HIV prevalence is significantly higher among men who have sex with men in India than among men reporting only sex with women, according to a study published in the March 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The study also revealed that the majority of men reporting sex with men were married, and that HIV-positive men who reported having sex with men were also likely to report multiple risk factors for HIV, including drug use, multiple sex partners and exchanging sex for money.
India has the second-highest number of HIV-positive people in the world, and evidence suggests that heterosexual sex is the main mode of transmission. The prevalence of HIV amongst men who have sex with men in India is not known, and, unlike the situation in many other countries, men who have sex with men in India often do not conform to a homosexual identity.
Investigators therefore wished to determine the prevalence of HIV and other sexually transmitted infections among men reporting oral or anal sex with another man in the Chennai slums.
The study was a cross-sectional population-based one, and recruited a random sample of 774 men in 2001. Participants provided details of their sexual and drug use behaviour to trained counsellors and provided a blood sample for HIV and syphilis testing and a urine sample for chlamydia and gonorrhoea testing.
A total of 46 men (5.9%) reported ever having sex with another man, and 6.5% of these men were HIV-positive compared to only 0.9% of men who did not report sex with another man.
Men who had sex with men were also more likely to report a history of sexually transmitted infections (odds ratio 2.66, 95% CI: 1.18 – 6.02), or to report having discharge from the penis (OR = 3.96, 95% CI: 1.87 – 8.38), than men who did not report sex with men.
The investigators also found that men reporting sex with other men were also significantly more likely to engage in other HIV risk behaviours, including the use of illicit drugs (OR = 4.94, 95% CI: 2.61 – 9.34), more than four life-time sexual partners (OR = 3.22, 95% CI: 1.78 – 5.83), and exchanging money for sex (OR = 5.50, 95% CI: 3.12 – 9.96).
”Overall, [men who have sex with men] are more likely than non-[men who have sex with men] to be infected with HIV and more likely to have a history of ST[I]s,” comment the investigators. However, they add that HIV-positive men who have sex with men are also more likely to report other risk activities that could result in HIV infection.
Although the investigators did not gather information on sexual identity, they noted that 57% of men reporting sex with another man were married, “reflecting the fluidity of sexual behaviour in India.”
The investigators conclude, “Our study suggests that unsafe sex among men who have sex with men is one of several high HIV risk behaviours that this subgroup of individuals engages in. Rather than targeting this group in the context of sexuality, HIV interventions might address a range of HIV risk behaviours, including a number of unsafe sexual practices, including sex with men.”
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Go VF et al. High prevalence and risk behaviours in men who have sex with men in Chennai, India. JAIDS 35: 314 – 319, 2004.