Psychosocial risk factors for HIV sexual risk among Indian men who have sex with men

Abstract

Indian men who have sex with men (MSM) are at increased risk for HIV compared to the general Indian population. Psychosocial factors may be uniquely associated with HIV risk among Indian MSM and may moderate the beneficial impact of standard HIV prevention approaches. Psychiatric diagnostic interviews and psychosocial and sexual risk assessments were conducted among 150 MSM in Mumbai, India. Logistic regression was employed to examine the association of psychiatric disorders and psychosocial problems to recent sexual risk behavior. Twenty-five percent of participants reported engaging in unprotected anal sex (UAS) during their last sexual contact with a man. Men who were married to a woman were more likely to have engaged in UAS during their last sexual contact with a man (35% vs. 17%, p = 0.018). In multivariable models, significant predictors of engaging in UAS were current major depression (adjusted odds ratio [AOR] = 2.61; 95% confidence interval [CI] 1.07, 6.39) and number of stressful life events (AOR = 0.91; 95% CI 0.83, 0.99). Alcohol dependence, anxiety, and self-esteem were not associated with engaging in UAS. Indian MSM with depression are at higher odds of engaging in UAS compared to MSM without depression. HIV prevention programs for Indian MSM may benefit from incorporating treatment or triage for mental health problems.

Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study

“…Models included random-intercepts for each site (to account for clustering) and incorporated scaled RDS-II sampling weights. Previous research on depression, with a focus on MSM both in India and in other settings, guided the development of a multivariable model [7, 15, 17, 20, 54–57]. Several variables associated with depression in prior research, including sex work [15], stigma [7], and experiences of violence [57, 58], have also been previously noted to be more prevalent among certain sexual identity groups in India [7, 9, 11, 24, 35–38].…”

“…Both qualitative and quantitative studies have identified significant psychosocial concerns among MSM in India, including high levels of psychological distress, depression, anxiety, suicidal ideation, and substance use [4, 5, 7, 8, 14–22]. These psychosocial factors are associated with increased HIV-risk behaviors and poorer HIV outcomes, including more frequent unprotected anal sex, lower testing rates, and reduced engagement in HIV care and treatment [4, 7, 9, 11, 19, 20, 23, 24]. Following the minority stress model [25], depression has been conceptualized as a co-occurring condition with HIV risk-behaviors, constituting a “syndemic” [5, 26].…”

“…Prior quantitative research on depression among MSM in India (from Chennai [7, 15], Kumbakonam [7], Mumbai [20], Kolkata [16] and Ahmedabad [22]) indicates that MSM are at risk for depression, with estimates ranging from 29 to 55 % [7, 15, 20]. These reports mainly rely on convenience sampling, usually collected in the context of HIV- and MSM-related outreach work by non-governmental organization (NGOs) and at STD clinics.…”

Association between Community Collectivization and Mental Depression among Men Who Have Sex with Men in Andhra Pradesh, India

“…Factors such as stigma, discrimination, and violence lead to several co-occurring mental health problems among MSM, which in turn restrict their ability to benefit from risk reduction counselling and moderate the beneficial impact of HIV prevention approaches/efforts [21]. Recent studies have shown the interrelationship between psychosocial factors and elevated HIV risk among MSM [21,22]. In order to address these elevated levels of HIV risk among MSM, a community-led structural intervention (CLSI) plays an architect role to address stigma, violence and harassments of MSM in public spaces and helps to create an enabling environment for them.…”

“…Despite the extensive HIV prevention efforts, the MSM continues to constitute a high-risk group (HRG) with national HIV prevalence of 4.4% and 10.1% in Andhra Pradesh [20]. Factors such as stigma, discrimination, and violence lead to several co-occurring mental health problems among MSM, which in turn restrict their ability to benefit from risk reduction counselling and moderate the beneficial impact of HIV prevention approaches/efforts [21]. Recent studies have shown the interrelationship between psychosocial factors and elevated HIV risk among MSM [21,22].…”