent a high-risk group for HIV infection. Case studies with 10 men who engage in transactional sex were conducted, who were recruited using purposive snowball sampling and interviewed at a social service organization. Participants differed in their sexual identity, sex roles, soliciting practices, and clients. Most of them listed economic crisis as their reason for entering transactional sex. Strategies to find clients included self-solicitation and referrals, while pimps played a major role in solicitation, negotiations, and events of crisis. The relationship among men who engage in transactional sex, pimps, and clients involves points of negotiation, opportunities, and limitations. HIV prevention should focus on identifying and addressing the groups' unique needs and working with pimps on risk-reduction strategies and crisis interventions.
Collapse
Affiliation(s)
- Ankur Srivastava
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , California , USA
| | - Jeremy T Goldbach
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , California , USA
| |
Collapse
|
14
|
Mimiaga MJ, Thomas B, Biello K, Johnson BE, Swaminathan S, Navakodi P, Balaguru S, Dhanalakshmi A, Closson EF, Menon S, O'Cleirigh C, Mayer KH, Safren SA. A Pilot Randomized Controlled Trial of an Integrated In-person and Mobile Phone Delivered Counseling and Text Messaging Intervention to Reduce HIV Transmission Risk among Male Sex Workers in Chennai, India. AIDS Behav 2017; 21:3172-3181. [PMID: 28831618 DOI: 10.1007/s10461-017-1884-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Men who have sex with men (MSM) are at increased risk for HIV infection in India, particularly those who engage in transactional sex with other men (i.e., male sex workers; MSW). Despite the need, HIV prevention efforts for Indian MSW are lacking. As in other settings, MSW in India increasingly rely on the use of mobile phones for sex work solicitation. Integrating mobile phone technology into an HIV prevention intervention for Indian MSW may mitigate some of the challenges associated with face-to face approaches, such as implementation, lack of anonymity, and time consumption, while at the same time proving to be both feasible and useful. This is a pilot randomized controlled trial to examine participant acceptability, feasibility of study procedures, and preliminary efficacy for reducing sexual risk for HIV. MSW (N = 100) were equally randomized to: (1) a behavioral HIV prevention intervention integrating in-person and mobile phone delivered HIV risk reduction counseling, and daily, personalized text or voice messages as motivating "cognitive restructuring" cues for reducing condomless anal sex (CAS); or (2) a standard of care (SOC) comparison condition. Both groups received HIV counseling and testing at baseline and 6-months, and completed ACASI-based, behavioral and psychosocial assessments at baseline, 3, and 6 months. Mixed-effects regression procedures specifying a Poisson distribution and log link with a random intercept and slope for month of follow-up was estimated to assess the intervention effect on the primary outcomes: (1) CAS acts with male clients who paid them for sex, and (2) CAS acts with male non-paying sexual partners-both outcomes assessed over the past month. The intervention was both feasible (98% retention at 6-months) and acceptable (>96% of all intervention sessions attended); all intervention participants rated the intervention as "acceptable" or "very acceptable." A reduction in the reported number of CAS acts with male clients who paid them for sex in the past month was seen in both study conditions. MSW in the intervention condition reported a faster rate of decline in the number of CAS acts with male clients in the past month from the baseline to both the 3-month (B = -1.20; 95% CI -1.68, -0.73; p < 0.0001) and 6-month (B = -2.44; 95% CI -3.35, -1.53; p < 0.00001) assessment visits compared to the SOC condition. Post-hoc contrasts indicated that, at 3 months, participants in the intervention condition reported 1.43 (SD = 0.29) CAS acts with male clients in the past month compared to 4.85 (SD = 0.87) in the control condition (p = 0.0003). Furthermore, at 6 months, the intervention condition participants reported 0.24 (SD = 0.09) CAS acts with male clients in the past month compared to 2.79 (SD = 0.79) in the control condition (p < 0.0001). Findings are encouraging and provide evidence of feasibility and acceptability, and demonstrate initial efficacy (for reducing sexual risk for HIV) of a behavioral HIV prevention intervention for Indian MSW that combines daily, personalized text or voice messages with mobile phone-delivered sexual risk reduction counseling and skills building. Future testing of the intervention in a fully powered randomized controlled efficacy trial is warranted.
Collapse
Affiliation(s)
- Matthew J Mimiaga
- Brown University, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Brown University, 121 South Main Street, Floor 8, Providence, RI, 02903, USA.
| | - Beena Thomas
- National Institute for Research in Tuberculosis (NIRT)/Indian Council of Medical Research, Chennai, India
| | - Katie Biello
- Brown University, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Soumya Swaminathan
- Ministry of Health and Family Welfare, Government of India/Indian Council of Medical Research, New Delhi, India
| | - Pandiyaraja Navakodi
- National Institute for Research in Tuberculosis (NIRT)/Indian Council of Medical Research, Chennai, India
| | - S Balaguru
- National Institute for Research in Tuberculosis (NIRT)/Indian Council of Medical Research, Chennai, India
| | - A Dhanalakshmi
- National Institute for Research in Tuberculosis (NIRT)/Indian Council of Medical Research, Chennai, India
| | - Elizabeth F Closson
- The Fenway Institute, Fenway Health, Boston, MA, USA
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- University of Miami, Coral Gables, FL, USA
| |
Collapse
|
15
|
Ganju D, Saggurti N. Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India. CULTURE, HEALTH & SEXUALITY 2017; 19:903-917. [PMID: 28132601 PMCID: PMC6176758 DOI: 10.1080/13691058.2016.1271141] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 12/07/2016] [Indexed: 05/23/2023]
Abstract
Among marginalised groups in India, HIV prevalence is highest among transgender persons; however, little is known about their HIV vulnerability. This study describes transgender sex workers' experiences of stigma and violence, a key driver of the HIV epidemic, and explores their coping responses. In-depth interviews were conducted with 68 respondents in Maharashtra state, India. Findings show that respondents face pervasive stigma and violence due to multiple marginalised social identities (transgender status, sex work, gender non-conformity), which reinforce and intersect with social inequities (economic and housing insecurity, employment discrimination, poverty), fuelling HIV vulnerability at the micro, meso and macro levels. Several factors, such as felt and internalised stigma associated with psycho-social distress and low self-efficacy to challenge abuse and negotiate condom use; clients' power in sexual transactions; establishing trust in regular partnerships through condomless sex; norms condoning violence against gender non-conforming persons; lack of community support; police harassment; health provider discrimination and the sex work environment create a context for HIV vulnerability. In the face of such adversity, respondents adopt coping strategies to shift power relations and mobilise against abuse. Community mobilisation interventions, as discussed in the paper, offer a promising vulnerability reduction strategy to safeguard transgender sex workers' rights and reduce HIV vulnerability.
Collapse
Affiliation(s)
- Deepika Ganju
- HIV and AIDS Program, Population Council, New Delhi, India
| | | |
Collapse
|
16
|
Chakrapani V, Newman PA, Shunmugam M, Mengle S, Nelson R, Rubincam C, Kumar P. "Like Holding an Umbrella Before It Rains": Acceptability of Future Rectal Microbicides Among Men Who Have Sex With Men in India-A Modified Technology Acceptance Model. QUALITATIVE HEALTH RESEARCH 2017; 27:1236-1248. [PMID: 28682740 DOI: 10.1177/1049732317697947] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Topical rectal microbicides (RMs) are a new prevention technology in development that aims to reduce the risk of HIV acquisition from anal sex. We examined RM acceptability among men who have sex with men (MSM) in India. We conducted a qualitative exploratory study guided by a modified Technology Acceptance Model, with 10 focus groups ( n = 61) of MSM and 10 key informant interviews. Data were explored using framework analysis. RM acceptability was influenced by technological contexts: perceived usefulness of RMs, perceived ease of use of RM and applicator, and habits around condom and lubricant use; individual and interpersonal contexts: perceived relevance and preferences for product formulation and dosing frequency; and MSM community/social contexts: perceived social approval, RM-related stigma, social support. Implementation of RMs for MSM in India may be supported by multi-level interventions that engage community-based organizations in destigmatizing and distributing RMs, ideally gel-based products that enable on-demand use before sex.
Collapse
Affiliation(s)
- Venkatesan Chakrapani
- 1 Centre for Sexuality and Health Research and Policy, Chennai, India
- 2 The Humsafar Trust, Mumbai, India
- 3 PostGraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Murali Shunmugam
- 1 Centre for Sexuality and Health Research and Policy, Chennai, India
| | | | - Ruban Nelson
- 1 Centre for Sexuality and Health Research and Policy, Chennai, India
| | | | | |
Collapse
|
17
|
Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study. J Int AIDS Soc 2017; 20:21422. [PMID: 28406598 PMCID: PMC5515035 DOI: 10.7448/ias.20.01/21422] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Transgender women are disproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non-sex work-involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study objective was to examine factors associated with sex work involvement among transgender women in Jamaica. Methods: In 2015, we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex. Results: Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n = 71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n = 64; 47.06%); survival needs (n = 27; 19.85%); and drugs/alcohol (n = 6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration perceived to be due to transgender identity, forced sex, homelessness, and lower resilience, in comparison with participants reporting no sex work involvement. Conclusions: Findings reveal high HIV infection rates among transgender women in Jamaica. Sex work-involved participants experience social and structural drivers of HIV, including violence, stigma, and unemployment. Transgender women involved in transactional sex also experience high rates of incarceration, forced sex and homelessness in comparison with non-sex workers. Taken together, these findings suggest that social ecological factors elevate HIV exposure among sex work-involved transgender women in Jamaica. Findings can inform interventions to advance human rights and HIV prevention and care cascades with transgender women in Jamaica.
Collapse
|
18
|
Thomas B, Closson EF, Biello K, Menon S, Navakodi P, Dhanalakshmi A, Mayer KH, Safren SA, Mimiaga MJ. Development and Open Pilot Trial of an HIV-Prevention Intervention Integrating Mobile-Phone Technology for Male Sex Workers in Chennai, India. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1035-1046. [PMID: 26714684 PMCID: PMC5432404 DOI: 10.1007/s10508-015-0665-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/27/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
In India men who have sex with men and engage in sex work (i.e., male sex workers; MSW) have a high risk of transmitting HIV. Globally, sex workers have become more spatially mobile due to advances in mobile-phone technology. In 2012 in-depth qualitative feedback was garnered from 40 interviews with MSW and four focus groups with 35 key informants (KIs) who had expert knowledge of the local MSW community to inform the design of an HIV-prevention intervention among MSW in Chennai, India. All MSW were recruited during outreach by employees of a Chennai-based organization for MSM (men who have sex with men). The data were analyzed using a descriptive qualitative approach. MSW and KIs discussed the need for intervention content that went beyond basic HIV psychoeducation. They emphasized the importance of addressing psychological distress, alcohol-related risk, and sexual communication skills. Concerns were raised about confidentiality, privacy, and scheduling. Participants endorsed a combination of in-person and mobile-phone-delivered sessions as well as the integration of mobile-phone messaging. These findings served as the basis for the development of a theoretically driven, manual-based intervention incorporating mobile phones. An open pilot assessed the feasibility and acceptability of the intervention with eight MSW. Assessments and HIV testing were administered at baseline, 3, and 6 months post-baseline. Exit interviews were conducted at the conclusion of the intervention. Retention for session attendance and assessment follow-up was 100 %. There was a high level of acceptability for the format, structure, and content. These data show initial promise, feasibility, and acceptability of the intervention.
Collapse
Affiliation(s)
- Beena Thomas
- National Institute for Research in Tuberculosis, Chennai, India
| | - Elizabeth F Closson
- The Fenway Institute, Fenway Health, Boston, MA, USA
- London School of Hygiene and Tropical Medicine, London, UK
| | - Katie Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02903, USA
| | | | | | - A Dhanalakshmi
- National Institute for Research in Tuberculosis, Chennai, India
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, University of Miami, Coral Gables, FL, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02903, USA.
| |
Collapse
|
19
|
Semple SJ, Stockman JK, Goodman-Meza D, Pitpitan EV, Strathdee SA, Chavarin CV, Rangel G, Torres K, Patterson TL. Correlates of Sexual Violence Among Men Who Have Sex With Men in Tijuana, Mexico. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1011-1023. [PMID: 27178173 PMCID: PMC5107348 DOI: 10.1007/s10508-016-0747-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/12/2016] [Accepted: 03/21/2016] [Indexed: 05/14/2023]
Abstract
Sexual violence among men who have sex with men (MSM) is prevalent in developing countries and is associated with increased HIV/STI risk. Despite high HIV prevalence (20 %) among MSM in Tijuana, Mexico, little attention has been paid to the occurrence of sexual violence in this high-risk group. The present study used a syndemic conditions framework to examine correlates of sexual violence victimization in a sample of 201 MSM surveyed in Tijuana, Mexico during 2012 and 2013. Participants were recruited through respondent-driven sampling and underwent a 2-h baseline interview and testing for HIV and syphilis. Sexual violence was defined as any incident during the past year in which the participant had been raped, sexually molested, or sexually harassed. The majority of participants self-identified as gay or bisexual, had never married, were employed, and had a high school education or greater. The average age was 29.7 years. Thirty-nine percent reported sexual violence in the past year. A hierarchical multiple linear regression model predicting more experiences of sexual violence was tested. In a final model, a higher number of experiences of sexual violence was associated with a history of childhood sexual abuse, more adult experiences of homophobia, more depression and hostility symptoms, and not living with a spouse or steady partner. The findings from this study support a model of co-occurring psychosocial factors that increase the likelihood of sexual violence experiences among MSM. Multi-level approaches to the prevention of childhood and adult experiences of sexual violence and homophobia are needed to avert the development of adverse mental and physical health outcomes associated with sexual violence victimization.
Collapse
Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA
| | - Jamila K Stockman
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - David Goodman-Meza
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Claudia V Chavarin
- Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA
| | | | - Karla Torres
- Agencia Familiar Binacional, A.C., Tijuana, Mexico
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
| |
Collapse
|
20
|
Chakrapani V, Vijin PP, Logie CH, Newman PA, Shunmugam M, Sivasubramanian M, Samuel M. Understanding How Sexual and Gender Minority Stigmas Influence Depression Among Trans Women and Men Who Have Sex with Men in India. LGBT Health 2017; 4:217-226. [PMID: 28422615 DOI: 10.1089/lgbt.2016.0082] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Few studies have assessed how sexual and gender minority stigmas affect the mental health of trans women and self-identified men who have sex with men (MSM) in India, populations with a high HIV burden. We tested whether social support and resilient coping act as mediators of the effect of sexual and gender minority stigmas on depression as proposed by Hatzenbuehler's psychological mediation framework, or as moderators based on Meyer's minority stress theory. METHODS We conducted a cross-sectional survey among trans women (n = 300) and MSM (n = 300) recruited from urban and rural sites in India. Standardized scales were used to measure depression (outcome variable), transgender identity stigma/MSM stigma (predictor variables), and social support and resilient coping (tested as moderators and parallel mediators). The mediation and moderation models were tested separately for trans women and MSM, using Hayes' PROCESS macro in SPSS. RESULTS Participants' mean age was 29.7 years (standard deviation 8.1). Transgender identity stigma and MSM stigma were significant predictors (significant total and direct effects) of depression, as were social support and resilient coping. Among trans women and MSM, social support and resilient coping mediated (i.e., significant specific indirect effects), but did not moderate, the effect of stigma on depression, supporting the psychological mediation framework. CONCLUSION Sexual and gender minority stigmas are associated with depression, with social support and resilient coping as mediators. In addition to stigma reduction interventions at the societal level, future interventions should focus on improving social support and promoting resilience among trans women and MSM in India.
Collapse
Affiliation(s)
- Venkatesan Chakrapani
- 1 Centre for Sexuality and Health Research and Policy (C-SHaRP) , Chennai, India .,2 The Humsafar Trust , Mumbai, India .,3 Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
| | | | - Carmen H Logie
- 4 Factor-Inwentash Faculty of Social Work/Centre for Applied Social Research, University of Toronto , Toronto, Canada .,5 Women's College Research Institute, Women's College Hospital, University of Toronto , Toronto, Canada
| | - Peter A Newman
- 4 Factor-Inwentash Faculty of Social Work/Centre for Applied Social Research, University of Toronto , Toronto, Canada
| | - Murali Shunmugam
- 1 Centre for Sexuality and Health Research and Policy (C-SHaRP) , Chennai, India
| | | | - Miriam Samuel
- 6 Department of Social Work, Madras Christian College , Chennai, India
| |
Collapse
|
21
|
Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study. J Int AIDS Soc 2017. [DOI: 10.7448/ias.20.1.21422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
22
|
Ganju D, Patel SK, Prabhakar P, Adhikary R. Knowledge and exercise of human rights, and barriers and facilitators to claiming rights: a cross-sectional study of female sex workers and high-risk men who have sex with men in Andhra Pradesh, India. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:29. [PMID: 27855692 PMCID: PMC5112884 DOI: 10.1186/s12914-016-0102-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 10/18/2016] [Indexed: 11/10/2022]
Abstract
Background HIV prevention interventions recognize the need to protect the rights of key populations and support them to claim their rights as a vulnerability reduction strategy. This study explores knowledge of human rights, and barriers and facilitators to claiming rights, among female sex workers (FSWs) and high-risk men who have sex with men (HR-MSM) who are beneficiaries of a community mobilization intervention in Andhra Pradesh, India. Methods Data are drawn from a cross-sectional survey (2014) among 2400 FSWs and 1200 HR-MSM. Human rights awareness was assessed by asking respondents if they had heard of human rights (yes/no); those reporting awareness of rights were asked to spontaneously name specific rights from the following five pre-defined categories: right to health; dignity/equality; education; property; and freedom from discrimination. Respondents were classified into two groups: more knowledgeable (could identify two or more rights) and less knowledgeable (could identify one or no right). Univariate and bivariate analyses and chi-square tests were used. Data were analyzed using STATA 11.2. Results Overall 17% FSWs and 8% HR-MSM were not aware of their rights. Among those aware, 62% and 31% respectively were aware of just one or no right (less knowledgeable); only around half (54% vs 57%) were aware of health rights, and fewer (20% vs 16%) aware of their right to freedom from discrimination. Notably, 27% and 17% respectively had not exercised their rights. Barriers to claiming rights among FSWs and HR-MSM were neighbors (35% vs 37%), lack of knowledge (15% vs 14%), stigma (13% vs 22%) and spouse (19% FSWs). Community organizations (COs) were by far the leading facilitator in claiming rights (57% vs 72%). Conclusions The study findings show that awareness of human rights is limited among FSWs and HR-MSM, and a large proportion have not claimed their rights, elevating their HIV vulnerability. For a sustained HIV response, community mobilization efforts must focus on building key populations’ awareness of rights, and addressing the multiple barriers to claiming rights, with a view to creating a safe environment where vulnerable groups can demand and use services without fear of stigma, discrimination and violation of rights.
Collapse
Affiliation(s)
- Deepika Ganju
- HIV and AIDS Program, Population Council, 142 Golf Links, New Delhi, 110003, India.
| | - Sangram Kishor Patel
- HIV and AIDS Program, Population Council, 142 Golf Links, New Delhi, 110003, India
| | - Parimi Prabhakar
- India HIV/AIDS Alliance, Sarovar Centre, Secretariat Road, Hyderabad, 500063, India
| | | |
Collapse
|
23
|
Tomori C, McFall AM, Srikrishnan AK, Mehta SH, Solomon SS, Anand S, Vasudevan CK, Solomon S, Celentano DD. Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study. AIDS Behav 2016; 20:304-16. [PMID: 26386592 DOI: 10.1007/s10461-015-1201-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Poor psychosocial health contributes to HIV risk behavior and reduced engagement in treatment and care. This study investigates depression and its correlates among 11,992 MSM recruited via respondent driven sampling in 12 cities across India using the Patient Health Questionnaire-9 and supplemented by analysis of qualitative research from 15 sites with 363 MSM. Overall prevalence of depression was 11 %, with substantial variation across sites and subgroups of MSM, and high prevalence of suicidal thoughts among depressed MSM. In multivariable analyses identification as a kothi (feminine sexual identity) [adjusted odds ratio (aOR) = 1.91], disclosure of being MSM to non-family (aOR = 1.7) and family (aOR = 2.4), disclosure of HIV-status (aOR = 5.6), and substance use were associated with significantly higher odds of depression. Qualitative results emphasized dire social consequences of disclosing MSM- and HIV-status, especially to family, including suicidality. Combination prevention interventions should include mental health services that address disclosure, suicidality, and substance use.
Collapse
|
24
|
Chakrapani V, Newman PA, Shunmugam M, Logie CH, Samuel M. Syndemics of depression, alcohol use, and victimisation, and their association with HIV-related sexual risk among men who have sex with men and transgender women in India. Glob Public Health 2015; 12:250-265. [PMID: 26457339 DOI: 10.1080/17441692.2015.1091024] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We examined the presence and co-occurrence of psychosocial health conditions (depression, frequent alcohol use, and victimisation) among men who have sex with men (MSM) and transgender (TG) women in India, and their cumulative association with sexual risk. A survey questionnaire was administered among a convenience sample of 600 participants (MSM = 300; TG women = 300) recruited through six non-governmental organisations in four states. Prevalences of the number of psychosocial health conditions among MSM were: none = 31.3%, one = 43%, two = 20%, and three = 5.7%; and among TG women: none = 9%; one = 35.33%, two = 38.33%, and three = 17.33%. In bivariate and multivariate models, these conditions were positively and additively related to sexual risk, providing evidence for a syndemic of psychosocial health conditions among MSM and TG women and their synergistic effect on sexual risk. In addition to the number of syndemic conditions, resilient coping and social support were significant predictors of sexual risk among MSM and TG women, respectively. HIV preventive interventions in India should screen for and address co-occurring psychosocial health conditions - experiences of violence, mental health issues, and alcohol use - among MSM and TG women.
Collapse
Affiliation(s)
- Venkatesan Chakrapani
- a Centre for Sexuality and Health Research and Policy (C-SHaRP) , Chennai , India.,b The Humsafar Trust , Mumbai , India
| | - Peter A Newman
- c Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - Murali Shunmugam
- a Centre for Sexuality and Health Research and Policy (C-SHaRP) , Chennai , India
| | - Carmen H Logie
- c Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - Miriam Samuel
- d Department of Social Work , Madras Christian College , Chennai , India
| |
Collapse
|
25
|
Woodford MR, Chakrapani V, Newman PA, Shunmugam M. Barriers and facilitators to voluntary HIV testing uptake among communities at high risk of HIV exposure in Chennai, India. Glob Public Health 2015; 11:363-379. [PMID: 26315563 DOI: 10.1080/17441692.2015.1057757] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In India, increasing uptake of voluntary HIV testing among 'core risk groups' is a national public health priority. While HIV testing uptake has been studied among key populations in India, limited information is available on multi-level barriers and facilitators to HIV testing, and experiences with free, publicly available testing services, among key populations. We conducted 12 focus groups (n = 84) and 12 key informant interviews to explore these topics among men who have sex with men, transgender women, cisgender female sex workers, and injecting drug users in the city of Chennai. We identified inter-related barriers at social-structural, health-care system, interpersonal, and individual levels. Barriers included HIV stigma, marginalised-group stigma, discrimination in health-care settings, including government testing centres, and fears of adverse social consequences of testing HIV positive. Facilitators included outreach programmes operated by community-based/non-governmental organisations, accurate HIV knowledge and risk perception for HIV, and access to drug dependence treatment for injecting drug users. Promoting HIV testing among these key populations requires interventions at several levels: reducing HIV-related and marginalised-group stigma, addressing the fears of consequences of testing, promoting pro-testing peer and social norms, providing options for rapid and non-blood-based HIV tests, and ensuring non-judgmental and culturally competent HIV counselling and testing services.
Collapse
Affiliation(s)
- Michael R Woodford
- a Lyle S. Hallman Faculty of Social Work , Wilfrid Laurier University , Kitchener , Ontario , Canada
| | | | - Peter A Newman
- c Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Murali Shunmugam
- b Centre for Sexuality and Health Research and Policy (C-SHaRP) , Chennai , India.,d Indian Network of People Living with HIV/AIDS , Tamil Nadu , India
| |
Collapse
|
26
|
Mahapatra T, Biswas S, Nandi S, Ghosh P, Ghosh M, Mondal S, Saha MK. Burden and Correlates of HIV among Men Who Have Sex with Men in West Bengal, India: Analysis of Sentinel Surveillance Data. PLoS One 2015; 10:e0127232. [PMID: 25996926 PMCID: PMC4440763 DOI: 10.1371/journal.pone.0127232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/12/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Little is known about the socio-behavioral risk factors for HIV acquisition among hard-to-reach men who have sex with men (MSM) population in India, particularly from the densely populated eastern part. Thus to measure the burden and correlates of HIV among MSM in West Bengal state of eastern India, a cross-sectional analysis of the national HIV Sentinel Surveillance (HSS) data was conducted. METHODS In 2011, between July and September, involving all sentinel sites of the state, 1237 consenting MSM were anonymously interviewed and tested for HIV following national guidelines. Using a short, structured questionnaire, information was collected on socio-behavioral factors along with sexual practices and was analyzed to determine burden of HIV and the role of its socio-behavioral correlates on HIV acquisition. RESULTS Among participants, mean age was 23.4 years, 44.55% were "Kothis" (usually receptive partner) and 25.1% admitted receiving money for sex with man. HIV sero-positivity was 5.09%. Using logistic regression method, for both bivariate and multivariate (with saturated model) analyses, transport-workers [adjusted odds ratio (AOR)=8.95, 95% confidence interval (95%CI): 1.09-73.71), large business-owners/self-employed (AOR=8.46, 95%CI: 1.25-57.49), small business-owners/cultivators (AOR=7.90, 95%CI: 1.67-37.38), those who visited the sentinel site for official purposes (AOR=7.60, 95%CI: 1.21-47.83) and paying money for having sex with men (AOR=3.03, 95%CI: 1.10-8.33) were strongly associated with higher HIV sero-positivity with than their counterparts. Using the parsimonious model for multivariate analysis, Kothis (AOR=4.64, 95%CI: 1.03-20.89), paying (AOR=2.96, 95%CI: 1.15-7.58) or receiving (AOR=2.06, 95%CI: 1.06-3.99) money for having sex with a man were associated with higher risk of HIV. CONCLUSIONS Focused intervention targeting the high risk MSM subgroups including Kothis, transport-workers, business-owners/self-employed and those who exchanged money for having sex with men, seemed to be the need of the hour for preventing the spread of HIV infection within and from this understudied population.
Collapse
Affiliation(s)
- Tanmay Mahapatra
- National Institute of Cholera and Enteric Diseases, P-33, Scheme—XM, Beliaghata, Kolkata, West Bengal, India
| | - Subrata Biswas
- National Institute of Cholera and Enteric Diseases, P-33, Scheme—XM, Beliaghata, Kolkata, West Bengal, India
| | - Srijita Nandi
- National Institute of Cholera and Enteric Diseases, P-33, Scheme—XM, Beliaghata, Kolkata, West Bengal, India
| | - Piyali Ghosh
- National Institute of Cholera and Enteric Diseases, P-33, Scheme—XM, Beliaghata, Kolkata, West Bengal, India
| | - Mallika Ghosh
- National Institute of Cholera and Enteric Diseases, P-33, Scheme—XM, Beliaghata, Kolkata, West Bengal, India
| | - Soumya Mondal
- Monitoring and Evaluation Division, West Bengal AIDS Prevention and Control Society, Salt Lake, Kolkata, West Bengal, India
| | - Malay K. Saha
- National Institute of Cholera and Enteric Diseases, P-33, Scheme—XM, Beliaghata, Kolkata, West Bengal, India
- * E-mail:
| |
Collapse
|
27
|
Saha MK, Mahapatra T, Biswas S, Ghosh P, Kire M. Burden and correlates of HIV risk among men who have sex with men in Nagaland, India: analysis of sentinel surveillance data. PLoS One 2015; 10:e0117385. [PMID: 25689469 PMCID: PMC4331270 DOI: 10.1371/journal.pone.0117385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/23/2014] [Indexed: 12/02/2022] Open
Abstract
Background Dynamics of HIV epidemic are largely understudied among men having sex with men (MSM) in India, while their potentially critical role in HIV spread is often stressed. Unfortunately, the epidemic has probably concentrated in this hard-to-reach population in the north-eastern high HIV-prevalent areas, especially in the bordering state of Nagaland, where HIV prevalence among MSM was found to be 2nd highest in the whole country. Dearth of information regarding the socio-behavioral correlates of HIV acquisition among MSM in this remote hilly region thus called for detailed analyses of the HIV Sentinel Surveillance (HSS) data. Methods During the first ever conducted HSS among MSM in Nagaland, between March and May, 2011, as per the operational guideline of Indian National AIDS Control Program, 243 MSM were recruited, interviewed and tested for HIV. Anonymous data on socio-demographics, sexual behavior and laboratory results were analyzed using SAS version-9.2 to conduct descriptive and logistic regression analyses. Results Among the recruited MSM, mean age was 28.30 years, 46.09% were illiterate, 27.16% were unemployed, 57.02% identified them as Kothi (predominantly receptive anal sex partner), 14.81% were bisexual, 19.75% exchanged money for sex (within last 1 year) with men and 13.58% were HIV sero-positive. Increasing age (for 25–34yrs, adjusted odds ratio: AOR = 3.89, p = 0.046; reference = <25yrs), middle school (AOR = 3.44, p = 0.046) or higher (AOR = 4.47, p = 0.034) education (reference = illiterate), being Kothi [AOR = 3.60, p = 0.026; reference = double-decker: (involved in both insertive and receptive roles)] and having paid and received money for sex with a man (AOR = 7.32, p = 0.026; reference = didn’t exchange money) were strongly associated with higher risk of HIV in both bivariate and multivariate analyses. Conclusion HIV burden was found to be alarmingly high among MSM in Nagaland. Targeted interventions for high-risk MSM, especially those who were older, educated, self-identified as kothis and involved in paid sex, seemed to be the need of the hour.
Collapse
Affiliation(s)
- Malay Kumar Saha
- Virology Division, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
- * E-mail:
| | - Tanmay Mahapatra
- Epidemiology Division, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Subrata Biswas
- Virology Division, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Piyali Ghosh
- Virology Division, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Medo Kire
- Monitoring and Evaluation Division, Nagaland State AIDS Control Society, Kohima, Nagaland, India
| |
Collapse
|
28
|
Jha UM, Raj Y, Venkatesh S, Dhingra N, Paranjpe RS, Saggurti N. HIV epidemic among men who have sex with men in India: national scenario of an unfinished agenda. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2014; 6:159-70. [PMID: 25429240 PMCID: PMC4242134 DOI: 10.2147/hiv.s69708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Although India has demonstrated success in the overall reduction of human immunodeficiency virus (HIV) incidence by 57% in the past 10 years, its control among men who have sex with men (MSM) remains a critical challenge. This paper describes the current status, geographic variability, and factors associated with HIV among MSM from the national perspective. Methods Data on the levels and trends of HIV seropositivity and associated risk behaviors among MSM were analyzed and presented from the following data sources: 1) annual HIV Sentinel Surveillance (HSS) conducted during 2003–10, 2) two rounds of the high-risk group size estimation conducted in 2005 and 2009, 3) two rounds of the Behavioral Surveillance Survey conducted in 2006 and 2009, and 4) the Integrated Bio-behavioral Assessment Round 2. Data were analyzed according to selected sociodemographic characteristics and sexual identities of MSM to understand the factors associated with high HIV prevalence. Results HSS data indicate that at the national level, HIV prevalence among MSM overall is declining (from 12.3% in 2003 to 4.43% in 2010). However, marginal increasing trends were observed in Chandigarh (from 1.4% in 2004 to 2.8% in 2008) and Haryana (from 0% in 2006 to 3.2% in 2008). HSS data indicate high (>5%) levels and increasing trends in HIV prevalence among MSM in eight states of India during 2003–10. Analysis of 2010 HSS data indicates that HIV prevalence was >10% in seven states. The factors associated with high HIV prevalence among MSM were being a kothi (the receptive partner in oral and anal sex, and typically with effeminate mannerisms) or a double-decker (both penetrative and receptive partner) rather than being a panthi (the penetrative partner in oral or anal sex) (8% vs 4.3%; P<0.05), being older than 25 years in age than their younger counterparts (9% vs 4.5%; P<0.05), illiterate rather than literate MSM (9.5% vs 6.9%; P<0.05), and employed versus unemployed MSM (9.1% vs 7.8%; P<0.05). Conclusion While HIV prevalence among MSM at the national level is declining, it continues to remain high in some states and cities. Programs need to build on the successes in reducing HIV among female sex workers in order to control the high HIV prevalence among MSM in India.
Collapse
Affiliation(s)
- Ugra Mohan Jha
- Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Yujwal Raj
- Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Srinivas Venkatesh
- Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Neeraj Dhingra
- Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | | | | |
Collapse
|
29
|
A pilot RCT of an intervention to reduce HIV sexual risk and increase self-acceptance among MSM in Chennai, India. AIDS Behav 2014; 18:1904-12. [PMID: 24770985 DOI: 10.1007/s10461-014-0773-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This is a 2-arm pilot randomized controlled trial (N = 96) of a behavioral intervention (4 group and 4 individual sessions) integrating risk reduction counseling with counseling to foster self-acceptance in MSM in India compared to enhanced standard of care (ESOC). Both conditions involved HIV and STI testing and counseling at baseline and 6-months, and assessments of condomless sex at baseline, 3-, and 6-months. A significant condition by time interaction suggested a difference in the rate of change in number of anal sex acts without condoms in the intervention versus ESOC (p < 0.0001). Post hoc contrasts suggested that the overall difference was due to intervention-response at 3-months. The incidence of bacterial STIs was 17.5 % in the intervention condition and a 28.6 % in ESOC. Addressing self-acceptance and related psychosocial concerns in the context sexual risk reduction counseling for MSM in India was feasible and acceptable. Testing the intervention for efficacy is justified.
Collapse
|
30
|
Yadav D, Chakrapani V, Goswami P, Ramanathan S, Ramakrishnan L, George B, Sen S, Subramanian T, Rachakulla H, Paranjape RS. Association between alcohol use and HIV-related sexual risk behaviors among men who have sex with men (MSM): findings from a multi-site bio-behavioral survey in India. AIDS Behav 2014; 18:1330-8. [PMID: 24458782 PMCID: PMC4045186 DOI: 10.1007/s10461-014-0699-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This paper examines the association between alcohol use and HIV-related sexual risk behaviors among men who have sex with men (MSM). A cross-sectional bio-behavioral survey was conducted among 3,880 MSM, recruited using time-location cluster sampling from cruising sites in three Indian states. Nearly three-fifths of the participants reported alcohol use. Among frequent users (40 % of the sample), defined as those who consumed alcohol daily or at least once a week, 66 % were aged 25 years and above, 53 % self-identified as kothi (feminine/receptive), and 63 % consistently used condoms with male paying partners. Multivariate logistic regression demonstrated that frequent users were more likely to be aged 25 years and above, less likely to self-identify as kothi, and less likely to consistently use condoms with male paying (AOR = 0.7; 95 % CI 0.5–0.9) and male regular (AOR = 0.7; 95 % CI 0.6–0.9) partners. HIV prevention interventions for MSM need to provide tailored information on alcohol use-related sexual risk, especially for MSM in sex work and MSM with male regular partners.
Collapse
|
31
|
Closson EF, Sivasubramanian M, Mayer KH, Srivastava A, Safren SA, Anand VR, Gangakhedkar R, Mimiaga MJ. The other side of the bridge: exploring the sexual relationships of men who have sex with men and their female partners in Mumbai, India. CULTURE, HEALTH & SEXUALITY 2014; 16:780-91. [PMID: 24815724 PMCID: PMC4090273 DOI: 10.1080/13691058.2014.911960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Behaviourally bisexual men have been identified as a 'bridge' population of HIV transmission to heterosexual women in India. Little is known about the sexual relationships that these men have with their female sex partners. The primary objective of this study was to explore the sexual practices and relationship dynamics between married and unmarried behaviourally bisexual men and their female sex partners in Mumbai, India. In 2009, semi-structured qualitative interviews were conducted with 32 men who reported sex with men and women. Participants discussed a variety of sexual practices and arrangements with female sex partners. Irrespective of marital status and sexual identity, many said that they had satisfying sexual experiences and feelings of affection for female sex partners. However, sexual incompatibility between married partners was also reported. Explanations of bisexual concurrency were discussed in terms of both sexual satisfaction and sexual preference. Self-perceived HIV risk related to same-sex sexual behaviour motivated many men to use condoms with female partners. Expectations of unprotected marital sex and perceptions of partner risk were barriers to condom use. HIV-prevention programmes for this population may benefit from tailored risk-reduction counselling that attends to the variations of these sexual and social relationship dynamics.
Collapse
Affiliation(s)
| | | | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, USA
- Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, USA
- Department of Global Health and Population, Harvard School of Public Health, Boston, USA
| | | | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, USA
- Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, USA
| | | | | | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, Boston, USA
- Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, USA
| |
Collapse
|
32
|
Saggurti N, Mishra RM, Proddutoor L, Tucker S, Kovvali D, Parimi P, Wheeler T. Community collectivization and its association with consistent condom use and STI treatment-seeking behaviors among female sex workers and high-risk men who have sex with men/transgenders in Andhra Pradesh, India. AIDS Care 2013; 25 Suppl 1:S55-66. [PMID: 23745631 PMCID: PMC4003583 DOI: 10.1080/09540121.2012.749334] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We examine community collectivization among female sex workers (FSWs) and high-risk men who have sex with men and transgenders (HR-MSM) following several years of HIV prevention programming with these populations, and its association with selected outcome indicators measuring individual behaviors (condom use with different partners and sexually transmitted infection [STI] treatment-seeking from government health facilities). Data for this study were collected from a large-scale cross-sectional survey conducted in 2010–2011 among FSWs (sample size: 3557) and HR-MSM (sample size: 2399) in Andhra Pradesh, India. We measured collectivization among FSWs in terms of three binary (low, high) indices of collective efficacy, collective agency, and collective action. Collectivization among HR-MSM was measured by participation in a public event (no, yes), and a binary (low, high) index of collective efficacy. Adjusted odds ratios (adjusted OR) and their 95% confidence intervals (CI) were computed to assess the relationships between collectivization and outcome indicators directly and through mediation of variables such as self-efficacy for condom use and utilization of government health facilities. Results show that among FSWs, high levels of collective efficacy (adjusted OR: 1.3, 95% CI: 1.1–1.7) and collective action (adjusted OR:1.3, 95% CI: 1.1–1.8) were associated with consistent condom use (CCU) with regular clients. Among HR-MSM, participation in a public event (adjusted OR: 2.7, 95% CI: 2.0–3.6) and collective efficacy (adjusted OR: 1.9, 95% CI: 1.5–2.3) were correlated with condom use with paying partners. The association between collectivization and outcome indicators continued to be significant in most cases even after adjusting for the potential mediators. Indicators of collectivization exhibited significant positive association with self-efficacy for condom use and service utilization from government health facilities among both FSWs and HR-MSM. The association of high levels of collectivization with CCU, STI treatment- seeking from government health facilities, ability to negotiate for condom use, and self-efficacy in utilizing government health facilities is relevant to effort to improve the effectiveness and sustainability of HIV prevention programs in India and beyond.
Collapse
|
33
|
Ramanathan S, Chakrapani V, Ramakrishnan L, Goswami P, Yadav D, Subramanian T, George B, Paranjape R. Consistent condom use with regular, paying, and casual male partners and associated factors among men who have sex with men in Tamil Nadu, India: findings from an assessment of a large-scale HIV prevention program. BMC Public Health 2013; 13:827. [PMID: 24020613 PMCID: PMC3854867 DOI: 10.1186/1471-2458-13-827] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 09/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are a marginalized population at high risk for HIV infection. Promoting consistent condom use (CCU) during anal sex is a key risk reduction strategy for HIV prevention among MSM. To inform effective HIV prevention interventions, we examined the factors associated with CCU among MSM with their regular, paying, and casual partners, as well as with all three types of partners combined. METHODS Data for this analysis were from a large-scale bio-behavioural survey conducted during 2009-2010 in Tamil Nadu, India. MSM aged 18 years or older were recruited for the survey using time-location cluster sampling at cruising sites in four districts of Tamil Nadu. Binary logistic regression analyses were conducted to assess the association of CCU with selected socio-demographic characteristics and other contextual factors. RESULTS Among 1618 MSM interviewed, CCU during anal sex with regular, paying, and a casual male partner was 45.3%, 50.8% and 57.9%, respectively. CCU with all three types of partners combined was 52.6%. Characteristics associated with increased odds for CCU with MSM having all three types of partners combined were frequent receptive anal sex acts with regular partners (adjusted odds ratio [AOR] 2.17, 95% confidence interval [CI] 1.01-4.65), fewer number of casual partners (AOR 3.41, 95% CI 1.50-7.73) and membership in a community-based organization (CBO) for MSM (AOR 3.54, 95% CI 1.62-7.74). CCU with regular partners was associated with membership in a CBO (AOR 1.96, 95% CI 1.23-3.11), whereas CCU with paying, and casual male partners was associated with perceived higher risk of acquiring HIV (AOR 1.92, 95% CI 1.22-3.01) and exposure to any HIV prevention intervention (AOR 3.62, 95% CI 1.31-10.0), respectively. Being aged 26 years or older, being in debt, and alcohol use were factors associated with inconsistent condom use across partner types. CONCLUSION HIV interventions among MSM need to promote CCU with all types (regular, paying, and causal) of male partners, and need to reach MSM across all age groups. In addition to enhancing interventions that focus on individual level risk reduction, it is important to undertake structural interventions that promote social acceptance of same-sex sexuality and address contextual barriers to condom use such as alcohol use.
Collapse
Affiliation(s)
- Shreena Ramanathan
- FHI 360 India, H-5 (Ground Floor), Green Park Extension, New Delhi 110016, India.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Thompson LH, Khan S, du Plessis E, Lazarus L, Reza-Paul S, Hafeez Ur Rahman S, Pasha A, Lorway R. Beyond internalised stigma: daily moralities and subjectivity among self-identified kothis in Karnataka, South India. CULTURE, HEALTH & SEXUALITY 2013; 15:1237-1251. [PMID: 23941386 DOI: 10.1080/13691058.2013.818714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Bill and Melinda Gates Foundation has poured a tremendous amount of resources into epidemic prevention in India's high HIV prevalence zones, through their Avahan initiative. These community-centred programmes operate under the assumption that fostering community-based organisational development and empowering the community to take charge of HIV prevention and education will help to transform the wider social inequalities that inhibit access to health services. Focusing on the South Indian state of Karnataka, this paper explores a troubling set of local narratives that, we contend, hold broader implications for future programme planning and implementation. Although confronting stigma and discrimination has become a hallmark in community mobilisation discourse, communities of self-identified kothis (feminine men) who were involved in Avahan programme activities continued to articulate highly negative attitudes about their own sexualities in relation to various spheres of social life. Rather than framing an understanding of these narratives in psychological terms of 'internalized stigma', we draw upon medical anthropological approaches to the study of stigma that emphasise how social, cultural and moral processes create stigmatising conditions in the everyday lives of people. The way stigma continues to manifest itself in the self-perceptions of participants points to an area that warrants critical public health attention.
Collapse
Affiliation(s)
- Laura H Thompson
- a Department of Community Health Sciences, Faculty of Medicine , Centre for Global Public Health, University of Manitoba , Winnipeg , Canada
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Chakrapani V, Boyce P, Newman PA, Row Kavi A. Contextual influences on condom use among men who have sex with men in India: subjectivities, practices and risks. CULTURE, HEALTH & SEXUALITY 2013; 15:938-951. [PMID: 23782243 DOI: 10.1080/13691058.2013.798032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Quantitative studies among men who have sex with men in India have shown high levels of unprotected anal sex. However, there is little information about the contexts in which such men may not use condoms. Relevant information on these contexts can assist in designing HIV prevention programmes to remove barriers to consistent condom use. As part of a larger study on sexual and social networks, we explored the contexts in which men who have sex with men did not use condoms, with a focus on personal, interpersonal and structural levels of experience. Data indicate the importance of understanding the different contexts that lead to unprotected sex but also reveal that the concept 'context' itself as a complex variable to consider in research of this kind, as research subjects interpret their social worlds and sexual risks in subtle and varied ways. Based on this viewpoint we make recommendations regarding HIV prevention.
Collapse
|
36
|
Ramanathan S, Chakrapani V, Ramakrishnan L, Goswami P, Yadav D, George B, Sen S, Rachakulla H, Subramanian T, Paranjape RS. Factors Associated with Use of Latex Condom-Compatible Lubricants by Men Who Have Sex with Men in India: Implications for HIV Prevention. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2013; 2013:161085. [PMID: 26316951 PMCID: PMC4475579 DOI: 10.1155/2013/161085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/04/2013] [Indexed: 11/28/2022]
Abstract
We examined the prevalence and type of rectal lubricants use and factors associated with exclusive use of latex-condom compatible lubricants (water-based lubricants) among men who have sex with men (MSM) using data from a large-scale cross-sectional survey conducted in 2009/10 in three Indian states. Using time-location cluster sampling, 3880 MSM were recruited from cruising sites. We used multiple logistic regression to assess the association between type of lubricants used and sociodemographic and programmatic indicators. Among those who reported using lubricants (64%) more than half (53%) exclusively used water-based lubricants, less than one-tenth used exclusively oil-based lubricants, and nearly 40% used both water-based and oil-based lubricants. Factors associated with exclusive use of water-based lubricants were exposure to HIV prevention interventions (AOR: 6.18, 95% CI 4.82 to 7.92) and kothi-identified MSM-feminine/anal-receptive (AOR: 2.56, 95% CI 2.12 to 3.10). Targeted HIV interventions among MSM need to promote and distribute latex condom-compatible lubricants for use during anal sex-irrespective of their presumed or stated sexual role in anal sex, and educate them not to use oil-based lubricants with condoms.
Collapse
Affiliation(s)
- Shreena Ramanathan
- FHI 360 India, H-5 (Ground Floor), Green Park Extension, New Delhi 110016, India
| | - Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), 38 (Old No. 167), Rangarajapuram Main Road, Kodmbakkam, Chennai 600 024, India
| | - Lakshmi Ramakrishnan
- FHI 360 India, H-5 (Ground Floor), Green Park Extension, New Delhi 110016, India
| | | | - Diwakar Yadav
- FHI 360 India, H-5 (Ground Floor), Green Park Extension, New Delhi 110016, India
| | - Bitra George
- FHI 360 India, H-5 (Ground Floor), Green Park Extension, New Delhi 110016, India
| | - Shrabanti Sen
- FHI 360 India, H-5 (Ground Floor), Green Park Extension, New Delhi 110016, India
| | - Harikumar Rachakulla
- National Institute of Nutrition (ICMR), Tarnaka, Jamai Osmania, Hyderabad 500007, India
| | - Thilakavathi Subramanian
- National Institute of Epidemiology (ICMR), Second Main Road, TNHB, Ayapakkam, Chennai 600 077, India
| | - Ramesh S. Paranjape
- National AIDS Research Institute (ICMR), T 71-1A/2, M.I.D.C., Telco Road, Bhosari, Pune 411 026, India
| |
Collapse
|
37
|
Newman PA, Lee SJ, Roungprakhon S, Tepjan S. Demographic and behavioral correlates of HIV risk among men and transgender women recruited from gay entertainment venues and community-based organizations in Thailand: implications for HIV prevention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2013; 13:483-92. [PMID: 22528046 DOI: 10.1007/s11121-012-0275-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
High HIV prevalence among men who have sex with men (MSM) and transgender women in Thailand suggest a vital need for targeted interventions. We conducted a cross-sectional survey to examine and compare sexual risk behaviors, and demographic and behavioral correlates of risk, among MSM and transgender women recruited from gay entertainment venue staff and community-based organization (CBO) participants. We used venue-based sampling across nine sites in Bangkok and Chiang Mai. Among 260 participants (57.3% gay-identified, 26.9% heterosexual/bisexual-identified, 15.8% transgender; mean age = 26.7 years), nearly one-fifth (18.5%) reported unprotected anal sex (UAS), half (50.4%) sex in exchange for money, and one-fifth (20.0%) STI diagnosis (past year). Nearly one-fourth (23.1%) reported oral erectile dysfunction medication use and nearly one-fifth (19.2%) illicit drug use (past 3 months). Overall, 43.1% indicated that healthcare providers exhibited hostility towards them. Gay entertainment venue staff were significantly more likely to self-identify as heterosexual/bisexual (versus gay or transgender female), and to have less than high school degree education, higher monthly income, to have engaged in sex in exchange for money, sex with women and unprotected vaginal sex, but were significantly less likely to have engaged in UAS than CBO participants. Targeted interventions for younger MSM and transgender women, for non gay-identified men, and strategies to address structural determinants of risk, including low education and discrimination from healthcare providers, may support HIV prevention among MSM and transgender women, and serve broader national HIV prevention efforts in Thailand.
Collapse
Affiliation(s)
- Peter A Newman
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1V4.
| | | | | | | |
Collapse
|
38
|
Elouard Y, Essén B. Psychological violence experienced by men who have sex with men in Puducherry, India: a qualitative study. JOURNAL OF HOMOSEXUALITY 2013; 60:1581-1601. [PMID: 24147588 DOI: 10.1080/00918369.2013.824325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Men who have sex with men are a hidden population in India. This study explores the psychological violence such men are exposed to in Puducherry, India. Eleven in-depth interviews probe experiences of blackmail, discrimination, and rejection. Some informants modified their behaviors or appearances to avoid harassment and safeguard their families' reputations. Others told how Indian men accepted their behaviors, but rejected their identities. Social pressure to marry was also a recurring theme. Understanding the factors behind these violent experiences may facilitate their amelioration.
Collapse
Affiliation(s)
- Yajna Elouard
- a Department of Women's and Children's Health , Division of International Maternal and Child Health, Uppsala University , Uppsala , Sweden
| | | |
Collapse
|
39
|
Chakrapani V, Newman PA, Singhal N, Jerajani J, Shunmugam M. Willingness to participate in HIV vaccine trials among men who have sex with men in Chennai and Mumbai, India: a social ecological approach. PLoS One 2012; 7:e51080. [PMID: 23226560 PMCID: PMC3514227 DOI: 10.1371/journal.pone.0051080] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 10/29/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recruitment of low- and middle-income country volunteers from most-at-risk populations in HIV vaccine trials is essential to vaccine development. In India, men who have sex with men (MSM) are at disproportionately high risk for HIV infection and an important population for trial recruitment. Investigations of willingness to participate (WTP) in HIV vaccine trials have focused predominantly on individual-level determinants. We explored multi-level factors associated with WTP among MSM in India. METHODS We conducted 12 focus groups (n = 68) with low socioeconomic MSM in Chennai and Mumbai, and 14 key informant interviews with MSM community leaders and service providers. Focus groups/interviews were recorded, transcribed and translated into English. Two bilingual investigators conducted thematic analysis using line-by-line coding and a constant comparative method, with member-checking by community representatives. RESULTS Factors associated with WTP were evidenced across the social ecology of MSM-social-structural: poverty, HIV-, sexual- and gender non-conformity stigma, institutionalized discrimination and government sponsorship of trials; community-level: endorsement by MSM community leaders and organizations, and fear of within-group discrimination; interpersonal: anticipated family discord, partner rejection, having financially-dependent family members and disclosure of same-sex sexuality; and individual-level: HIV vaccine trial knowledge and misconceptions, safety concerns, altruism and preventive misconception. CONCLUSION Pervasive familial, community and social-structural factors characteristic of the Indian sociocultural context may complicate individual-focused approaches to WTP and thereby constrain the effectiveness of interventions to support recruitment and retention in HIV vaccine trials. Interventions to reduce stigma and discrimination against MSM and people living with HIV, capacity-building of MSM community organizations and transparent communications tailored to the knowledge and educational level of local communities may support meaningful engagement of MSM in HIV vaccine trials. Vigilance in providing fair but not excessive compensation and healthcare benefits and in mitigating preventive misconception are warranted to support ethical conduct of trials among MSM in India.
Collapse
Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy, Chennai, India
- The Humsafar Trust, Mumbai, India
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy, Chennai, India
- The Humsafar Trust, Mumbai, India
| |
Collapse
|
40
|
Logie C. The case for the World Health Organization's Commission on the Social Determinants of Health to address sexual orientation. Am J Public Health 2012; 102:1243-6. [PMID: 22594723 DOI: 10.2105/ajph.2011.300599] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The World Health Organization's (WHO's) social determinants of health discussion underscores the need for health equity and social justice. Yet sexual orientation was not addressed within the WHO Commission on the Social Determinants of Health final report Closing the Gap in a Generation. This omission of sexual orientation as a social determinant of health stands in stark contrast with a body of evidence that demonstrates that sexual minorities are disproportionately affected by health problems associated with stigma and discrimination, such as mental health disorders. I propose strategies to integrate sexual orientation into the WHO's social determinants of health dialogue. Recognizing sexual orientation as a social determinant of health is an important first step toward health equity for sexual minorities.
Collapse
Affiliation(s)
- Carmen Logie
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
41
|
Logie CH, Newman PA, Chakrapani V, Shunmugam M. Adapting the minority stress model: Associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India. Soc Sci Med 2012; 74:1261-8. [DOI: 10.1016/j.socscimed.2012.01.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/31/2011] [Accepted: 01/11/2012] [Indexed: 10/28/2022]
|
42
|
Shaw SY, Lorway RR, Deering KN, Avery L, Mohan HL, Bhattacharjee P, Reza-Paul S, Isac S, Ramesh BM, Washington R, Moses S, Blanchard JF. Factors associated with sexual violence against men who have sex with men and transgendered individuals in Karnataka, India. PLoS One 2012; 7:e31705. [PMID: 22448214 PMCID: PMC3308942 DOI: 10.1371/journal.pone.0031705] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 01/18/2012] [Indexed: 11/21/2022] Open
Abstract
Objectives There is a lack of information on sexual violence (SV) among men who have sex with men and transgendered individuals (MSM-T) in southern India. As SV has been associated with HIV vulnerability, this study examined health related behaviours and practices associated with SV among MSM-T. Design Data were from cross-sectional surveys from four districts in Karnataka, India. Methods Multivariable logistic regression models were constructed to examine factors related to SV. Multivariable negative binomial regression models examined the association between physician visits and SV. Results A total of 543 MSM-T were included in the study. Prevalence of SV was 18% in the past year. HIV prevalence among those reporting SV was 20%, compared to 12% among those not reporting SV (p = .104). In multivariable models, and among sex workers, those reporting SV were more likely to report anal sex with 5+ casual sex partners in the past week (AOR: 4.1; 95%CI: 1.2–14.3, p = .029). Increased physician visits among those reporting SV was reported only for those involved in sex work (ARR: 1.7; 95%CI: 1.1–2.7, p = .012). Conclusions These results demonstrate high levels of SV among MSM-T populations, highlighting the importance of integrating interventions to reduce violence as part of HIV prevention programs and health services.
Collapse
Affiliation(s)
- Souradet Y Shaw
- Department of Community Health Sciences, Faculty of Medicine, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Correlates of HIV testing uptake among kothi-identified men who have sex with men in public sex environments in Chennai, India. AIDS Behav 2012; 16:53-62. [PMID: 21630011 DOI: 10.1007/s10461-011-9974-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Kothi-identified men who have sex with men in India are highly marginalized and are at high-risk for HIV. This study examines HIV testing among 132 self-reported HIV-negative and unknown serostatus kothis recruited from public sex environments in Chennai, India. Using logistic regression we identified variables associated with HIV testing uptake (i.e., being tested and knowing the result). Sixty-one percent reported HIV testing uptake. At the bivariate level, married men, those with low HIV transmission knowledge, those who engaged in unprotected anal sex and unprotected receptive anal sex were at lower odds of reporting testing uptake. In multivariate analysis, married men and those with low levels of HIV transmission knowledge were at decreased odds of being tested, as were kothis who experienced forced sex. Culturally competent programs engaging married kothis are needed. Interventions to facilitate HIV prevention education and systemic interventions to combat sexual violence may facilitate HIV testing uptake among kothis.
Collapse
|
44
|
Sivasubramanian M, Mimiaga MJ, Mayer KH, Anand VR, Johnson CV, Prabhugate P, Safren SA. Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample. PSYCHOL HEALTH MED 2011; 16:450-62. [PMID: 21749242 DOI: 10.1080/13548506.2011.554645] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD = 5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR = 0.85, 95% CI: 0.78-0.93; social support AOR = 0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR = 0.79, 95% CI: 0.71-0.89; social support AOR = 0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR = 0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.
Collapse
|
45
|
Chakrapani V, Newman PA, Shunmugam M, Dubrow R. Barriers to free antiretroviral treatment access among kothi-identified men who have sex with men and aravanis (transgender women) in Chennai, India. AIDS Care 2011; 23:1687-94. [PMID: 22117127 PMCID: PMC3228306 DOI: 10.1080/09540121.2011.582076] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Indian government provides free antiretroviral treatment (ART) for people living with HIV. To assist in developing policies and programs to advance equity in ART access, we explored barriers to ART access among kothis (men who have sex with men [MSM] whose gender expression is feminine) and aravanis (transgender women, also known as hijras) living with HIV in Chennai. In the last quarter of 2007, we conducted six focus groups and four key-informant interviews. Data were explored using framework analysis to identify categories and derive themes. We identified barriers to ART access at the family/social-level, health care system-level, and individual-level; however, we found these barriers to be highly interrelated. The primary individual-level barrier was integrally linked to the family/social and health care levels: many kothis and aravanis feared serious adverse consequences if their HIV-positive status were revealed to others. Strong motivations to keep one's HIV-positive status and same-sex attraction secret were interconnected with sexual prejudice against MSM and transgenders, and HIV stigma prevalent in families, the health care system, and the larger society. HIV stigma was present within kothi and aravani communities as well. Consequences of disclosure, including rejection by family, eviction from home, social isolation, loss of subsistence income, and maltreatment (although improving) within the health care system, presented powerful disincentives to accessing ART. Given the multi-level barriers to ART access related to stigma and discrimination, interventions to facilitate ART uptake should address multiple constituencies: the general public, health care providers, and the kothi and aravani communities. India needs a national policy and action plan to address barriers to ART access at family/social, health care system, and individual levels for aravanis, kothis, other subgroups of MSM and other marginalized groups.
Collapse
|
46
|
Lorway R, Hwang SD, Reza-Paul S, Pasha A, Rahman SHU, Moses S, Blanchard J. Sex in the city: Privacy-making practices, spatialized intimacies and the environmental risks of men-who-have-sex-with-men in South India. Health Place 2011; 17:1090-7. [DOI: 10.1016/j.healthplace.2011.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 05/20/2011] [Accepted: 05/23/2011] [Indexed: 11/16/2022]
|
47
|
Mustanski BS, Newcomb ME, Du Bois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. JOURNAL OF SEX RESEARCH 2011; 48:218-53. [PMID: 21409715 PMCID: PMC3351087 DOI: 10.1080/00224499.2011.558645] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the United States. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. The article concludes that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, the article suggests that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors.
Collapse
Affiliation(s)
- Brian S Mustanski
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60608, USA.
| | | | | | | | | |
Collapse
|
48
|
Phillips AE, Boily MC, Lowndes CM, Garnett GP, Gurav K, Ramesh BM, Anthony J, Watts R, Moses S, Alary M. Sexual identity and its contribution to MSM risk behavior in Bangaluru (Bangalore), India: the results of a two-stage cluster sampling survey. ACTA ACUST UNITED AC 2009; 4:111-26. [PMID: 19856744 DOI: 10.1080/15574090902922975] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In India, there are categories of MSM (hijras, kothis, double-deckers, panthis and bisexuals), which are generally associated with different HIV-risk behaviors. Our objective was to quantify differences across MSM identities (n = 357) and assess the extent they conform to typecasts that prevail in policy-orientated discourse. More feminine kothis (26%) and hijras (13%) mostly reported receptive sex, and masculine panthis (15%) and bisexuals (23%) insertive anal sex. However, behavior did not always conform to expectation, with 25% and 16% of the sample reporting both insertive and receptive anal intercourse with known and unknown noncommercial partners, respectively (p < 0.000). Although behavior often complied with stereotyped role and identity, male-with-male sexual practices were fluid. Reification of these categories in an intervention context may hinder our understanding of the differential HIV risk among MSM.
Collapse
Affiliation(s)
- A E Phillips
- Department of Infectious Disease Epidemiology, Imperial College, St Mary Hospital, London, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Thomas B, Mimiaga MJ, Mayer KH, Johnson CV, Menon S, Chandrasekaran V, Murugesan P, Swaminathan S, Safren SA. HIV prevention interventions in Chennai, India: are men who have sex with men being reached? AIDS Patient Care STDS 2009; 23:981-6. [PMID: 19821722 DOI: 10.1089/apc.2009.0092] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
India has the greatest number of HIV infections in Asia and the third highest total number of infected persons globally. Men who have sex with men (MSM) are considered by the Government of India's National AIDS Control Organization (NACO) a "core risk group" for HIV in need of HIV prevention efforts. However there is a dearth of information on the frequency of participation in HIV prevention interventions and subsequent HIV risk and other correlates among MSM in India. Recruited through peer outreach workers, word of mouth and snowball sampling techniques, 210 MSM in Chennai completed an interviewer-administered assessment, including questions about participating in any HIV prevention interventions in the past year, sexual risk taking, demographics, MSM identities, and other psychosocial variables. Bivariate and multivariable logistic regression procedures were used to examine behavioral and demographic correlates with HIV prevention intervention participation. More than a quarter (26%) of the sample reported participating in an HIV prevention intervention in the year prior to study participation. Participants who reported engaging in unprotected anal sex (UAS; odds ratio [OR] = 0.28; p = 0.01) in the 3 months prior to study enrollment were less likely to have participated in an HIV prevention program in the past year. MSM who were older (OR = 1.04; p = 0.05), kothis (feminine acting/appearing and predominantly receptive partners in anal sex) compared to panthis (masculine appearing, predominantly insertive partners; OR = 5.52, p = 0.0004), those with higher educational attainment (OR = 1.48, p = 0.01), being "out" about having sex with other men (OR = 4.03, p = 0.0001), and MSM who reported ever having been paid in exchange for sex (OR = 2.92, p = 0.001) were more likely to have reported participation in an HIV prevention intervention in the preceding year. In a multivariable model, MSM reporting UAS in the prior 3 months were less likely to have participated in an HIV prevention intervention (AOR = 0.34, p = 0.04). MSM who were older (AOR = 1.05, p = 0.05), those with higher educational attainment (AOR = 1.92, p = 0.0009), and MSM who were "out" about having sex with other men (AOR = 2.71, p = 0.04) were more likely to have reported participating in an HIV prevention program. Findings suggest that exposure to HIV prevention interventions may be protective against engaging in UAS for some MSM in India. Understanding predictors of participation in an HIV prevention intervention is helpful for identifying Indian MSM who might have had no exposure to HIV prevention information and skills building, hence allowing researchers and prevention workers to focus efforts on individuals at greatest need.
Collapse
Affiliation(s)
- Beena Thomas
- Tuberculosis Research Center, Indian Council of Medical Research, Chennai, India
| | - Matthew J. Mimiaga
- Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Brown Medical School/Miriam Hospital, Providence, Rhode Island
| | | | | | - V. Chandrasekaran
- Tuberculosis Research Center, Indian Council of Medical Research, Chennai, India
| | - P. Murugesan
- Tuberculosis Research Center, Indian Council of Medical Research, Chennai, India
| | - Soumya Swaminathan
- Tuberculosis Research Center, Indian Council of Medical Research, Chennai, India
| | - Steven A. Safren
- Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| |
Collapse
|
50
|
Newman PA, Chakrapani V, Cook C, Shunmugam M, Kakinami L. Determinants of Sexual Risk Behavior Among Men Who Have Sex with Men Accessing Public Sex Environments in Chennai, India. ACTA ACUST UNITED AC 2009; 4:81-7. [DOI: 10.1080/15574090902913669] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P. A. Newman
- a Factor-Inwentash Faculty of Social Work/Center for Applied Social Research , University of Toronto , Toronto , Ontario , Canada
| | - V. Chakrapani
- b Indian Network of People Living With HIV , Chennai , India
| | - C. Cook
- c Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - M. Shunmugam
- d Social Welfare Association for Men (SWAM) , Chennai , India
| | - L. Kakinami
- e Division of Public Health , University of Rochester , Rochester , NY
| |
Collapse
|