Background
Men who have sex with
men (MSM) are marginalized, hidden, underserved and at high risk for HIV in
Nepal. We examined the association between MSM sub-populations, psychosocial
health problems and support, access to prevention and non-use of condoms.
Methods
Between
September-November of 2010, a cross-sectional survey on HIV-related risk
behavior was performed across Nepal through snowball sampling facilitated by
non-governmental organizations, recruiting 339 MSM, age 15 or older. The
primary outcomes were: (a) non-use of condoms at least once in last three anal
sex encounters with men and (b) non-use of condoms with women in the last
encounter. The secondary outcome was participation in HIV prevention
interventions in the past year.
Results
Among the 339 MSM interviewed,
78% did not use condoms at their last anal sex with another man, 35% did not
use condoms in their last sex with a woman, 70% had experienced violence in the
last 12 months, 61% were experiencing depression and 47% had thought of
committing suicide. After adjustment for age, religion, marital status, and MSM
subpopulations (bisexual, ta, meti, gay),
non-use of condoms at last anal sex with a man was significantly associated
with non-participation in HIV interventions, experience of physical and sexual
violence, depression, repeated suicidal thoughts, small social support network
and being dissatisfied with social support. Depression was marginally
associated with non-use of condoms with women. The findings suggest that among
MSM who reported non-use of condoms at last anal sex, the ta subgroup and those lacking family acceptance
were the least likely to have participated in any preventive interventions.
Conclusions
MSM in Nepal have a
prevalence of psychosocial health problems in turn associated with high risk
behavior for HIV. Future HIV prevention efforts targeting MSM in Nepal should
cover all MSM subpopulations and prioritize psychosocial health interventions.
Full article at: http://goo.gl/0Gchu8
By: Keshab Deuba,1,* Anna Mia Ekström,2,3 Rachana Shrestha,4 George Ionita,5 Laxmi Bhatta,4 and Deepak Kumar Karki6
1Department of Public Health Sciences,
Karolinska Institutet, Stockholm, Sweden
2Division of Global Health (IHCAR),
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
3Department of Infectious Diseases,
Huddinge, Karolinska University Hospital, Stockholm, Sweden
4Nobel College, Pokhara University,
Kathmandu, Nepal
5United Nations Development Programme
(UNDP), Kathmandu, Nepal
6National Centre for AIDS and STD Control,
Kathmandu, Nepal
University of
Washington, United States of America
* E-mail: moc.liamg@k4abued
More at: https://twitter.com/hiv_insight
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