Male-To-Male Sex among Men Who Inject Drugs in Delhi, India: Overlapping HIV Risk Behaviours
BACKGROUND:
HIV 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.
METHODS:
We
analysed data collected in April-May of 2012 from a community-based sample of
420 male PWID in Delhi obtained using time location sampling.
RESULTS:
One 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).
CONCLUSION:
Male-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.
- 1Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia. Electronic address: g.armstrong@unimelb.edu.au.
- 2Population Mental Health Group, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
- 3The Society for Service to Urban Poverty (SHARAN), Delhi, India.
- 4Department of Social Work, School of Health Sciences, University of Melbourne, Victoria, Australia.
- 5Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
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