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Agarwal H, Núñez I, Hill LM, Dubé K, Knoble A, Pamilerin O. Perceptions and experiences of daily and long-acting pre-exposure prophylaxis (PrEP) among MSM in India. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001477. [PMID: 38232067 PMCID: PMC10793913 DOI: 10.1371/journal.pgph.0001477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/08/2023] [Indexed: 01/19/2024]
Abstract
Oral pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy with high efficacy. An increased willingness to use PrEP among at-risk Indian men who have sex with men (MSM) population has been reported; however, little is known about their real experiences that guide their key motivators, facilitators, and barriers with using oral and Long-Acting (LA) Injectable PrEP. We recruited participants (n = 18) through active MSM social media networks. The interviews were conducted using teleconferencing software. Interview topics included participants' sources of knowledge, experiences accessing daily PrEP, safe-sex behaviors while on PrEP, barriers and facilitators around PrEP, long-term goals with PrEP, perceptions around LA PrEP, and discussion around decision-making to switch from oral PrEP to LA PrEP. Transcripts were coded according to interview topics, and key themes were analyzed using a topical data analysis approach. Participants (median age 28 years, ranging from 18 to 40) reported a high perceived risk of HIV. This increased perceived risk was a key motivator for oral PrEP uptake. Most participants shared that they accessed PrEP through non-profit organizations serving the MSM community, where doctor consultations and medication were either free or subsidized. Even when participants reported high adherence to oral PrEP, they expressed discontent with the requirement to take it daily. High condom usage was reported concomitantly with PrEP use among most participants, except for a few who preferred bareback sex. Participants shared that they would prefer to continue PrEP until they are in a monogamous, exclusive relationship. The cost and affordability remained recurring themes, and while participants could afford oral PrEP, they wished it was cheaper, making it more accessible to the community at large. Most participants did not have prior knowledge of LA injectable PrEP but welcomed the intervention, alluding to cost and availability as the key decision-making factors affecting switching. MSM from India we interviewed adopted oral PrEP as an additional HIV prevention strategy to condoms through non-profit and private channels. Cost and broader access remains a concern among the MSM community. More acceptability research about long-acting PrEP is needed among MSM in the Indian context, and it is recommended for government interventions to include oral PrEP groups at higher risk of HIV acquisition.
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Affiliation(s)
- Harsh Agarwal
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ivania Núñez
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lauren M. Hill
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego (UCSD), San Diego, California, United States of America
| | - Abigail Knoble
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Oluwamuyiwa Pamilerin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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2
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Saleem M, Marimuthu J, Gandhi AP. Uptake and impact of COVID-19 vaccination among HIV key populations: a cohort study from Tamil Nadu, India. J Rural Med 2023; 18:215-221. [PMID: 37854511 PMCID: PMC10579930 DOI: 10.2185/jrm.2023-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/12/2023] [Indexed: 10/20/2023] Open
Abstract
Objective Human Immunodeficiency Virus (HIV) Key Populations (KPs) include Female Sex Workers (FSWs), men who have sex with men (MSM), transgender (TG), and transsexual (TS) persons. This study assessed coronavirus disease 2019 (COVID-19) vaccine uptake among KPs for HIV in India, adverse events following immunization (AEFI), and breakthrough infections among the vaccinated. Materials and Methods This retrospective cohort study was conducted among 421 KPs enrolled in 41 Targeted Intervention (TI) clusters in 31 districts of the Tamil Nadu State Acquired Immunodeficiency Syndrome (AIDS) Control Society (TANSACS), India, from June to September 2022. A semi-structured, bilingual (English and Tamil), interviewer-administered questionnaire was used to collect data on socio-demographic characteristics, vaccination status, AEFIs, and breakthrough infections among the KPs under the TIs. Results Among the KPs, 45.4% were FSWs, 37.1% were MSM, 16.2% were TG, and 1.4% were TS persons. Among them, 4.3% had HIV, and 2.9% had syphilis or other sexually transmitted infections (STIs). The COVID-19 vaccine uptake rate was 96%. Among the KPs, TG/TS persons had the highest vaccine uptake (98.6%), followed by FSWs (96.3%) and MSM (94.2%). AEFIs were reported by 85.4% of the participants. HIV positive status was significantly associated with the incidence of AEFI. The breakthrough infection rate was 5.4% among the vaccinated participants. Conclusion The COVID-19 vaccine uptake among HIV KPs was high in Tamil Nadu. AEFIs and breakthrough infections among COVID-19 vaccinated HIV KPs may be low, with mild AEFIs.
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Affiliation(s)
- M Saleem
- Department of Community Medicine, Government Dindigul Medical
College, India
| | - Janakiram Marimuthu
- Department of Community Medicine, Government Dindigul Medical
College, India
- Department of Community Medicine, Government Vellore Medical
College, India
- Targeted Intervention and Strategic Information Management
Unit, Tamil Nadu AIDS Control Society, India
| | - Aravind P Gandhi
- Department of Community Medicine, ESIC Medical College &
Hospital, Hyderabad, India
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3
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Santhakumar A, David JK, Nagaraj J, Mathiyazhakan M, Ganesh B, Manikandan N, Padmapriya VM, Kumar P, Rajan S, Elangovan A. Socio-demographic and behavioural determinants of HIV prevalence among homosexual and bisexual men having sex with men (MSM) in India: Integrated bio-behavioural surveillance. Afr Health Sci 2023; 23:67-80. [PMID: 38223617 PMCID: PMC10782288 DOI: 10.4314/ahs.v23i2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background HIV prevalence among men who have sex with men (MSM) is 16.5 times higher than adult HIV prevalence. With a socio-cultural context that demands marriage, a considerable proportion of MSM in India have female sexual partners and act as a bridge population. Stratified analysis of HIV risk factors among homosexual and bisexual MSM will be instrumental in identifying the high-risk MSM. We aim to identify the socio-demographic and behavioural factors associated with HIV risk among homosexual and bisexual MSM. Methods Overall, 23081 MSM were enrolled in the IBBS conducted across India between October 2014 and November 2015. Data and blood samples were collected. Chi-square test, univariate and multivariable logistic regression methods were used in data analysis. Results HIV prevalence was significantly higher among homosexual MSM than bisexual MSM. Older age, lesser education, being a sex worker, being married, living with a male or hijra partner, younger age at initiation of MSM behaviour, duration, injecting drugs, and having STI symptoms were associated with higher prevalence. The prevalence of new homosexual MSM was 11.4%. Nearly 75% of the bisexual MSM reported inconsistent condom usage with female partners. Conclusion Interventions for early identification of new MSM and advocacy for safe sex with alternative preventive techniques are recommended.
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Affiliation(s)
- Aridoss Santhakumar
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Joseph K David
- Scientist-D (Former), ICMR - National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu
| | - Jaganathasamy Nagaraj
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Malathi Mathiyazhakan
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Balasubramanian Ganesh
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Natesan Manikandan
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - VM Padmapriya
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Pradeep Kumar
- National AIDS Control Organization, Ministry of Health Family Welfare, Government of India, 36 Janpath road, New Delhi-110 001, India
| | - Shobini Rajan
- National AIDS Control Organization, Ministry of Health Family Welfare, Government of India, 36 Janpath road, New Delhi-110 001, India
| | - Arumugam Elangovan
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
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4
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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.
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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
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5
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Bangar S, Mohan U, Kumar S, Mahapatra A, Singh SK, Kohli R, Verma A, Katendra TL, Rahane G, Shewale SP, Yenbhar N, Verma V, Saravanamurthy P, George B, Kushwaha BS, Das C, Rajan S, Sahay S. Exploring access to HIV-related services and programmatic gaps for Men having Sex with Men (MSM) in rural India- a qualitative study. PLoS One 2023; 18:e0284901. [PMID: 37141198 PMCID: PMC10159193 DOI: 10.1371/journal.pone.0284901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/02/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Despite the Link Worker Scheme to address the HIV risk and vulnerabilities in rural areas, reaching out to unreached men having sex with men (MSM) remains a challenge in rural India. This study explored issues around health care access and programmatic gaps among MSM in rural settings of India. METHODS We conducted eight Focused Group Discussions (FGDs), 20 Key Informant Interviews (KIIs), and 20 In-Depth Interviews (IDIs) in four rural sites in Maharashtra, Odisha, Madhya Pradesh, and Uttar Pradesh between November 2018 and September 2019. The data in the local language were audio-recorded, transcribed, and translated. Data were analyzed in NVivo version 11.0 software using the grounded theory approach. RESULTS Primary barriers to health care access were lack of knowledge, myths and misconceptions, not having faith in the quality of services, program invisibility in a rural setting, and anticipated stigma at government health facilities. Government-targeted intervention services did not seem to be optimally advertised in rural areas as MSM showed a lack of information about it. Those who knew reported not accessing the available government facilities due to lack of ambient services, fear of the stigma transforming into fear of breach of confidentiality. One MSM from Odisha expressed, "…they get fear to go to the hospital because they know that hospital will not maintain confidentiality because they are local people. If society will know about them, then family life will be disturbed" [OR-R-KI-04]. Participants expressed the desire for services similar to those provided by the Accredited Social Health Activists (ASHA), frontline health workers for MSM. CONCLUSION Programme invisibility emerges as the most critical issue for rural and young MSM. Adolescent and panthis emerged as Hidden MSM and they need focused attention from the programme. The need for village-level workers such as ASHA specifically for the MSM population emerged. MSM-friendly health clinics would help to improve healthcare access in rural MSMs under Sexual and Reproductive Health Care.
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Affiliation(s)
- Sampada Bangar
- Epidemiology Division, ICMR-National AIDS Research Institute, Pune, India
| | - Uday Mohan
- Upgraded Department of Community Medicine and Public Health, King George's Medical University, Lucknow, India
| | - Sanjeev Kumar
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Amarendra Mahapatra
- Epidemiology Division, ICMR-Regional Medical Research Center, Bhubaneswar, India
| | - Shivendra Kumar Singh
- Upgraded Department of Community Medicine and Public Health, King George's Medical University, Lucknow, India
| | - Rewa Kohli
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Archana Verma
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Tuman Lal Katendra
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Girish Rahane
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Suhas P Shewale
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Nayana Yenbhar
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Vinita Verma
- National AIDS Control Organization, New Delhi, India
| | | | | | | | - Chinmoyee Das
- National AIDS Control Organization, New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organization, New Delhi, India
| | - Seema Sahay
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
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Bhutada K, Chakrapani V, Gulfam FR, Ross J, Golub SA, Safren SA, Prasad R, Patel VV. Pathways Between Intersectional Stigma and HIV Treatment Engagement Among Men Who Have Sex with Men (MSM) in India. J Int Assoc Provid AIDS Care 2023; 22:23259582231199398. [PMID: 37701971 PMCID: PMC10501078 DOI: 10.1177/23259582231199398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/13/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
In India and other low-and-middle-income countries, little is known about how intersectional stigma affects MSM engagement in ART. Informed by the Health Stigma and Discrimination Framework, we qualitatively examined how multiple stigmas influence ART engagement among Indian MSM. We conducted 3 focus groups (N = 22) with MSM living with HIV, aged 21-58 years, in Delhi and Hyderabad to identify potential intervention targets and solutions to improve treatment outcomes. Framework analysis and techniques were used to code and analyze translated audio-recordings. Findings revealed enacted stigma, associated with HIV and MSM identity, manifested as familial shame and healthcare discrimination, inhibiting access to support, and decreasing HIV care engagement. Anticipated stigma led to worry about disclosure and societal repercussions. Community-Based-Organizations, ART centers, and family members were primary sources of support, leading to increased ART initiation and retention. Potential solutions included using MSM peer-counselors, increasing social support, and providing HIV education to the general community.
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Affiliation(s)
- Kiran Bhutada
- Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA
| | - Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), C-ShaRP, Chennai, India Chennai, India
| | | | - Jonathan Ross
- Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA
| | | | | | | | - Viraj V Patel
- Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA
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7
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Chakrapani V, Newman PA, Sebastian A, Rawat S, Mittal S, Gupta V, Kaur M. Mental health, economic well-being and health care access amid the COVID-19 pandemic: a mixed methods study among urban men who have sex with men in India. Sex Reprod Health Matters 2022; 30:2144087. [PMID: 36476183 PMCID: PMC9733688 DOI: 10.1080/26410397.2022.2144087] [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: 12/12/2022] Open
Abstract
Scant empirical research from Asia has addressed the impact of COVID-19 on sexual minority health. We aimed to explore and understand the impact of COVID-19 on income security, mental health, HIV risk and access to health services among men who have sex with men (MSM) in India. We conducted a concurrent mixed methods study from April to June 2020, including a cross-sectional survey and in-depth semi-structured interviews with MSM recruited from three non-governmental organisations providing HIV prevention services in Chandigarh, India. We examined the associations of sexual minority stressors (sexual stigma, internalised homonegativity), economic stressors, and stress due to social distancing, with depression and anxiety, HIV risk, and access to health services. Survey findings (n = 132) indicated that internalised homonegativity and stress related to social distancing were significantly associated with depressive and anxiety symptoms. Results also showed reduced access to condoms, HIV testing and counselling services. Qualitative findings (n = 10) highlighted adverse economic impacts of COVID-19, including loss of employment/wages and engaging in survival sex work, which contributed to psychological distress and HIV risk. The COVID-19 pandemic has resulted in considerable psychological and financial distress among low socioeconomic status MSM in India, including those involved in sex work - communities already marginalised in economic, family and healthcare sectors. Structural interventions to improve access to mental health and HIV services and decrease financial burden are critical to mitigate the impact of COVID-19.
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Affiliation(s)
- Venkatesan Chakrapani
- Chairperson, Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India; DBT/Wellcome Trust India Alliance Senior Fellow, The Humsafar Trust, Mumbai, India. Correspondence: ,
| | - Peter A Newman
- Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Aleena Sebastian
- Assistant Professor, National Institute of Advanced Studies (NIAS), Bangalore, India
| | - Shruta Rawat
- Research Manager, The Humsafar Trust, Mumbai, India
| | - Sandeep Mittal
- Deputy Director (Targeted Interventions), Chandigarh State AIDS Control Society (CSACS), Chandigarh, India
| | - Vanita Gupta
- Project Director, Chandigarh State AIDS Control Society (CSACS), Chandigarh, India
| | - Manmeet Kaur
- Professor, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Kazemian P, Ding DD, Scott JA, Feser MK, Biello K, Thomas BE, Dange A, Bedoya CA, Balu V, Rawat S, Kumarasamy N, Mimiaga MJ, O'Cleirigh C, Weinstein MC, Kumar JP, Kumar S, Mayer KH, Safren SA, Freedberg KA. The cost-effectiveness of a resilience-based psychosocial intervention for HIV prevention among MSM in India. AIDS 2022; 36:1223-1232. [PMID: 35471644 PMCID: PMC9283429 DOI: 10.1097/qad.0000000000003231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE MSM in India are at a high risk for HIV infection given psychosocial challenges, sexual orientation stress, and stigma. We examined the cost-effectiveness of a novel resilience-based psychosocial intervention for MSM in India. DESIGN We parameterized a validated microsimulation model (CEPAC) with India-specific data and results from a randomized trial and examined two strategies for MSM: status quo HIV care ( SQ ), and a trial-based psychosocial intervention ( INT ) focused on building resilience to stress, improving mental health, and reducing condomless anal sex (CAS). METHODS We projected lifetime clinical and economic outcomes for MSM without HIV initially. Intervention effectiveness, defined as reduction in self-reported CAS, was estimated at 38%; cost was $49.37/participant. We used a willingness-to-pay threshold of US$2100 (2019 Indian per capita GDP) per year of life saved (YLS) to define cost-effectiveness. We also assessed the 5-year budget impact of offering this intervention to 20% of Indian MSM. RESULTS Model projections showed the intervention would avert 2940 HIV infections among MSM over 10 years. Over a lifetime horizon, the intervention was cost-effective (ICER = $900/YLS). Results were most sensitive to intervention effectiveness and cost; the intervention remained cost-effective under plausible ranges of these parameters. Offering this intervention in the public sector would require an additional US$28 M over 5 years compared with SQ . CONCLUSION A resilience-based psychosocial intervention integrated with HIV risk reduction counseling among MSM in India would reduce HIV infections and be cost-effective. Programs using this approach should be expanded as a part of comprehensive HIV prevention in India.
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Affiliation(s)
- Pooyan Kazemian
- Department of Operations, Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio
| | - Delaney D Ding
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Justine A Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary K Feser
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Katie Biello
- Center for Health Promotion and Health Equity
- Department of Behavioral and Social Sciences
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Beena E Thomas
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu
| | | | - C Andres Bedoya
- Behavioral Medicine Program, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Vinoth Balu
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu
| | | | - Nagalingeswaran Kumarasamy
- CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services, Chennai, Tamil Nadu, India
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Epidemiology, UCLA Fielding School of Public Health
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, California
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Behavioral Medicine Program, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jacob Prem Kumar
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
| | - Steven A Safren
- Center for HIV and Research in Mental Health
- Health Promotion and Care Research Program
- Department of Psychology, University of Miami, Miami, Florida
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Health Policy and Management
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
- Division of General Internal Medicine
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
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9
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Mapping and size estimation of men who have sex with men in virtual platforms in Delhi, India. PLoS One 2022; 17:e0262094. [PMID: 35051213 PMCID: PMC8775339 DOI: 10.1371/journal.pone.0262094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction In India, the HIV epidemic is concentrated among Key Populations (KPs), such as men who have sex with men (MSM), who bear a disproportionate burden of HIV disease. Conventional targeted interventions (TI) mitigate HIV transmission among MSM by focusing on physical hotspots. As increasingly, there is a shift within India’s MSM community to connect with sex partners online, novel approaches are needed to map virtual platforms where sexual networks are formed. The objective of this study was to estimate the number of MSM in Delhi using virtual platforms to connect for sex and to describe patterns of their use. Methods The study was conducted in the state of Delhi among MSM over 18 years of age who used virtual platforms to look for sexual partners. Virtual platforms were identified through community consultations. Size estimation was carried out by enumerating the number of online users, accounting for duplication across sites and time and based on interviews with 565 MSM. Results 28,058 MSM (95% CI: range 26,455–29,817) use virtual sites to find sexual partners. We listed 14 MSM specific virtual sites, 14 general virtual sites, 19 social networking pages and 112 messenger groups, all used by MSM. Five virtual sites met feasibility criteria to be included in the virtual mapping. Of the MSM on these sites, 81% used them at night and 94% used them on Sundays, making these the peak time and day of use. Only 16% of users were aware of organizations providing HIV services and 7% were contacted by peer educators in the preceding three months. Two-fifths (42%) also visited a physical location to connect with sexual partners in the month prior to the study. Discussion TI programs that focus on physical hotspots do not reach the majority of MSM who use virtual sites. MSM active on virtual sites have a low awareness of HIV services. Virtual mapping and programmatic interventions to include them must be incorporated into current public health interventions to reach MSM at risk of HIV.
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Pan H, Lin B, Shi G, Ma Y, Zhong X. Anxiety and Depression Status and Influencing Factors of MSM in the Post-COVID-19 Epidemic Period: A Cross-Sectional Study in Western China. Am J Mens Health 2021; 15:15579883211057701. [PMID: 34836469 PMCID: PMC8649104 DOI: 10.1177/15579883211057701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study aimed to explore the psychological status and influencing factors of men who have sex with men (MSM) during the stable period of the COVID-19 epidemic, to provide a reference for the mental health counseling of MSM, and to provide a scientific basis for this group to actively respond to public health emergencies. A cross-sectional survey was conducted on the demographic characteristics, epidemic experiences, risk perception, and COVID-19-related attitudes of MSM in western China, and MSM anxiety and depression were assessed by using the Anxiety Self-Rating Scale and the Center for Epidemiological Studies Depression (CES-D) Scale. The incidences of MSM anxiety and depression in the post-COVID-19 epidemic period are 21.7% and 38.0%, respectively. Logistic regression analysis showed that in terms of anxiety, high controllability of the epidemic (OR = 0.7616) is a protective factor. Thinking that they are more susceptible to COVID-19 (OR = 1.6168) and worrying about another outbreak of the epidemic (OR = 1.4793) are risk factors. In terms of depression, being able to protect themselves from being infected with COVID-19 (OR = 0.6280) is a protective factor. The role of anal sex as “0”/“0.5,” and believing that they are more susceptible to COVID-19 (OR = 1.3408) are risk factors. The sudden outbreak affected the psychological state of MSM and even caused negative feelings of anxiety and depression. These findings suggest that prevention and education should be strengthened, and effective intervention measures should be taken as soon as possible, to improve the mental health of MSM.
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Affiliation(s)
- Hong Pan
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Bing Lin
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Guiqian Shi
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yingjie Ma
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
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11
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Pufahl J, Rawat S, Chaudary J, Shiff NJ. Even Mists Have Silver Linings: Promoting LGBTQ+ Acceptance and Solidarity through Community-Based Theatre in India. Public Health 2021; 194:252-259. [PMID: 33991810 DOI: 10.1016/j.puhe.2021.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This project aimed to assess the effectiveness of a community-based theatre intervention to improve attitudes towards and increase knowledge about LGBTQ+ communities among audiences in Mumbai, India. STUDY DESIGN This study was a program evaluation using pre- and post-show surveys that incorporated an adapted version of The Riddle Scale: Attitudes Towards Difference and questions assessing self-reported knowledge about LGBTQ+-related issues to assess changes in attitudes and knowledge after viewing the theatre intervention. METHODS An original 90-min devised play was created by a company of Indian, American, and Canadian theatre artists using Participatory Action Research methods and was designed to bring audiences to a deeper understanding of LGBTQ+ identity. The show was performed four times in Mumbai, India, and pre-/post-show surveys were collected at each performance. Audience survey responses were analysed using parametric and non-parametric descriptive statistics as appropriate, and Likert scale questions were compared using Wilcoxon Signed Rank for non-parametric data. RESULTS A total 184 surveys were completed across four performances between March 7 and 14, 2020. Significant increases in audiences' self-reported knowledge of LGBTQ+ identity, impacts of discrimination, and struggles faced by LGBTQ+ communities were reported after viewing the show. Furthermore, attitudes towards LGBTQ+ rights, understanding of the challenges of being LGBTQ+ in India, and recognition of the contributions LGBTQ+ individuals make to society improved significantly among our audiences after test. The play further fostered increased acceptance of prosocial behaviours towards LGBTQ+ individuals with higher percentages of audiences recognizing the importance of standing up to homophobia and anti-gay attitudes. While these observations were seen across audiences, they were particularly pronounced among cisgender heterosexual men and audiences ages 18-24. CONCLUSION Community-based theatre intervention is highly acceptable and effective as a medium for informing positive attitudes, improving knowledge, and promoting acceptance of and solidarity towards LGBTQ+ communities among young adult heterosexual audiences.
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Affiliation(s)
- J Pufahl
- Center for Arts in Medicine, University of Florida, USA.
| | - S Rawat
- The Humsafar Trust, Mumbai, India
| | | | - N J Shiff
- Department of Community Health and Epidemiology, University of Saskatchewan, Canada
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Safren SA, Thomas B, Biello KB, Mayer KH, Rawat S, Dange A, Bedoya CA, Menon S, Anand V, Balu V, O'Cleirigh C, Klasko-Foster L, Baruah D, Swaminathan S, Mimiaga MJ. Strengthening resilience to reduce HIV risk in Indian MSM: a multicity, randomised, clinical efficacy trial. Lancet Glob Health 2021; 9:e446-e455. [PMID: 33740407 PMCID: PMC8091574 DOI: 10.1016/s2214-109x(20)30547-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention. METHODS We did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resilience-related mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294. FINDINGS Between Sept 4, 2015, and June 28, 2018, we enrolled 608 participants; 305 (50%) were assigned to the psychosocial intervention condition and 303 (50%) were assigned to the control condition. 510 (84%) of 608 men completed an assessment at 4 months after randomisation, 483 (79%) at 8 months, and 515 (85%) at 12 months. 512 (99%) of 515 men had STI data from the 12-month assessment. The intervention condition had a 56% larger reduction in condomless anal sex acts (95% CI 35-71; p<0·0001) from baseline to 4-month follow-up, 72% larger reduction (56-82; p<0·0001) from baseline to 8-month follow-up, and 72% larger reduction (53-83; p<0·0001) from baseline to 12-month follow-up, compared with the standard-of-care control condition (condition by time interaction; χ2=40·29, 3 df; p<0·0001). Improvements in self-esteem and depressive symptoms both mediated 9% of the intervention effect on condomless anal sex acts. Bacterial STI incidence did not differ between study conditions at 12-month follow-up. INTERPRETATION A resilience-based psychosocial intervention for MSM at risk of HIV acquisition or transmission in India was efficacious in reducing condomless anal sex acts, with evidence for mediation effects in two key target resilience variables. HIV prevention programmes for MSM in India should address mental health resilience to augment reductions in the risk of sexually transmitted HIV. FUNDING National Institute of Mental Health.
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Affiliation(s)
- Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA; Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Beena Thomas
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Katie B Biello
- Department of Behavioural and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H Mayer
- Fenway Institute, Fenway Health, Boston, MA, USA; Department of Infectious Diseases, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - C Andres Bedoya
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Vinoth Balu
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Conall O'Cleirigh
- Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Lynne Klasko-Foster
- Department of Psychiatry and Human Behaviour, Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Soumya Swaminathan
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Matthew J Mimiaga
- Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioural Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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13
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Haldar P, Jha S, Rath R, Goswami K, Thakur N, Kumar P. Is Inclusion of informed consent associated with HIV seropositivity rate? findings from 2017 HIV sentinel surveillance among men having sex with men in select states of India. Indian J Public Health 2021; 64:S22-S25. [PMID: 32295952 DOI: 10.4103/ijph.ijph_37_20] [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: 11/04/2022] Open
Abstract
Background During round 2017 of HIV Sentinel Surveillance (HSS) for men who have sex with men (MSM) in India, sampling strategy was changed from consecutive sampling to random sampling, and recruitment was conditioned on informed written consent. Objective The study aimed to explore whether inclusion of informed consent is associated with HIV seropositivity rates among MSM population in select four states of Central India. Methods The cross-sectional study was conducted in four states of Delhi, Jharkhand, Uttar Pradesh, and Uttarakhand that were supervised by All India Institute of Medical Sciences, New Delhi. We did analysis of data collected during 2017 HSS, supplemented with additional program data from targeted intervention (TI) sites. All nine MSM sites in four states were included. Participants were defined as all those MSM who participated in HSS 2017 irrespective of whether they were mentioned in the random list or were selected by the TI partner. The MSM in the random list who either refused to participate or could not be contacted even after three attempts were classified as "nonparticipants." Seropositivity of both groups was compared. Descriptive statistics were derived. Results Overall nonparticipation rate was 14.7%, the highest being in Jharkhand (26%) and lowest in Uttarakhand (6.8%). Overall HIV positivity rate was significantly higher (P < 0.001) in nonparticipants (4.2%) when compared to participants (1.42%). Conclusion The change in sampling strategy and introduction of written informed consent for recruitment of high-risk groups in HSS 2017 round could have led to an underestimation of HIV seropositivity rate among MSM in the states in Central Zone.
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Affiliation(s)
- Partha Haldar
- Associate Professor, Centre for Community Medicine, AIIMS, New Delhi, India
| | - Shreya Jha
- Consultant, Centre for Community Medicine, AIIMS, New Delhi, India
| | - Ramashankar Rath
- Assistant Professor, Department of Community Medicine and Family Medicine, AIIMS, Gorakhpur, Uttar Pradesh, India
| | - Kiran Goswami
- Professor, Centre for Community Medicine, AIIMS, New Delhi, India
| | - Nishakar Thakur
- Statistician, Centre for Community Medicine, AIIMS, New Delhi, India
| | - Pradeep Kumar
- Program Officer - Surveillance, National AIDS Control Organization, MoHFW, GOI, New Delhi, India
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14
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Kazemian P, Costantini S, Kumarasamy N, Paltiel AD, Mayer KH, Chandhiok N, Walensky RP, Freedberg KA. The Cost-effectiveness of Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis and HIV Testing Strategies in High-risk Groups in India. Clin Infect Dis 2021; 70:633-642. [PMID: 30921454 DOI: 10.1093/cid/ciz249] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/21/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The human immunodeficiency virus (HIV) epidemic in India is concentrated among 3.1 million men who have sex with men (MSM) and 1.1 million people who inject drugs (PWID), with a mean incidence of 0.9-1.4 per 100 person-years. We examined the cost-effectiveness of both preexposure prophylaxis (PrEP) and HIV testing strategies for MSM and PWID in India. METHODS We populated an HIV microsimulation model with India-specific data and projected clinical and economic outcomes of 7 strategies for MSM/PWID, including status quo; a 1-time HIV test; routine HIV testing every 3, 6, or 12 months; and PrEP with HIV testing every 3 or 6 months. We used a willingness-to-pay threshold of US$1950, the 2017 Indian per capita gross domestic product, to define cost-effectiveness. RESULTS HIV testing alone increased life expectancy by 0.07-0.30 years in MSM; PrEP added approximately 0.90 life-years to status quo. Results were similar in PWID. PrEP with 6-month testing was cost-effective for both MSM (incremental cost-effectiveness ratio [ICER], $1000/year of life saved [YLS]) and PWID (ICER, $500/YLS). Results were most sensitive to HIV incidence. PrEP with 6-month testing would increase HIV-related expenditures by US$708 million (MSM) and US$218 million (PWID) over 5 years compared to status quo. CONCLUSIONS While the World Health Organization recommends PrEP with quarterly HIV testing, our analysis identifies PrEP with semiannual testing as the cost-effective HIV prevention strategy for Indian MSM and PWID. Since nationwide scale-up would require a substantial fiscal investment, areas of highest HIV incidence may be the appropriate initial targets for PrEP scale-up.
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Affiliation(s)
- Pooyan Kazemian
- Medical Practice Evaluation Center, Boston, Massachusetts.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | - Nagalingeswaran Kumarasamy
- CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services, Chennai, India
| | - A David Paltiel
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Kenneth H Mayer
- Harvard Medical School, Boston, Massachusetts.,Fenway Institute, Fenway Health, Boston, Massachusetts.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nomita Chandhiok
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Boston, Massachusetts.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Harvard University Center for AIDS Research, Boston, Massachusetts
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Boston, Massachusetts.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Harvard University Center for AIDS Research, Boston, Massachusetts.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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15
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Prioritizing HIV Services for Transgender Women and Men Who Have Sex With Men in Manila, Philippines: An Opportunity for HIV Provider Interventions. J Assoc Nurses AIDS Care 2020; 31:405-416. [PMID: 31592803 DOI: 10.1097/jnc.0000000000000131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Transgender women (TW) and men who have sex with men (MSM) are highly affected by the rising HIV epidemic in the Philippines. HIV providers are essential to curbing the epidemic. Between July and August 2017, we conducted one-on-one qualitative interviews with 15 HIV providers in Manila, Philippines. Overall, providers reported tension between willingness to provide care versus actual competencies. Most discussed treating every patient equally regardless of gender or sexual identities. However, many expressed hesitancies in providing HIV services due to (a) not knowing the health needs of TW and MSM, (b) having little to no training in HIV, and (c) difficulty being sensitive to patient gender and sexuality. Although providers were unsure about how to prioritize HIV services for TW and MSM, some expressed interest in learning and engaging these populations in their practices. Our findings suggest the importance of provider-focused interventions to prioritize TW and MSM health needs.
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16
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Kazemian P, Costantini S, Neilan AM, Resch SC, Walensky RP, Weinstein MC, Freedberg KA. A novel method to estimate the indirect community benefit of HIV interventions using a microsimulation model of HIV disease. J Biomed Inform 2020; 107:103475. [PMID: 32526280 PMCID: PMC7374016 DOI: 10.1016/j.jbi.2020.103475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/22/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Microsimulation models of human immunodeficiency virus (HIV) disease that simulate individual patients one at a time and assess clinical and economic outcomes of HIV interventions often provide key details regarding direct individual clinical benefits ("individual benefit"), but they may lack detail on transmissions, and thus may underestimate an intervention's indirect benefits ("community benefit"). Dynamic transmission models can be used to simulate HIV transmissions, but they may do so at the expense of the clinical detail of microsimulations. We sought to develop, validate, and demonstrate a practical, novel method that can be integrated into existing HIV microsimulation models to capture this community benefit, integrating the effects of reduced transmission while keeping the clinical detail of microsimulations. METHODS We developed a new method to capture the community benefit of HIV interventions by estimating HIV transmissions from the primary cohort of interest. The method captures the benefit of averting infections within the cohort of interest by estimating a corresponding gradual decline in incidence within the cohort. For infections averted outside the cohort of interest, our method estimates transmissions averted based on reductions in HIV viral load within the cohort, and the benefit (life-years gained and cost savings) of averting those infections based on the time they were averted. To assess the validity of our method, we paired it with the Cost-effectiveness of Preventing AIDS Complications (CEPAC) Model - a validated and widely-published microsimulation model of HIV disease. We then compared the consistency of model-estimated outcomes against outcomes of a widely-validated dynamic compartmental transmission model of HIV disease, the HIV Optimization and Prevention Economics (HOPE) model, using the intraclass correlation coefficient (ICC) with a two-way mixed effects model. Replicating an analysis done with HOPE, validation endpoints were number of HIV transmissions averted by offering pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) and people who inject drugs (PWID) in the US at various uptake and efficacy levels. Finally, we demonstrated an application of our method in a different setting by evaluating the clinical and economic outcomes of a PrEP program for MSM in India, a country currently considering PrEP rollout for this high-risk group. RESULTS The new method paired with CEPAC demonstrated excellent consistency with the HOPE model (ICC = 0.98 for MSM and 0.99 for PWID). With only the individual benefit of the intervention incorporated, a PrEP program for MSM in India averted 43,000 transmissions over a 5-year period and resulted in a lifetime incremental cost-effectiveness ratio (ICER) of US$2,300/year-of-life saved (YLS) compared to the status quo. After applying both the direct (individual) and indirect (community) benefits, PrEP averted 86,000 transmissions over the same period and resulted in an ICER of US$600/YLS. CONCLUSIONS Our method enables HIV microsimulation models that evaluate clinical and economic outcomes of HIV interventions to estimate the community benefit of these interventions (in terms of survival gains and cost savings) efficiently and without sacrificing clinical detail. This method addresses an important methodological gap in health economics microsimulation modeling and allows decision scientists to make more accurate policy recommendations.
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Affiliation(s)
- Pooyan Kazemian
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Sydney Costantini
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Anne M Neilan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, USA
| | - Stephen C Resch
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Milton C Weinstein
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
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17
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Chan BT, Pradeep A, Chandrasekaran E, Prasad L, Murugesan V, Kumarasamy N, Mayer KH, Tsai AC. Reliability, Validity, and Factor Structure of the Internalized AIDS-Related Stigma Scale in Southern India. J Int Assoc Provid AIDS Care 2020; 18:2325958219831025. [PMID: 30782053 PMCID: PMC6748476 DOI: 10.1177/2325958219831025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We used data from 660 people living with HIV in southern India to evaluate the
reliability, validity, and factor structure of the Internalized AIDS-Related Stigma Scale.
Exploratory factor analysis revealed the presence of 2 factors: a 2-item factor related to
disclosure concerns and a 4-item factor related to self-hatred. The self-hatred factor
demonstrated acceptable internal consistency (Cronbach α = .80). As evidence of construct
validity, both factors were correlated with depression symptom severity as measured by the
Patient Health Questionnaire-9. Further study is needed to understand the correlates of
these factors and their impact on the Indian HIV care continuum.
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Affiliation(s)
- Brian T Chan
- 1 Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Amrose Pradeep
- 3 Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - Lakshmi Prasad
- 3 Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | | | - Kenneth H Mayer
- 2 Harvard Medical School, Boston, MA, USA.,4 Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA.,5 Fenway Health, Boston, MA, USA
| | - Alexander C Tsai
- 2 Harvard Medical School, Boston, MA, USA.,6 MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.,7 Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Patel VV, Rawat S, Dange A, Lelutiu-Weinberger C, Golub SA. An Internet-Based, Peer-Delivered Messaging Intervention for HIV Testing and Condom Use Among Men Who Have Sex With Men in India (CHALO!): Pilot Randomized Comparative Trial. JMIR Public Health Surveill 2020; 6:e16494. [PMID: 32297875 PMCID: PMC7193444 DOI: 10.2196/16494] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/08/2020] [Accepted: 02/22/2020] [Indexed: 01/18/2023] Open
Abstract
Background Leveraging internet-based communication tools (eg, messaging apps, SMS text messaging, and email) may be an effective avenue for delivery of HIV prevention messages to men who have sex with men (MSM) in India, but there are limited models for such internet-based interventions. Objective The CHALO! pilot was an online educational and behavioral intervention aimed to determine the feasibility, acceptability, and preliminary impact of a peer-delivered, internet-based messaging intervention for HIV testing and consistent condom use for MSM in India. The messages addressed barriers to HIV testing and condom use and were theoretically based on the information-motivation-behavioral skills model. Methods Between February and March 2015, we recruited, enrolled, and randomized 244 participants via online advertisements on mobile dating apps and Facebook. Eligible men (18 years or older, sexually active with other men, and self-reported HIV-negative or unknown status) were randomized to receive educational and motivational messages framed as either approach (ie, a desirable outcome to be achieved) or avoidance (an undesirable outcome to be avoided) over 12 weeks via internet-based messaging platforms. Participants completed online surveys at baseline and immediately postintervention. Results Participants were similar across arms with respect to sociodemographic and behavioral characteristics. Over 82.0% (200/244) of participants were retained (ie, viewed final messages), and 52.3% (130/244) of them completed the follow-up survey. Of those completing the follow-up survey, 82.3% (107/130) liked or strongly liked participating in CHALO!. The results showed a significant increase in self-reported HIV testing in the past 6 months from baseline to follow-up (41/130, 31.5% to 57/130, 43.8%; P=.04). When including those who reported intentions to test, this percentage increased from 44.6% (58/130) at baseline to 65.4% (85/130) at follow-up (P<.01). When examining intentions to test among those without prior HIV testing, intentions increased from 32% (16/50) of the sample at baseline to 56% (28/50) of the sample at follow-up (P=.02). Condom use during anal sex did not significantly change from baseline to follow-up. HIV testing and condom use did not significantly differ between approach and avoidance conditions at follow-up. Conclusions As one of the first studies of an online HIV prevention intervention for Indian MSM, CHALO! was feasible to implement by a community-based organization, was acceptable to participants, and demonstrated potential to improve HIV testing rates.
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Affiliation(s)
- Viraj V Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, United States
| | | | | | - Corina Lelutiu-Weinberger
- François-Xavier Bagnoud Center, School of Nursing, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Sarit A Golub
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
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Wagner GJ, Ghosh-Dastidar B, El Khoury C, Abi Ghanem C, Balan E, Kegeles S, Mutchler MG, Mokhbat J. Major Depression Among Young Men Who Have Sex with Men in Beirut, and Its Association with Structural and Sexual Minority-Related Stressors, and Social Support. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:513-520. [PMID: 32051694 PMCID: PMC7013382 DOI: 10.1007/s13178-018-0352-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Guided by the minority stress model, we assessed depression and its relationship to structural and sexual minority-related stressors and social support in a sample of 226 young (age 18-29 years) men who have sex with men in Beirut, Lebanon. The sample was recruited with long-chain peer referrals and administered a survey that included the PHQ-9 measure of depression. 16% had current major depression based on our PHQ-9 criteria, and 33% reported any lifetime history of suicidal ideation (including 8% who had made an attempt); 69% had experienced any sexual minority-related discrimination in the past year. In bivariate analysis, structural (unemployment, no legal resident status) and sexual minority-related (greater number of types of discrimination experienced, greater discomfort with one's sexual orientation) stressors were associated with major depression, as was lower social support. Discomfort with one's sexual orientation was the only correlate of major depression when controlling for other stressors, social support and socio-demographics. These findings highlight a high level of depression, and the potential for community building and social solidarity for mitigating the effects of stressors based in personal security, internalized stigma and discrimination.
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Affiliation(s)
| | | | | | | | - Elie Balan
- Arab Foundation for Freedom and Equality, Beirut, Lebanon
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Thomas PPM, Yadav J, Kant R, Ambrosino E, Srivastava S, Batra G, Dayal A, Masih N, Pandey A, Saha S, Heijmans R, Lal JA, Morré SA. Sexually Transmitted Infections and Behavioral Determinants of Sexual and Reproductive Health in the Allahabad District (India) Based on Data from the ChlamIndia Study. Microorganisms 2019; 7:microorganisms7110557. [PMID: 31726703 PMCID: PMC6920780 DOI: 10.3390/microorganisms7110557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs), like Chlamydia trachomatis and Neisseria gonorrhoeae (CT and NG, respectively) are linked to an important sexual and reproductive health (SRH) burden worldwide. Behavior is an important predictor for SRH, as it dictates the risk for STIs. Assessing the behavior of a population helps to assess its risk profile. METHODS Study participants were recruited at a gynecology outpatient department (OPD) in the Allahabad district in Uttar Pradesh India, and a questionnaire was used to assess demographics, SRH, and obstetric history. Patients provided three samples (urine, vaginal swab, and whole blood). These samples were used to identify CT and NG using PCR/NAAT and CT IgG ELISA. RESULTS A total of 296 women were included for testing; mean age was 29 years. No positive cases of CT and NG were observed using PCR/NAAT. A 7% (22/296) positivity rate for CT was observed using IgG ELISA. No positive association was found between serology and symptoms (vaginal discharge, abdominal pain, dysuria, and dyspareunia) or adverse pregnancy outcomes (miscarriage and stillbirth). Positive relations with CT could be observed with consumption of alcohol, illiteracy, and tenesmus (p-value 0.02-0.03). DISCUSSION STI prevalence in this study was low, but a high burden of SRH morbidity was observed, with a high symptomatic load. High rates of miscarriage (31%) and stillbirth (8%) were also observed among study subjects. No associations could be found between these ailments and CT infection. These rates are high even for low- and middle-income country standards. CONCLUSION This study puts forward high rates of SRH morbidity, and instances of adverse reproductive health outcomes are highlighted in this study, although no associations with CT infection could be found. This warrants more investigation into the causes leading to these complaints in the Indian scenario and potential biases to NAAT testing, such as consumption of over-the-counter antimicrobials.
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Affiliation(s)
- Pierre P. M. Thomas
- Institute of Public Health Genomics, Genetics and Cell Biology Cluster, GROW Research School for Oncology and Development Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (E.A.); (J.A.L.)
- Correspondence: (P.P.M.T.); (S.A.M.)
| | - Jay Yadav
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh 211007, India; (J.Y.); (R.K.); (N.M.); (A.P.)
| | - Rajiv Kant
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh 211007, India; (J.Y.); (R.K.); (N.M.); (A.P.)
| | - Elena Ambrosino
- Institute of Public Health Genomics, Genetics and Cell Biology Cluster, GROW Research School for Oncology and Development Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (E.A.); (J.A.L.)
| | - Smita Srivastava
- Hayes Memorial Mission Hospital, Shalom Institute of Health and Allied Sciences, SHUATS Allahabad, Uttar Pradesh 211007, India; (S.S.); (G.B.); (A.D.)
| | - Gurpreet Batra
- Hayes Memorial Mission Hospital, Shalom Institute of Health and Allied Sciences, SHUATS Allahabad, Uttar Pradesh 211007, India; (S.S.); (G.B.); (A.D.)
| | - Arvind Dayal
- Hayes Memorial Mission Hospital, Shalom Institute of Health and Allied Sciences, SHUATS Allahabad, Uttar Pradesh 211007, India; (S.S.); (G.B.); (A.D.)
| | - Nidhi Masih
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh 211007, India; (J.Y.); (R.K.); (N.M.); (A.P.)
| | - Akash Pandey
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh 211007, India; (J.Y.); (R.K.); (N.M.); (A.P.)
| | - Saurav Saha
- Department of Computational Biology and Bioinformatics, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh 211007, India;
| | - Roel Heijmans
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU Medical Center, 1081 HV Amsterdam, The Netherlands;
| | - Jonathan A. Lal
- Institute of Public Health Genomics, Genetics and Cell Biology Cluster, GROW Research School for Oncology and Development Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (E.A.); (J.A.L.)
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh 211007, India; (J.Y.); (R.K.); (N.M.); (A.P.)
| | - Servaas A. Morré
- Institute of Public Health Genomics, Genetics and Cell Biology Cluster, GROW Research School for Oncology and Development Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (E.A.); (J.A.L.)
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh 211007, India; (J.Y.); (R.K.); (N.M.); (A.P.)
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU Medical Center, 1081 HV Amsterdam, The Netherlands;
- Correspondence: (P.P.M.T.); (S.A.M.)
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Barriers to HIV Testing Among Men Who Have Sex With Men in India Reached Online: Implications for Interventions. J Acquir Immune Defic Syndr 2019; 78:e30-e34. [PMID: 29649075 DOI: 10.1097/qai.0000000000001698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wilkerson JM, Rhoton JM, Li D, Rawat S, Patankar P, Rosser BRS, Ekstrand ML. Information, Motivation, and Self-Efficacy Among Men Who Have Sex With Men and Transgender Women in the State of Maharashtra, India. HEALTH EDUCATION & BEHAVIOR 2019; 46:304-311. [PMID: 30205760 PMCID: PMC6734545 DOI: 10.1177/1090198118796880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND India's National AIDS Control Programme calls for, among other things, targeted behavioral interventions that address determinants contributing to new infections among men who have sex with men (MSM) and hijras (transgender women). AIM To determine if the information-motivation-behavioral skills model was transferable to an Indian context. METHODS We recruited 442 MSM and 7 hijras into an online cross-sectional study that asked questions about condom use knowledge, motivation, self-efficacy, and sexual behavior. Structural equation modeling was used to test the overall information-motivation-behavioral skills structure. RESULTS Condom use and HIV risk knowledge did not significantly predict condom use self-efficacy or having condomless anal sex with more than one male partner in the past 3 months, and knowledge was not significantly correlated with attitudes toward barebacking. Despite this, the final structural model explained 14.4% of the variance in condom use self-efficacy and 20.0% of the variance in risky sexual behavior. Overall fit of the model was good: χ2(201, N = 447) = 445.002, p < .0001, root mean square error of approximation = .052, 90% CI [.046, .059], comparative fit index = .989, Tucker-Lewis Index = .987. CONCLUSION The public health response to India's HIV epidemic is currently different than in the West due to differences in medication access and public health infrastructure. As Indian MSM and hijras learn more about the effectiveness of viral suppression and hopefully have greater access to preexposure prophylaxis, researchers should monitor for changing attitudes toward condoms and be prepared to collaborate with the public health infrastructure in order to develop interventions that reinforce positive attitudes toward condom use.
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Affiliation(s)
- J. Michael Wilkerson
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, USA
| | - Jayson M. Rhoton
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, USA
| | - Dennis Li
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, USA
| | | | | | - B. R. Simon Rosser
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Maria L. Ekstrand
- University of California San Francisco Center for AIDS Prevention Studies, San Francisco, California, USA
- St John’s Research Institute of St John’s National Academy of Health Sciences, Bengaluru, India
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Gautam A, Chakravarty J, Singh VK, Ghosh A, Chauhan SB, Rai M, Sundar S. Human papillomavirus infection & anal cytological abnormalities in HIV-positive men in eastern India. BMC Infect Dis 2018; 18:692. [PMID: 30587145 PMCID: PMC6307225 DOI: 10.1186/s12879-018-3618-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 12/13/2018] [Indexed: 02/02/2023] Open
Abstract
Background Oncogenic Human papillomavirus (HPV) infections are closely associated with anal cancer which is high among human immunodeficiency virus (HIV) infected males. There are no data regarding anal HPV infection and cytological abnormalities in HIV positive males receiving free therapy in the national program. Thus, this cross-sectional study was performed to assess the prevalence and risk factors of anal HPV infection and cytological abnormalities in HIV positive males. Methods We screened 126 HIV-positive male patients attending the antiretroviral treatment center (ART) between 2014 and 2015 with anal papanicolaou smear cytology and HPV-DNA testing. HPV-DNA was detected by using polymerase chain reaction (PCR) method with two consensus primer sets E6 and MY09/11 and further analyzed for the presence of various HPV genotype by Sanger sequencing. Risk factors associated with anal cytological abnormalities and HPV infection was analyzed by using univariate and multivariate logistic regression models. Results Out of 126, 52 were on antiretroviral therapy. 91% were married to female partners but during the study 48 (38%) gave positive history of anal intercourse with other men. Anal cytology was done in 95 patients, out of which 60 (63.15%) had cytological abnormalities. LSIL (low-grade squamous intraepithelial lesions) was present in 27 (45%), ASCUS (atypical squamous cells of undetermined significance) in 31 (52%) and ASC-H (atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion) in 2 (3.33%). In multivariate analysis, the risk factors for cytological abnormality were presence of history of anal intercourse (OR, 6.1; 95% CI, 2.0–18.7) and WHO stage III & IV (OR, 2.7; 95% CI, 1.1–7.5). HPV-DNA was detected in 33/119 (27.73%) patients. The most prevalent HPV type in the study was HPV-16 (10.08%), other HPV types detected were 18,31,35,17,66,72,52,68 and 107 (17.65%). Conclusions High prevalence of anal cytological abnormalities in our study suggests that regular anal Pap smear screening should be done in HIV positive males in the ART center.
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Affiliation(s)
- Abhilasha Gautam
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Jaya Chakravarty
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
| | - Vijay Kumar Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Amrita Ghosh
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Shashi Bhushan Chauhan
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Madhukar Rai
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
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Sharma N, Sharma LK, Anand A, Gadpayle AK, Gaurav K, Mukherjee S, Kulshreshtha B, Dutta D. Presence, patterns & predictors of hypocortisolism in patients with HIV infection in India. Indian J Med Res 2018; 147:142-150. [PMID: 29806602 PMCID: PMC5991125 DOI: 10.4103/ijmr.ijmr_43_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background & objectives: Adrenal insufficiency (AI) is rarely diagnosed in patients with HIV infection, in spite of autopsy studies showing very high rates of adrenal involvement. This study was aimed to determine the presence, patterns and predictors of AI in patients with HIV infection. Methods: Consecutive HIV patients, 18-70 yr age, without any severe co-morbid state, having at least one-year follow up at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays. Results: From initially screened 527 patients, 359 patients having good immune function were analyzed. Basal morning cortisol <6 μg/dl (<165 nmol/l; Group 1), 6-11 μg/dl (165-300 nmol/l; Group 2), 11-18 μg/dl (300-500 nmol/l; Group 3) and ≥18 μg/dl (500 nmol/l; Group 4) were observed in 13, 71, 199 and 76 patients, respectively. Adrenocorticotropic hormone (ACTH) stimulation test revealed 87 patients (24.23%) to have AI. AI in groups 1-4 was 100, 56.34, 17.09 and 0 per cent, respectively. AI patients were more likely to be females (P< 0.05), having longer disease duration (P< 0.05), immune reconstitution inflammatory syndrome, hyperkalaemia (P< 0.01), lower fasting glucose (P< 0.01), dehydroepiandrosterone sulphate (DHEAS) and vitamin D. Regression analysis revealed morning cortisol and DHEAS to be best predictors of AI (P=0.004 and 0.028, respectively). Interpretation & conclusions: AI is a significant problem in HIV-infected individuals, observed in nearly a quarter of patients. Diagnosis warrants high index of suspicion and low threshold for screening, especially in those having low DHEAS and hyperkalaemia. Morning cortisol is a reasonable screening test, with ACTH stimulation warranted to confirm diagnosis, especially in patients with morning cortisol <11 μg/dl (300 nmol/l).
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Affiliation(s)
- Neera Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Lokesh Kumar Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Atul Anand
- Anti-Retroviral Therapy Clinic, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Adesh Kisanji Gadpayle
- Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Kumar Gaurav
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Sabyasachi Mukherjee
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Bindu Kulshreshtha
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
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Thaker J, Dutta M, Nair V, Rao VP. The Interplay between Stigma, Collective Efficacy, and Advocacy Communication among Men Who Have Sex with Men and Transgender Females. JOURNAL OF HEALTH COMMUNICATION 2018; 23:614-623. [PMID: 30064349 DOI: 10.1080/10810730.2018.1499833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Stigma and discrimination are primary drivers of health disparities among marginalized communities. Drawing on stigma management, minority stress model, and social cognitive theories, this article tests the interplay between dimensions of stigma, collective efficacy, and advocacy communication among men who have sex with men (MSM) and transgender females. Using data from a cross-sectional survey conducted in south India (N = 225), five distinct dimensions of stigma were identified using factor analysis: experienced stigma, self-stigma, felt normative stigma, and two new dimensions-HIV-related vicarious stigma and media stigma. Respondents reported highest levels of media stigma. While most of the dimensions of stigma were negatively associated with both collective efficacy and advocacy communication, collective efficacy mediated the relationship between stigma and advocacy. Implications for public health campaigns among MSM groups are discussed.
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Affiliation(s)
- Jagadish Thaker
- a School of Communication, Journalism & Marketing , Massey University , Wellington , New Zealand
| | - Mohan Dutta
- b School of Communication, Journalism & Marketing, Massey University , Palmerston North , New Zealand
| | - Vijay Nair
- c India HIV/AIDS Alliance , Hyderabad , India
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Mimiaga MJ, Thomas B, Mayer KH, Regenauer KS, Dange A, Andres Bedoya C, Rawat S, Balu V, O’Cleirigh C, Biello KB, Anand V, Swaminathan S, Safren SA. A randomized clinical efficacy trial of a psychosocial intervention to strengthen self-acceptance and reduce HIV risk for MSM in India: study protocol. BMC Public Health 2018; 18:890. [PMID: 30021566 PMCID: PMC6052541 DOI: 10.1186/s12889-018-5838-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) in India are a key group at risk for HIV acquisition and transmission. They are also an extremely marginalized and stigmatized population, facing immense psychosocial stressors including, but not limited to, stigma, homophobia, discrimination, criminalization, low self-esteem, low self-acceptance, distress, and, as a result, high rates of mental health problems. Although these multi-level psychosocial problems may put MSM at high risk for HIV acquisition and transmission, currently HIV prevention interventions in India do not address them. This paper describes the design of a psychosocial intervention to reduce HIV risk for MSM in India. METHODS Funded by the National Institute of Mental Health, this study is a two-arm randomized clinical efficacy trial of a self-acceptance based psychosocial HIV prevention intervention, informed by the minority stress model and syndemic theory, that was developed with extensive community-based formative work and input from the Indian MSM community and key informants who are knowledgeable about the experiences faced by MSM in India. Participants are MSM in Chennai and Mumbai who endorsed recent sexual behaviors placing them at high risk for HIV/sexually transmitted infection (STI) acquisition and transmission. Enrolled participants are equally randomized to either 1) the experimental condition, which consists of four group and six individual counseling sessions and includes standard of care HIV/STI testing and counseling, or 2) the standard of care condition, which includes HIV/STI testing and counseling alone. The primary outcomes are changes in the frequency of condomless anal sex acts and STI incidence (syphilis seropositivity and urethral, rectal, and pharyngeal gonorrhea and chlamydia infection. Major study assessment visits occur at baseline, 4-, 8-, and 12-months. DISCUSSION HIV prevention interventions that address the psychosocial stressors faced by MSM in India are needed; this study will examine the efficacy of such an intervention. If the intervention is successful, it may be able to reduce the national HIV/AIDS burden in India while empowering a marginalized and highly stigmatized group. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02556294 , registered 22 September 2015.
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Affiliation(s)
- Matthew J. Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI USA
- Center for Health Equity Research, Brown University, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI USA
| | - Beena Thomas
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Beth Israel Deaconness Medical Center, Boston, MA USA
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Kristen S. Regenauer
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | | | - C. Andres Bedoya
- Harvard Medical School, Boston, MA USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | | | - Vinoth Balu
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Katie B. Biello
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI USA
| | | | | | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychology, University of Miami, Coral Gables, FL USA
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Tomori C, McFall AM, Solomon SS, Srikrishnan AK, Anand S, Balakrishnan P, Mehta SH, Celentano DD. Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India. Soc Sci Med 2018; 206:110-116. [PMID: 29615297 DOI: 10.1016/j.socscimed.2018.03.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/24/2022]
Abstract
Syndemic theory describes the clustering and synergistic interaction of disease driven by contextual and social factors, which worsen health outcomes for a population, and has been applied to men who have sex with men (MSM) and their risk for HIV and other sexually transmitted infections. Recent reviews, however, have critiqued prevailing approaches in syndemic studies that assess only additive associations without evaluation of synergy. Following these suggestions, we compared the traditional additive approach with a test for synergistic association of 5 syndemic conditions (alcohol dependence, illicit drug use, depression, intimate partner violence (IPV), and childhood sexual abuse (CSA)) with unprotected anal intercourse (UAI) and active syphilis infection among 11,771 MSM recruited through respondent driven sampling from 12 cities in India. UAI was assessed via self-report and active syphilis infection was diagnosed by RPR and THPA tests. An additive association was explored using a condition count (range 0-5), and synergy was tested using relative excess risk due to interactions (RERIs) calculated from all 2-way and common 3-way interactions between conditions in adjusted regression models. There was a significant dose response associated with the syndemic count and UAI, and a similar pattern for syphilis, though not statistically significant. RERIs showed synergy for only one pair of conditions for UAI and syphilis, respectively: IPV + depression and alcohol dependence + illicit drug use. In this study, we found an additive association between syndemic conditions and UAI with evidence of synergistic interaction between a pair of psychosocial conditions, and no significant additive association, but a synergistic interaction between another pair of psychosocial conditions for syphilis. Our results lend further support to a critical reassessment of syndemic analyses. Closer attention to the cumulative development, underlying causal pathways, and possible synergistic interaction of co-occurring epidemics through combined qualitative and quantitative methodologies may yield more effective interventions for vulnerable, marginalized populations.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States; YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Aylur K Srikrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - P Balakrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States
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Uthappa CK, Allam RR, Pant R, Pal S, Dinaker M, Oruganti G, Yeldandi VV. Pre-exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population. HIV Med 2017; 19:243-251. [PMID: 29178158 DOI: 10.1111/hiv.12572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This exploratory study examined the facilitators of and barriers to acceptance of pre-exposure prophylaxis (PrEP) and potential risk compensation behaviour emerging from its use among men who have sex with men (MSM) and transgender individuals (TGs) in India. METHODS A questionnaire was administered to 400 individuals registered with a targeted intervention programme. Logistic regression models were used to identify facilitators of and barriers to PrEP acceptance. RESULTS The respondents consisted of 68% MSM and 32% TGs. Risk behaviour categorization identified 40% as low risk, 41% as medium risk and, 19% as high risk for HIV infection. About 93% of the respondents were unaware of PrEP, but once informed about it, 99% were willing to use PrEP. The facilitators of PrEP acceptance were some schooling [odds ratio (OR) 2.16; P = 0.51], being married or in a live-in relationship (OR 2.08; P = 0.46), having a high calculated risk (OR 3.12; P = 0.33), and having a high self-perceived risk (OR 1.8; P = 0.35). Increasing age (OR 2.12; P = 0.04) was a significant barrier. TGs had higher odds of acceptance of PrEP under conditions of additional cost (OR 2.12; P = 0.02) and once-daily pill (OR 2.85; P = 0.04). Individuals identified as low risk for HIV infection showed lower odds of potential risk compensation, defined as more sexual partners (OR 0.8; P = 0.35), unsafe sex with new partners (OR 0.71; P = 0.16), and decreased condom use with regular partners (OR 0.95; P = 0.84), as compared with medium-risk individuals. The associations, although not statistically significant, are nevertheless important for public health action given the limited scientific evidence on PrEP use among MSM and TGs in India. CONCLUSIONS With high acceptability and a low likelihood of risk compensation behaviour, PrEP can be considered as an effective prevention strategy for HIV infection among MSM and TGs in India.
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Affiliation(s)
- C K Uthappa
- Department of Health Research, SHARE India, Hyderabad, India
| | - R R Allam
- Department of Health Research, SHARE India, Hyderabad, India
| | - R Pant
- Department of Health Research, SHARE India, Hyderabad, India
| | - S Pal
- Prantakatha, New Delhi, India
| | - M Dinaker
- GYD Diagnostics and Reference Laboratories (P) Ltd, Secunderabad, India
| | - G Oruganti
- Department of Health Research, SHARE India, Hyderabad, India.,GYD Diagnostics and Reference Laboratories (P) Ltd, Secunderabad, India
| | - V V Yeldandi
- Department of Health Research, SHARE India, Hyderabad, India.,GYD Diagnostics and Reference Laboratories (P) Ltd, Secunderabad, India.,College of Medicine, University of Illinois, Chicago, IL, USA
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Li DH, Rawat S, Rhoton J, Patankar P, Ekstrand ML, Simon Rosser BR, Wilkerson JM. Harassment and Violence Among Men Who Have Sex with Men (MSM) and Hijras After Reinstatement of India's "Sodomy Law". SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2017; 14:324-330. [PMID: 29552236 PMCID: PMC5851470 DOI: 10.1007/s13178-016-0270-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
On December 11, 2013, the Indian Supreme Court recriminalized non-peno-vaginal sex under Sec. 377 of the Indian Penal Code (IPC), overturning a 2009 ruling that deemed IPC Sec. 377 unconstitutional. Similar "sodomy laws" in other countries have been associated with increased violence, harassment, and other discrimination against men who have sex with men (MSM) and transgender women. However, few studies have looked at the effects of such a law in an Indian context. This study examined experiences of victimization among MSM and hijra/transgender women (MSM-H) in the State of Maharashtra using a mixed-method approach. Data came from a quantitative survey and qualitative focus groups and interviews from an HIV prevention study as well as qualitative media and case reports from a local MSM-H-serving community-based organization. MSM-H in Maharashtra reported experiencing a high frequency of harassment, violence, and extortion, particularly from male sex partners met online and police. IPC Sec. 377 was implicated across qualitative sources as creating a culture of protection for harassment against MSM-H by being used directly as a tool for harassment, hindering victims of harassment from seeking legal recourse, and adversely impacting HIV and healthcare services. The reinstated IPC Sec. 377 may directly and indirectly facilitate negative health outcomes among MSM-H. Health agencies and advocates should continue to monitor the impact of IPC Sec. 377, incorporate rights-based approaches to protect MSM-H identities while addressing their health and well-being, and explore avenues to initiate discussions with the government to work toward repealing the law.
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Affiliation(s)
- Dennis H Li
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 2700, Chicago, IL 60611, USA
| | | | - Jayson Rhoton
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | | | - Maria L Ekstrand
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - J Michael Wilkerson
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Ghosh K, Misra K. HIV risk associated with nucleic acid testing tested seronegative blood donation where the donor was not preassessed for the risk. Asian J Transfus Sci 2017; 11:213-214. [PMID: 28970697 PMCID: PMC5613436 DOI: 10.4103/ajts.ajts_136_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kanjaksha Ghosh
- Surat Raktadan Kendra and Research Centre, Surat, Gujarat, India
| | - Kanchan Misra
- Surat Raktadan Kendra and Research Centre, Surat, Gujarat, India
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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.
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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.
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Wang Y, Wang Z, Jia M, Liang A, Yuan D, Sun Z, Gan F, Wang Y, Cai Y, Zhang Z. Association between a syndemic of psychosocial problems and unprotected anal intercourse among men who have sex with men in Shanghai, China. BMC Infect Dis 2017; 17:46. [PMID: 28061819 PMCID: PMC5219803 DOI: 10.1186/s12879-016-2132-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 12/15/2016] [Indexed: 11/12/2022] Open
Abstract
Background Previous studies have discussed the overlapping and reinforcing effects (defined as a syndemic) of psychosocial problems on high-risk sexual behaviors among men who have sex with men (MSM). The present study aimed to apply the syndemic theory to verify the reinforcing effects of psychosocial problems on unprotected anal intercourse (UAI) among MSM in Shanghai, and determine if other important psychosocial factors fit into the syndemic theory. Methods Data were collected from 547 MSM in Shanghai, China, through face-to-face interviews. The measures for psychosocial problems included the Rosenberg Self-Esteem Scale; the Generalized Anxiety Disorder-7; the Center for Epidemiological Studies Depression Scale; the University of California, Los Angeles Loneliness Scale; and the Sexual Compulsivity Scale. We used multivariate analysis and binary logistic regression to investigate the associations between psychosocial problems and high-risk sexual behaviors. Results The prevalence of UAI among MSM in the past 6 months was 54.5%. Education (graduate from college vs. high school) served as a protective factor against UAI (OR 0.59, 95% CI: 0.38–0.94). There was a high prevalence of psychosocial problems, and at least one-third of participants reported experiencing more than two psychosocial symptoms. Of these psychosocial factors that we investigated, lower self-esteem was associated with UAI in both univariate and multivariate regression model (P = 0.009). Result suggests that overlapping and reinforcing effects of psychosocial problems may increase high risk sexual behaviors among MSM in Shanghai, China (OR 1.65, 95% CI: 1.09–2.50; P = 0.018). Conclusions We found further evidence for a syndemic of psychosocial problems among MSM in Shanghai, China. This syndemic may also increase high risk sexual behaviors among MSM. Most HIV prevention interventions are focused on behavior change and only have moderate effects; our findings suggest that a shift from behavior-focused interventions to a more comprehensive strategy that addresses psychosocial factors may be necessary.
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Affiliation(s)
- Ying Wang
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Zezhou Wang
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Mengmeng Jia
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Ajuan Liang
- Renji Hospital, affiliated with School of Medicine Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Dong Yuan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Zhe Sun
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Feng Gan
- School of Continuing Education, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yichen Wang
- Ruijin Hospital, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Yong Cai
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
| | - Zhiruo Zhang
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
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Ekstrand ML, Rawat S, Patankar P, Heylen E, Banu A, Rosser BRS, Wilkerson JM. Sexual identity and behavior in an online sample of Indian men who have sex with men. AIDS Care 2016; 29:905-913. [PMID: 28027656 DOI: 10.1080/09540121.2016.1271103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Indian men who have sex with men are disproportionately impacted by HIV. While prevention efforts to date have focused on men who visit drop-in centers or physical cruising sites, little is known about men who are meeting sexual partners on virtual platforms. This paper explores issues related to sexual identity and sexual behaviors in an online sample of men who identified as gay (n = 279) or bisexual (n = 123). There were significant differences in outedness between the two groups, with 48% of bisexually identified men reporting that they were out to "no one" and 82% stating that they present themselves as heterosexual to family and friends. Corresponding rates for gay-identified men were 15% and 41%, respectively (both p < .001). Twenty-nine percent of bisexually identified men reported being married, compared to only 3% of the gay-identified men (p < .001). Bisexually identified men were also more likely to report having exclusively insertive anal sex (49% vs 30% p < .001), while gay-identified men were more likely to report exclusively receptive anal sex (41% vs 13% p < .0001). Rates of unprotected anal sex (UAS) in the two groups were similar; however, married men were significantly more likely to report unprotected vaginal sex (76% vs 35%, p < .012). Positive attitudes toward UAS and lower self-efficacy were associated with sexual risk in both groups; however, substance use was associated with sexual risk only among bisexually identified men. These findings show that a large proportion of Indian bisexually identified men lead closeted lives, especially in their interactions with friends and family, with the vast majority presenting as heterosexual. The lower condom use with wives may be due to societal pressures to have children. The results suggest that bisexually identified men may benefit from targeted programs and non-directive, non-judgmental individual or couples counseling which emphasizes condom use with both male and female partners.
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Affiliation(s)
- Maria L Ekstrand
- a Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA.,b St John's Research Institute, St John's National Academy of Health Sciences , Bengaluru , India
| | | | | | - Elsa Heylen
- a Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA
| | - Asha Banu
- d The Tata Institute of Social Sciences , Mumbai , India
| | - B R Simon Rosser
- e Division of Epidemiology and Community Health , University of Minnesota , Minneapolis , MN , USA
| | - J Michael Wilkerson
- f School of Public Health , The University of Texas Health Sciences Center at Houston (UTHealth) Houston , TX , USA
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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.
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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
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Tomori C, McFall AM, Srikrishnan AK, Mehta SH, Nimmagadda N, Anand S, Vasudevan CK, Solomon S, Solomon SS, Celentano DD. The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India. BMC Public Health 2016; 16:784. [PMID: 27520978 PMCID: PMC4983056 DOI: 10.1186/s12889-016-3446-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/25/2016] [Indexed: 12/22/2022] Open
Abstract
Background Childhood sexual abuse (CSA) is a significant global public health problem, which is associated with negative psychosocial outcomes and high-risk sexual behaviors in adults. Men who have sex with men (MSM) often report higher prevalence of CSA history than the general population, and CSA may play a key role in MSM’s greater vulnerability to HIV. Methods This study examined the prevalence of CSA history and its impact on the number of recent HIV-related risk behaviors (unprotected anal intercourse, high number of male and female sexual partners, alcohol use, drug use, and sex work in prior 6 months) and lifetime risk behaviors and experiences (high number of lifetime male and female sexual partners, early sexual debut, injection drug use, sex work, and intimate partner violence) among 11,788 adult MSM recruited via respondent driven sampling across 12 sites in India, with additional insights from thematic analysis of qualitative research with 363 MSM from 15 sites. Results Nearly a quarter (22.4 %) of participants experienced CSA, with substantially higher prevalence of CSA in the South and among kothis (feminine sexual identity). Qualitative findings revealed that older, trusted men may target young and, especially, gender nonconforming boys, and perpetrators’ social position facilitates nondisclosure. CSA may also initiate further same-sex encounters, including sex work. In multivariable analysis, MSM who experienced CSA had 21 % higher rate of recent (adjusted rate ratio [aRR = 1.21], 95 % confidence interval [CI]: 1.14–1.28), and 2.0 times higher lifetime (aRR = 2.04, 95 % CI: 1.75–2.38) HIV-related behaviors/experiences compared with those who did not. Conclusion This large, mixed-methods study found high overall prevalence of CSA among MSM (22.4 %), with substantially higher prevalence among MSM residing in the South and among more feminine sexual identities. Qualitative findings highlighted boys’ vulnerabilities to CSA, especially gender nonconformity, and CSA’s role in further sexual encounters, including sex work. Additionally, CSA was associated with an elevated rate of recent, and an even higher rate of lifetime HIV-related risk factors. Our results suggest an acute need for the development of CSA prevention interventions and the integration of mental health services for MSM with histories of CSA as part of HIV-prevention efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3446-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | | | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - Suniti Solomon
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.,YR Gaitonde Centre for AIDS Research and Education, Chennai, India.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David D Celentano
- 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
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Differing Identities but Comparably High HIV and Bacterial Sexually Transmitted Disease Burdens Among Married and Unmarried Men Who Have Sex With Men in Mumbai, India. Sex Transm Dis 2016; 42:629-33. [PMID: 26462187 DOI: 10.1097/olq.0000000000000344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although HIV incidence has declined in India, men and transgender women who have sex with men (MSM) continue to have high rates of HIV and sexually transmitted disease (STD). Indian MSM face substantial pressures to marry and have families, but the HIV/STD burden among married Indian MSM is not well characterized. METHODS A diverse sample of Indian MSM were recruited through respondent-driven sampling. Independent variables that produced a P value of 0.10 or less were then added to a multivariable logistic regression model. RESULTS Most of the 307 MSM (95 married and 212 unmarried) recruited into the study were younger than 30 years, and less than one-third had more than a high school education. Almost two-thirds of the married men had children, compared with 1.4% of the unmarried men (P < 0.001). The numbers of condomless anal sex acts did not differ by marriage status. Although unmarried MSM more often identified themselves as "kothi" (receptive role), their rates of HIV or bacterial STD were similar to married MSM, with 14.3% being HIV infected. The respondent-driven sampling-adjusted prevalence of any bacterial STD was 18.3% for married MSM and 20% for unmarried MSM (not significant). Participants reported high levels of psychological distress, with 27.4% of married and 20.1% of unmarried MSM reporting depressive symptoms (not significant). CONCLUSIONS Men who have sex with men in Mumbai had high rates of HIV, STD, and behavioral health concerns. Clinicians need to become more comfortable in eliciting sexual histories so that they can identify MSM who need HIV/STD treatment and/or prevention services.
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Shaw SY, Lorway R, Bhattacharjee P, Reza-Paul S, du Plessis E, McKinnon L, Thompson LH, Isac S, Ramesh BM, Washington R, Moses S, Blanchard JF. Descriptive Epidemiology of Factors Associated with HIV Infections Among Men and Transgender Women Who Have Sex with Men in South India. LGBT Health 2016; 3:292-9. [PMID: 27058882 PMCID: PMC4976224 DOI: 10.1089/lgbt.2015.0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: Men and transgender women who have sex with men (MTWSM) continue to be an at-risk population for human immunodeficiency virus (HIV) infection in India. Identification of risk factors and determinants of HIV infection is urgently needed to inform prevention and intervention programming. Methods: Data were collected from cross-sectional biological and behavioral surveys from four districts in Karnataka, India. Multivariable logistic regression models were constructed to examine factors related to HIV infection. Sociodemographic, sexual history, sex work history, condom practices, and substance use covariates were included in regression models. Results: A total of 456 participants were included; HIV prevalence was 12.4%, with the highest prevalence (26%) among MTWSM from Bellary District. In bivariate analyses, district (P = 0.002), lack of a current regular female partner (P = 0.022), and reported consumption of an alcoholic drink in the last month (P = 0.004) were associated with HIV infection. In multivariable models, only alcohol use remained statistically significant (adjusted odds ratios: 2.6, 95% confidence intervals: 1.2–5.8; P = 0.02). Conclusion: The prevalence of HIV continues to be high among MTWSM, with the highest prevalence found in Bellary district.
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Affiliation(s)
- Souradet Y Shaw
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Robert Lorway
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | | | - Sushena Reza-Paul
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Elsabé du Plessis
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Lyle McKinnon
- 3 Department of Medicine, University of Toronto , Toronto, Ontario, Canada .,4 Department of Medical Microbiology, University of Nairobi , Nairobi, Kenya
| | - Laura H Thompson
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Shajy Isac
- 2 Karnataka Health Promotion Trust , Bangalore, India
| | | | - Reynold Washington
- 2 Karnataka Health Promotion Trust , Bangalore, India .,5 St. John's Research Institute , Bangalore, India
| | - Stephen Moses
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada .,6 Department of Medical Microbiology, University of Manitoba , Winnipeg, Manitoba, Canada
| | - James F Blanchard
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
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McFall AM, Mehta SH, Srikrishnan AK, Lucas GM, Vasudevan CK, Celentano DD, Kumar MS, Solomon S, Solomon SS. Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India. AIDS Care 2016; 28:1230-9. [PMID: 27054274 DOI: 10.1080/09540121.2016.1168915] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
UNAIDS set an ambitious target of "90-90-90" by 2020. The first 90 being 90% of those HIV-infected will be diagnosed; the second 90 being 90% of those diagnosed will be linked to medical care and on antiretroviral therapy (ART). While there has been dramatic improvement in HIV testing and ART use, substantial losses continue to occur at linkage-to-care following HIV diagnosis. Data on linkage among men who have sex with men (MSM) and people who inject drugs (PWID) are sparse, despite a greater burden of HIV in these populations. This cross-sectional study was conducted in 27 sites across India. Participants were recruited using respondent-driven sampling and had to be ≥18 years and self-identify as male and report sex with a man in the prior year (MSM) or injection drug use in the prior 2 years (PWID). Analyses were restricted to HIV-infected persons aware of their status. Linkage was defined as ever visiting a doctor for management of HIV after diagnosis. We explored factors that discriminated between those linked and not linked to care using multi-level logistic regression and area under the receiver operating curves (AUC), focusing on modifiable factors. Of 1726 HIV-infected persons aware of their status, 80% were linked to care. Modifiable factors around the time of diagnosis that best discriminated linkage included receiving assistance with HIV medical care (odds ratio [OR]: 10.0, 95% confidence interval [CI]): 5.6-18.2), disclosure of HIV-positive status (OR: 2.8; 95% CI: 2.4-6.1) and receiving information and counseling on management of HIV (OR: 2.3; 95% CI: 1.1-4.6). The AUC for these three factors together was 0.85, higher than other combinations of factors. We identified three simple modifiable factors around the time of diagnosis that could facilitate linkage to care among MSM and PWID in low- and middle-income countries to achieve UNAIDS targets.
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Affiliation(s)
- Allison M McFall
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Shruti H Mehta
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | - Gregory M Lucas
- c Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | | | - David D Celentano
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | - Suniti Solomon
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sunil S Solomon
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Tomori C, Srikrishnan AK, Ridgeway K, Solomon SS, Mehta SH, Solomon S, Celentano DD. Friends, Sisters, and Wives: Social Support and Social Risks in Peer Relationships Among Men Who Have Sex With Men (MSM) in India. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:153-164. [PMID: 27459166 PMCID: PMC4966165 DOI: 10.1521/aeap.2016.28.2.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Globally, men who have sex with men (MSM) are at high risk for HIV. Many HIV-prevention efforts rely on community outreach and mobilization to engage MSM. This study examines peer relationships and their potential role in HIV prevention through 31 focus group discussions (FGDS) and 121 in-depth interviews (IDIs) with 363 MSM across 15 sites in India. Results indicate that MSM receive social support in friendships, sex-worker collaborations, constructed kin relationships, and romantic partnerships. Access to these relationships, however, is uneven across MSM, and can carry risks of disclosure of same-sex behavior and exclusion based on HIV- positive status. Positive peer relationships can serve as the basis of community empowerment, education, and couple-based interventions for MSM, and peer counselors can also provide a buffer against the social risks of peer relationships and facilitate linkage to care and continued engagement in treatment. These insights can improve HIV interventions for MSM in India and elsewhere.
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Affiliation(s)
- Cecilia Tomori
- Johns Hopkins Bloomberg School of Public Health, Department of
Epidemiology, Baltimore, Maryland, USA
| | | | - Kathleen Ridgeway
- Johns Hopkins Bloomberg School of Public Health, Department of
International Health, Baltimore, Maryland, USA
| | - Sunil S. Solomon
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore,
Maryland, USA
| | - Shruti H. Mehta
- Johns Hopkins Bloomberg School of Public Health, Department of
Epidemiology, Baltimore, Maryland, USA
| | - Suniti Solomon
- YR Gaitonde Centre for AIDS Research and Education, Chennai,
India
| | - David D. Celentano
- Johns Hopkins Bloomberg School of Public Health, Department of
Epidemiology, Baltimore, Maryland, USA
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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.
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Aggarwal P, Bhattar S, Sahani SK, Bhalla P, Garg VK. Sexually transmitted infections and HIV in self reporting men who have sex with men: A two-year study from India. J Infect Public Health 2016; 9:564-70. [PMID: 26776704 DOI: 10.1016/j.jiph.2015.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/18/2015] [Accepted: 12/11/2015] [Indexed: 11/25/2022] Open
Abstract
Homosexuality is not legally and socially accepted in India. Thus, this area of research has largely been ignored by Indian authors, resulting in dearth of knowledge, particularly with respect to sexually transmitted infections (STIs) in this high-risk group. Over a period of two years (2013-2014), 738 males sought care at skin and venereal diseases clinics, 52 (7.05%, 95% CI=5.4-9.14%) of who identified themselves as MSM and were enrolled in the study. Diagnosis was made on the basis of clinical presentation and laboratory testing, wherever indicated. Thirty six percent of MSM had only homosexual preferences, while 64% were bisexual. The most common sexually transmitted infection was genital warts (23.08%, 95% CI=13.58-36.28%). Fourteen patients (26.92%, 95% CI=16.67-40.35%) were VDRL and TPHA positive (two, five and four with primary syphilis, secondary syphilis and latent syphilis, respectively). These were followed by genital herpes (11.54%, 95% CI=5.03-23.34%), genital molluscum contagiosum (9.62% 95% CI=3.75-21.04%), and gonorrhea (5.77%, 95% CI=1.38-16.25%). Of those tested, 23.08% (95% CI=13.58-36.28%) of patients were reactive for HIV serology. Thus, MSM is a high-risk group with high prevalence of HIV and other STIs in this group, mandating greater focus, education and counseling.
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Affiliation(s)
- Prabhav Aggarwal
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India.
| | - Sonali Bhattar
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India.
| | - Satyendra K Sahani
- Department of Dermatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi 110002, India.
| | - Preena Bhalla
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India.
| | - Vijay K Garg
- Department of Dermatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi 110002, India.
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Affiliation(s)
- Jean-Louis Excler
- U.S. Military HIV Research Program 6720-A Rockledge Drive, Suite 400 Bethesda, MD 20817, USA
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Phanuphak N, Lo YR, Shao Y, Solomon SS, O'Connell RJ, Tovanabutra S, Chang D, Kim JH, Excler JL. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials. AIDS Res Hum Retroviruses 2015; 31:1060-76. [PMID: 26107771 DOI: 10.1089/aid.2015.0049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.
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Affiliation(s)
| | - Ying-Ru Lo
- HIV, Hepatitis, and STI Unit, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Yiming Shao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sunil Suhas Solomon
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Robert J. O'Connell
- Department of Retrovirology, U.S. Army Medical Component, Armed Forces Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - David Chang
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jerome H. Kim
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jean Louis Excler
- U.S. Military HIV Research Program, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Raj Y, Sahu D, Pandey A, Venkatesh S, Reddy D, Bakkali T, Das C, Singh KJ, Kant S, Bhattacharya M, Stover J, Jha UM, Kumar P, Mishra RM, Chandra N, Gulati BK, Mathur S, Joshi D, Chavan L. Modelling and estimation of HIV prevalence and number of people living with HIV in India, 2010-2011. Int J STD AIDS 2015; 27:1257-1266. [PMID: 26494704 DOI: 10.1177/0956462415612650] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022]
Abstract
This paper provides HIV estimation methodology used in India and key HIV estimates for 2010-2011. We used a modified version of the Spectrum tool that included an Estimation and Projection Package as part of its AIDS Impact Module. Inputs related to population size, age-specific pattern of fertility, gender-ratio at birth, age and gender-specific pattern of mortality, and volume and age-gender distribution of net migration were derived from census records, the Sample Registration System and large-scale demographic health surveys. Epidemiological and programmatic data were derived from HIV sentinel surveillance, large-scale epidemiological surveys and the programme management information system. Estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35-0.47%). By 2010 and 2011, it levelled at estimates of 0.28% (0.24-0.34%) and 0.27% (0.22-0.33%), respectively. The estimated number of people living with HIV (PLHIV) reduced by 8% between 2007 and 2011. While children accounted for approximately 6.3% of total HIV infections in 2007, this proportion increased to about 7% in 2011. With changing priorities and epidemic patterns, the programme has to customise its strategies to effectively address the emerging vulnerabilities and adapt them to suit the requirements of different geographical regions.
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Affiliation(s)
- Yujwal Raj
- National AIDS Control Organization, New Delhi, India
| | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Arvind Pandey
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - S Venkatesh
- National AIDS Control Organization, New Delhi, India
| | - Dcs Reddy
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India (Ex-Professor)
| | | | - Chinmoyee Das
- National AIDS Control Organization, New Delhi, India
| | - Kh Jitenkumar Singh
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Shashi Kant
- Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - M Bhattacharya
- Department of Community Health Administration, National Institute of Health & Family Welfare, New Delhi, India
| | | | | | - Pradeep Kumar
- National AIDS Control Organization, New Delhi, India
| | | | | | - B K Gulati
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Sharad Mathur
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
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Mimiaga MJ, Closson EF, Thomas B, Mayer KH, Betancourt T, Menon S, Safren SA. Garnering an in-depth understanding of men who have sex with men in Chennai, India: a qualitative analysis of sexual minority status and psychological distress. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:2077-86. [PMID: 25358949 PMCID: PMC4441605 DOI: 10.1007/s10508-014-0369-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 05/14/2014] [Accepted: 06/02/2014] [Indexed: 05/20/2023]
Abstract
Men who have sex with men (MSM) in India are a hidden and largely understudied population, and have an HIV prevalence 17 times higher than that of the general Indian population. Experiences of social marginalization and negative psychosocial conditions occur concurrent to HIV risk among Indian MSM. To better understand the contextual variables driving HIV risk and inform intervention development, five focus groups (n = 46) and nine key informant interviews were conducted with 55 MSM in Chennai in 2010. NVivo software was used to code the transcripts, and data were analyzed using qualitative descriptive analysis methodology. Participants described sources of psychological distress and low self-worth related to gender non-conformity and sexual minority status. These included stigma from society, pressure to marry, lack of familial acceptance, childhood sexual abuse, and the imperative to keep sexual minority status a secret. Participants' personal evaluations revealed that self-acceptance may be an important resilience factor that can shield these psychosocial and HIV risk factors. In promoting health-seeking behavioral changes for Indian MSM at an individual level, our findings point to the potential strength of strategies that focus on self-acceptance of one's sexual minority identity to foster better psychosocial and overall health.
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Affiliation(s)
- Matthew J Mimiaga
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Behavioral Medicine, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
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Satyanarayan S, Kapur A, Azhar S, Yeldandi V, Schneider JA. Women Connected to at Risk Indian Men Who Have Sex with Men: An Unexplored Network. AIDS Behav 2015; 19:1031-6. [PMID: 25403143 DOI: 10.1007/s10461-014-0946-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Little is known about the women connected to Indian MSM and their impact on HIV risk. We surveyed 240 Indian MSM, who identified their social networks (n = 7,092). Women (n = 1,321) comprised 16.7 % of the network, with 94.7 % representing non-sexual connections. MSM were classified as having low, moderate, or high female network proportion. MSM with moderate female network proportion (8-24 % total network) had significantly lowered odds of HIV seropositivity (AOR = 0.24, 95 % CI = 0.1-0.6). This suggests moderate proportions of female connections could mediate HIV risk. HIV prevention interventions in India could consider the greater involvement of women among their target audiences. Se sabe poco sobre las mujeres conectadas a HSH en India y su impacto en el riesgo de VIH. Se encuestó a 240 HSH indios, quienes identificaron sus redes sociales (n = 7,092). Las mujeres (n = 1,321) formaron al 16.7 % de la red, del cual el 94.7 % representa conexiones no sexuales. Los HSH se clasificaron como baja, moderada o alta proporción de red femenina. HSH con proporción moderada de red femenina (8-24 % del red total) tuvieron un riesgo significativamente reducido de seropositividad de VIH (AOR = 0,24; IC 95 % = 0,1-0,6). Esto sugiere que tener una proporción moderada de contactos femeninos podría atenuar el riesgo de VIH. Las intervenciones de prevención del VIH en India podrían considerar una mayor participación de las mujeres en su público objetivo.
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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.
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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:
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Abstract
OBJECTIVE To characterize prevalence, incidence, and associated correlates of HIV infection among MSM in 12 cities across India. DESIGN Cross-sectional sample using respondent-driven sampling from September 2012 to June 2013. METHODS A total 12022 MSM (~1000/city) were recruited. Participants had to be at least 18 years, self-identify as male, and report oral/anal intercourse with a man in the prior year. HIV infection was diagnosed using three rapid tests. Cross-sectional HIV incidence was estimated using a multiassay algorithm. All estimates incorporate respondent-driven sampling-II weights. RESULTS Median age was 25 years, 45% self-identified as 'panthi' (predominantly penetrative anal intercourse) and 30.6% reported being married to a woman. Weighted HIV prevalence was 7.0% (range: 1.7-13.1%). In multivariate analysis, significantly higher odds of HIV infection was observed among those who were older, had lower educational attainment, were practicing purely receptive anal sex or both receptive and penetrative sex, and those who were herpes simplex virus-2 positive. Of 1147 MSM who tested HIV positive, 53 were identified as recent HIV infections (annualized incidence = 0.87%; range = 0-2.2%). In multivariate analysis, injecting drugs in the prior 6 months, syphilis, and higher number of male partners and fewer female partners were significantly associated with recent HIV infection. CONCLUSION We observed a high burden of HIV among MSM in India with tremendous diversity in prevalence, incidence, and risk behaviors. In particular, we observed high incidence in areas with relatively low prevalence suggesting emerging epidemics in areas not previously recognized to have high HIV burden.
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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.
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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
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Agarwal A, Hamdallah M, Swain SN, Mukherjee S, Singh N, Mahapatra S, King EJ, Pulerwitz J, Thior I. Implementation of a confidential helpline for men having sex with men in India. JMIR Mhealth Uhealth 2015; 3:e17. [PMID: 25673240 PMCID: PMC4342662 DOI: 10.2196/mhealth.3978] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In India, men who have sex with men (MSM) often face physical violence and harassment from police and the general society. Many MSM may not openly disclose their sexual identity, especially if they are married to women and have families. Due to pervasive stigma and discrimination, human immunodeficiency virus (HIV) prevention programs are unable to reach many MSM effectively. OBJECTIVE The objective of this paper was to describe the design, operations, and monitoring of the Sahaay helpline, a mHealth intervention for the MSM population of India. METHODS We established the "Sahaay" mHealth intervention in 2013; a MSM-dedicated helpline whose main goal was to increase access to comprehensive, community-based HIV prevention services and improve knowledge, attitudes, and behaviors of MSM towards HIV and sexually transmitted infections (STI) in three states of India (Chhattisgarh, Delhi, and Maharashtra). The helpline provided a 24x7 confidential and easy to use interactive voice response system (IVRS) to callers. IVRS function was monitored through an online dashboard of indicators. The system also provided real-time reporting on callers and services provided. RESULTS The helpline received more than 100,000 calls from 39,800 callers during the first nine months of operation. The helpline maintained an operational uptime of 99.81% (6450/6462 hours); and answered more than 81.33% (83,050/102,115) of all calls. More than three-fourths of the calls came between 9:00 am-12:00 pm. The most successful promotional activity was "interpersonal communication" (reported by 70.05%, 27,880/39,800, of the callers). Nearly three-fourths of the callers self-identified as MSM, including 17.05% (6786/39,800) as rural MSM and 5.03% (2001/39,800) as a married MSM. Most callers (93.10%, 37,055/39,800) requested information, while some (27.01%, 10,750/39,800) requested counseling on HIV/acquired immune deficiency syndrome (AIDS), STIs, and other health and nonhealth issues. There were 38.97% (15,509/39,800) of the callers that were provided contacts of different HIV/AIDS referral services. Many MSM clients reported increased self-esteem in dealing with their sexual identity and disclosing the same with their family and spouse; and an increase in HIV/AIDS risk-reduction behaviors like consistent condom use and HIV testing. CONCLUSIONS National HIV/AIDS prevention interventions for MSM in India should consider scaling-up this helpline service across the country. The helpline may serve as an important mechanism for accessing hard-to-reach MSM, and thus improving HIV prevention programing.
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