Abstract
BackgroundIndian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM.MethodsBetween March-May 2011, 4682 men (15–49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites.ResultsOf 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, ‘being bisexual’ was found to be independently associated with ‘older age’: 26–30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; ‘reporting penetrative behaviour alone’ with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and ‘reporting both penetrative and receptive behaviour’ [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual.ConclusionsA substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population.
Highlights
India has a largely heterosexual HIV epidemic, which is concentrated among various core populations at high risk of HIV [1,2]
In order to recruit the sample of 250 Men having Sex with Men (MSM) the most up to date list of MSM registered as active beneficiaries was obtained and 300 were selected by simple random sampling
In all 4682 MSM were tested for HIV under sentinel surveillance conducted at 19 sites in 4 states of west-central region of India (Goa, Gujarat, Maharashtra and Madhya Pradesh)
Summary
India has a largely heterosexual HIV epidemic, which is concentrated among various core populations at high risk of HIV [1,2]. In 2011, the average national HIV prevalence among MSM was 4.43% and it was greater than 5% in nine Indian states [5]. MSM are a core population subgroup for these interventions as well as HIV surveillance [1,2,3,4,7]. To consolidate India’s HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM
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