Although HIV incidence has declined in India, men and
transgender women who have sex with men (MSM) continue to have high rates of
HIV and sexually transmitted disease (STD). Indian MSM face substantial
pressures to marry and have families, but the HIV/STD burden among married
Indian MSM is not well characterized.
A diverse sample of Indian MSM were recruited through
respondent-driven sampling. Independent variables that produced a P value of
0.10 or less were then added to a multivariable logistic regression model.
Most of the 307 MSM (95 married and 212 unmarried) recruited
into the study were younger than 30 years, and less than one-third had more
than a high school education. Almost two-thirds of the married men had
children, compared with 1.4% of the unmarried men. The numbers
of condomless anal sex acts did not differ by marriage status. Although
unmarried MSM more often identified themselves as "kothi" (receptive
role), their rates of HIV or bacterial STD were similar to married MSM, with
14.3% being HIV infected. The respondent-driven sampling-adjusted prevalence of
any bacterial STD was 18.3% for married MSM and 20% for unmarried MSM (not
significant). Participants reported high levels of psychological distress, with
27.4% of married and 20.1% of unmarried MSM reporting depressive symptoms (not
significant).
Men who have sex with men in Mumbai had high rates of HIV,
STD, and behavioral health concerns. Clinicians need to become more comfortable
in eliciting sexual histories so that they can identify MSM who need HIV/STD
treatment and/or prevention services.
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By:
- 1From the *The Fenway Institute, Fenway Health, Boston, MA; †Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ‡National AIDS Research Institute, Pune, India; §The Humsafar Trust, Mumbai, India; and ¶Harvard T.H. Chan School of Public Health and ∥Harvard Medical School, Massachusetts General Hospital, Boston, MA.
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