HIV in Indian MSM: Reasons for a concentrated epidemic & strategies for prevention

Abstract

Men who have sex with men (MSM) in India are disproportionately likely to be HIV-infected, and face distinct psychosocial challenges. Understanding the unique socio-cultural issues of MSM in India and how they relate to HIV risk could maximize the utility of future prevention efforts. This review discusses: (i) the importance of addressing co-occurring mental health issues, such as depression, which may interfere with MSM's ability to benefit from traditional risk reduction counselling, (ii) reducing HIV-related stigma among health providers, policymakers and the lay public, and (iii) the role for non-governmental organizations that work with the community to play in providing culturally relevant HIV prevention programmes for MSM.

Sociobehavioral Correlates of HIV Risk among Men Who Have Sex with Men in Chhattisgarh, India: Analysis of Sentinel Surveillance Data

“…The HIV prevalence among MSM in Southeast Asia has been found to be 5-15 times higher than that in the general population (3). An estimated 3.1 million MSM live in India, and this population is often a target for social discrimination or abuse (4,5). From an Indian perspective, the term MSM refers to the sexual behaviors of men, irrespective of their sexual identity, orientation, and desire (3,6).…”

Social correlates of sexual risk behaviors among urban men who have sex with men in Kolkata, India

“…Lack of legislative protection against abuse and violence is another factor contributing to the syndemics of higher HIV risk. 9,12,28 …”

“…Moreover, discovering and adapting to a non normative sexual identity, particularly without the psychological resilience and coping resource of maturity makes them more vulnerable to gay related stressors. 28 Internalized homophobia, extreme stigmatization and criminalization of MSM activity limit the same sex sexual discourse in the public sphere. As a reason most of the MSM sexual activities are conducted in clandestine manner.…”

“…Condom negotiation is also difficult, if not impossible, in clandestine sexual encounters taking place in public places, making MSM more vulnerable to sexual violence and assault, thereby adding up to the life stress in this marginalized population group. 28 Living with MSM identity in Indian homophobic societal structure marginalizes a person. Discovering ones sexual identity and disclosure to the family is generally the beginning of a stigmatized existence which is associated with cultural and familial stressors.…”

Mobile Game Based Learning

“…In response to the stigmatisation and discrimination of these MSM behaviours, peer education is part of the Indian government's efforts to prevent and control HIV/AIDS. MSM peer educators are the members of the same group and similarly experience multiple forms of social and legal discrimination (Chakrapani et al, 2002;Gupta, 2006;Thomas et al, 2011). Same sex behaviours are stigmatised in India, leading to this extreme marginalisation and discrimination.…”