Abstract
BackgroundHIV/AIDS in India disproportionately affects women, not by their own risks, but by those of their partners, generally their spouses. We address two marginalized populations at elevated risk of acquiring HIV: women who are married to men who also have sex with men (MSM) and wives of injection drug users (IDUs).MethodsWe used a combination of focus groups (qualitative) and structured surveys (quantitative) to identify the risks that high-risk men pose to their low-risk wives and/or sexual partners. Married MSM were identified using respondent-driven recruitment in Tamil Nadu, India, and were interviewed by trainer assessors. A sample of wives of injection drug users in Chennai were recruited from men enrolled in a cohort study of the epidemiology of drug use among IDUs in Chennai, and completed a face-to-face survey. Focus groups were held with all groups of study participants, and the outcomes transcribed and analyzed for major themes on family, HIV and issues related to stigma, discrimination and disclosure.ResultsUsing mixed-methods research, married MSM are shown to not disclose their sexual practices to their wives, whether due to internalized homophobia, fear of stigma and discrimination, personal embarrassment or changing sexual mores. Married MSM in India largely follow the prevailing norm of marriage to the opposite sex and having a child to satisfy social pressures. Male IDUs cannot hide their drug use as easily as married MSM, but they also avoid disclosure. The majority of their wives learn of their drug-using behaviour only after they are married, making them generally helpless to protect themselves. Fear of poverty and negative influences on children were the major impacts associated with continuing drug use.ConclusionsWe propose a research and prevention agenda to address the HIV risks encountered by families of high-risk men in the Indian and other low- and middle-income country contexts.
Highlights
HIV/AIDS in India disproportionately affects women, not by their own risks, but by those of their partners, generally their spouses
The ability to discriminate between homosexual and heterosexual transmission in India is challenging because many men who have sex with men (MSM) are married and/or bisexual, and are hesitant to self-identify as homosexual or bisexual
HIV prevalence among married MSM was largely explained by higher risk behaviours among married MSM, including having a greater number of male partners and not reporting a primary male partner [37]
Summary
HIV/AIDS in India disproportionately affects women, not by their own risks, but by those of their partners, generally their spouses. Injection drug use and men having sex with men remain two drivers of the HIV epidemic in the developing world, a fact that is commonly overlooked in the planning and implementation of treatment and prevention programmes [1, 2]. Many of these men who have sex with men (MSM) and injecting drug users (IDUs) are married; they face unique risks and social pressures in many resource-constrained settings, which place their female sex partners and, by consequence, their children at high risk for HIV and associated co-infections. Injection drug use drives the HIV epidemic in the north-east, but has been increasingly recognized in other parts
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