Structural Violence AgainstKothi–Identified Men Who Have Sex with Men in Chennai, India: A Qualitative Investigation

Abstract

This qualitative investigation explored the experiences and contexts of stigma and discrimination among HIV-positive and high-risk kothi-identified men who have sex with men (MSM) in Chennai, India, and ramifications for HIV prevention. MSM were recruited through community agencies (n = 10) and public sex environments (n = 8), along with three key informants. In-depth, semistructured interviews were conducted, audiotaped, and transcribed. Narrative thematic analysis and a constant comparative method were used to identify themes. Findings revealed multiple intersecting social and institutional contexts and experiences of stigmatization, discrimination, and violence across police, community, family, and health care systems, as well as illuminating consequences for MSM. Multisystemic structural violence places kothis at extreme vulnerability for HIV infection and AIDS. Public mass media antidiscrimination campaigns, education and training of health care providers and police, funding of indigenous MSM community organizations, and decriminalization of consensual sex between same-sex adults may help to combat stigma, discrimination, and violence against MSM, which is fundamental to effective HIV prevention.

Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey

“…Most (60%) MSM who sold sex in our sample experienced forced sex; these men had almost three times the odds of experiencing forced sex relative to MSM who did not sell sex. Our findings corroborate studies in other contexts that report elevated risks for experiencing sexual and other physical violence among MSM who sell sex [1,2,4,7,36]. This prevalence of forced sex is very high, particularly in comparison to data from other low- and middle-income countries which show prevalence ranging from 6.5 to 40.5% [1,64].…”

“…Men who have sex with men (MSM) who sell sex include diverse populations who often experience criminalization and intersecting forms of stigma, violence and social marginalization that elevate HIV risks [1–7]. Yet MSM who sell sex have largely been overlooked in epidemiological and social HIV research.…”

A systematic review of HIV/AIDS-related stigma and discrimination in India: Current understanding and future needs

“…Some, therefore, chose to pass as positive heterosexual men rather than risk being found out to be homosexual (Bharat et al, 2001). HIV-positive Kothi identified MSM in a study by Chakrapani et al (2007) reported stigma, discrimination and violence in a variety of social and institutional contexts for example, the police, community, family and health care. The reality of double stigma is underscored by the following quote, 'My father told me that he could tolerate that I was HIVpositive but asked me not to tell others that I got it by having sex with men' (Chakrapani et al, 2007, p. 355).…”

Contextual influences on condom use among men who have sex with men in India: subjectivities, practices and risks

“…Yet only a few qualitative studies from India have demonstrated the role of social-structural influences on condom use among men who have sex with men in general (Chakrapani et al 2007), and HIV-positive men who have sex with men in particular (Chakrapani, Newman, and Shunmugam 2008). Several authors (Blankenship et al 2006;Chakrapani et al 2007;Parker, Easton, and Klein, 2000;Sumartojo 2000) have suggested that sexual-risk behaviours and riskreduction strategies should be seen as being influenced and shaped by factors at the individual, inter-personal and social-structural levels.…”