Burden and Correlates of HIV among Men Who Have Sex with Men in West Bengal, India: Analysis of Sentinel Surveillance Data

Abstract

BackgroundLittle is known about the socio-behavioral risk factors for HIV acquisition among hard-to-reach men who have sex with men (MSM) population in India, particularly from the densely populated eastern part. Thus to measure the burden and correlates of HIV among MSM in West Bengal state of eastern India, a cross-sectional analysis of the national HIV Sentinel Surveillance (HSS) data was conducted.MethodsIn 2011, between July and September, involving all sentinel sites of the state, 1237 consenting MSM were anonymously interviewed and tested for HIV following national guidelines. Using a short, structured questionnaire, information was collected on socio-behavioral factors along with sexual practices and was analyzed to determine burden of HIV and the role of its socio-behavioral correlates on HIV acquisition.ResultsAmong participants, mean age was 23.4 years, 44.55% were “Kothis” (usually receptive partner) and 25.1% admitted receiving money for sex with man. HIV sero-positivity was 5.09%. Using logistic regression method, for both bivariate and multivariate (with saturated model) analyses, transport-workers [adjusted odds ratio (AOR)=8.95, 95% confidence interval (95%CI): 1.09-73.71), large business-owners/self-employed (AOR=8.46, 95%CI: 1.25-57.49), small business-owners/cultivators (AOR=7.90, 95%CI: 1.67-37.38), those who visited the sentinel site for official purposes (AOR=7.60, 95%CI: 1.21-47.83) and paying money for having sex with men (AOR=3.03, 95%CI: 1.10-8.33) were strongly associated with higher HIV sero-positivity with than their counterparts. Using the parsimonious model for multivariate analysis, Kothis (AOR=4.64, 95%CI: 1.03-20.89), paying (AOR=2.96, 95%CI: 1.15-7.58) or receiving (AOR=2.06, 95%CI: 1.06-3.99) money for having sex with a man were associated with higher risk of HIV.ConclusionsFocused intervention targeting the high risk MSM subgroups including Kothis, transport-workers, business-owners/self-employed and those who exchanged money for having sex with men, seemed to be the need of the hour for preventing the spread of HIV infection within and from this understudied population.

Demographic and Sexual Behavior Characteristics of Men Who Have Sex with Men (MSM) Registered in a Targeted Intervention (TI) Program in India

“…Double-decker was the predominant sub-typology identified in the TI program. This finding is contrary to the results of various studies, which indicate that Kothis are the dominant sub-typology in India attributed to their self-identifiable nature as compared to other sub-typologies [6] [15]. Corroborating with other studies, the proportion of Panthis in our study was also low.…”

“…The demographic characteristics of MSM observed in this study are similar to previous studies based on HIV Sentinel Surveillance (HSS) data in India [6] [15]. Almost-two thirds of MSM belonged to the younger age group (<35 years).…”

“…Other things being equal, the higher number of sexual acts makes these MSM more vulnerable to acquisition of HIV infection than others [6]. Illiterate MSM had reported higher sexual activity, unlike other studies in India [6] [15]. The reason(s) for the difference is not clear.…”

A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people’s health in India

“…Forty-seven articles [ 48 – 94 ] reported correlates of HIV-related risk among MSM and TGW. Among MSM, significant correlates of HIV risk behaviors/indicators such as condomless sex [ 48 – 50 , 58 , 64 , 77 , 78 , 92 , 93 ], infrequent HIV testing [ 60 , 65 , 72 , 74 ], and HIV/STI positivity [ 48 , 51 , 55 , 79 ] were low literacy and unemployment [ 48 , 76 , 77 ], alcohol and/or drug use [ 54 , 60 , 64 , 65 , 79 , 90 , 93 ], engagement in sex work [ 49 , 60 , 61 , 65 , 67 , 68 , 75 , 76 , 78 ], higher number of male sexual partners [ 48 – 50 , 53 , 56 , 72 , 74 ], early age of sexual debut [ 93 ], and low HIV risk perception [ 60 , 65 , 72 , 74 ]. Six of the 47 articles included data on TGW; five of these [ 79 , 81 ,…”

A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people’s health in India

“…Forty-seven articles [48–94] reported correlates of HIV-related risk among MSM and TGW. Among MSM, significant correlates of HIV risk behaviors/indicators—i.e., condomless sex [48-50, 58, 64, 77, 78, 92, 93], infrequent HIV testing [60, 65, 72, 74], and HIV/STI positivity [48, 51, 55, 79]—were low literacy and unemployment [48, 76, 77], alcohol and/or drug use [54, 60, 64, 65, 79, 90, 93], engagement in sex work [49, 60, 61, 65, 67, 68, 75, 76, 78], higher number of male sexual partners [48-50, 53, 56, 72, 74], early age of sexual debut [93], and low HIV risk perception [60, 65, 72, 74]. Six of the 47 articles included data on TGW; five of these [79, 81, 84, 87, 89] did not provide details on correlates of HIV risk behaviors, with one study [94] reporting that having a male regular partner was associated with HIV seropositivity.…”