Psychosocial Health Problems Associated with Increased HIV Risk Behavior among Men Who Have Sex with Men in Nepal: A Cross-Sectional Survey

Abstract

BackgroundMen who have sex with men (MSM) are marginalized, hidden, underserved and at high risk for HIV in Nepal. We examined the association between MSM sub-populations, psychosocial health problems and support, access to prevention and non-use of condoms.MethodsBetween September-November of 2010, a cross-sectional survey on HIV-related risk behavior was performed across Nepal through snowball sampling facilitated by non-governmental organizations, recruiting 339 MSM, age 15 or older. The primary outcomes were: (a) non-use of condoms at least once in last three anal sex encounters with men and (b) non-use of condoms with women in the last encounter. The secondary outcome was participation in HIV prevention interventions in the past year.ResultsAmong the 339 MSM interviewed, 78% did not use condoms at their last anal sex with another man, 35% did not use condoms in their last sex with a woman, 70% had experienced violence in the last 12 months, 61% were experiencing depression and 47% had thought of committing suicide. After adjustment for age, religion, marital status, and MSM subpopulations (bisexual, ta, meti, gay), non-use of condoms at last anal sex with a man was significantly associated with non-participation in HIV interventions, experience of physical and sexual violence, depression, repeated suicidal thoughts, small social support network and being dissatisfied with social support. Depression was marginally associated with non-use of condoms with women. The findings suggest that among MSM who reported non-use of condoms at last anal sex, the ta subgroup and those lacking family acceptance were the least likely to have participated in any preventive interventions.ConclusionsMSM in Nepal have a prevalence of psychosocial health problems in turn associated with high risk behavior for HIV. Future HIV prevention efforts targeting MSM in Nepal should cover all MSM subpopulations and prioritize psychosocial health interventions.

Male-to-male sex among men who inject drugs in Delhi, India: Overlapping HIV risk behaviours

“…This finding is consistent with studies in India and neighboring Nepal that have found condom use among MSM populations to be low (Brahmam et al, 2008;Dandona et al, 2005;Deuba et al, 2013). For example, Deuba et al (2013) studied MSM in Nepal and found that 78.0% did not use condoms at last anal sex with another male partner, compared to 35% having not used a condom at last sex with a female partner. Dandona et al (2005) documented the main reasons for not using condoms at last anal sex with a male partner among a large sample (n = 6661) of MSM in Andhra Pradesh (India), including: (1) dislike of condoms (27.3%),…”

Migration Stress, Poor Mental Health, and Engagement in Sex with High-Risk Partners: a Mediation Modeling Analysis of Data from Rural-to-Urban Migrants in China

“…Engaging in risk and unprotected sex has been documented as a coping strategy to deal with stress in migrant (Du & Li, 2015)and non-migrant populations (Brody, Chen, & Kogan, 2010; Deuba et al, 2013; Folkman, Chesney, Pollack, & Phillips, 1992; Muñoz-Laboy, Severson, & Bannan, 2014). The research findings described in the previous sections suggest a potential mechanism by which poor mental health mediates the association between migration stress and sexual risk behaviors.…”

Effects of Antiretroviral Therapy on the Survival of Human Immunodeficiency Virus-positive Adult Patients in Andhra Pradesh, India: A Retrospective Cohort Study, 2007-2013

“…The poor outcomes in the initial few months after ART initiation might be due to delayed diagnosis and/or treatment, and explained by the fact that 60.5% of patients had advanced disease (CD4 count <200 cells/mm 3 ) and 37.2% of patients had advanced clinical symptoms (WHO clinical stage III or IV) at the time of treatment initiation. Several factors such as HIV-related stigma and discrimination [22] may have played a vital role in delaying diagnosis and/or treatment. Moreover, the lack of proper screening diagnostic facilities for opportunistic infections and the limited availability of prophylaxis may have also increased mortality [19,21].…”