Male-to-male sex among men who inject drugs in Delhi, India: Overlapping HIV risk behaviours

Abstract

BackgroundHIV among people who inject drugs (PWID) is a major public health challenge in India. This paper examines PWID in Delhi who also have male-to-male sex with a focus on overlapping HIV risk behaviours and the psychosocial correlates of a history of male-to-male anal sex. MethodsWe analysed data collected in April–May of 2012 from a community-based sample of 420 male PWID in Delhi obtained using time location sampling. ResultsOne third (37%) of the men reported a history of anal sex with men, among whom just 16% used a condom at last anal sex. Almost all (93%) participants who had a history of anal sex with men also had sex with women. Chi-square tests revealed that a history of anal sex with men was associated with a higher number of female sexual partners and sharing of needles and syringes. Additionally, unprotected sex at last sex with a male partner was significantly associated with unprotected sex at last sex with regular and paid female partners. Multivariate binary logistic regression revealed that the psychosocial correlates of a history of anal sex with other men were: being aged 18–24 (OR=2.4, p=0.014), illiteracy (OR=1.9, p=0.033), having never been married (OR=2.6, p=0.007), a main source of income of crime/begging (OR=3.1, p=0.019), a duration of injecting drug use greater than 20 years (OR=3.4, p=0.035) and suicidal ideation (OR=1.7, p=0.048). ConclusionMale-to-male sex was associated with psychosocial vulnerability, including a longer history of injecting drug use, suicidal ideation and socio-economic disadvantage. Given the extent of overlapping HIV risk behaviours, HIV programs for PWID would benefit from a strong focus on prevention of sexual HIV transmission, especially among male injectors who also have sex with other men.