Predictors of bisexual behaviour among MSM attending intervention sites may help in prevention interventions for this bridge to the heterosexual epidemic in India: data from HIV sentinel surveillance
Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and cre...
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| Published in: | PloS one Vol. 9; no. 9; p. e107439 |
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| Abstract | Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM.
Between March-May 2011, 4682 men (15-49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites.
Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, 'being bisexual' was found to be independently associated with 'older age': 26-30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; 'reporting penetrative behaviour alone' with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and 'reporting both penetrative and receptive behaviour' [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual.
A substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population. |
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| AbstractList | BACKGROUNDIndian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM. METHODSBetween March-May 2011, 4682 men (15-49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites. RESULTSOf 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, 'being bisexual' was found to be independently associated with 'older age': 26-30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; 'reporting penetrative behaviour alone' with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and 'reporting both penetrative and receptive behaviour' [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual. CONCLUSIONSA substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population. Background Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM. Methods Between March-May 2011, 4682 men (15–49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites. Results Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, ‘being bisexual’ was found to be independently associated with ‘older age’: 26–30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; ‘reporting penetrative behaviour alone’ with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and ‘reporting both penetrative and receptive behaviour’ [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual. Conclusions A substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population. Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM. Between March-May 2011, 4682 men (15-49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites. Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, 'being bisexual' was found to be independently associated with 'older age': 26-30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; 'reporting penetrative behaviour alone' with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and 'reporting both penetrative and receptive behaviour' [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual. A substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population. Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM. Between March-May 2011, 4682 men (15-49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites. Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, 'being bisexual' was found to be independently associated with 'older age': 26-30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; 'reporting penetrative behaviour alone' with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and 'reporting both penetrative and receptive behaviour' [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual. A substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population. Background Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM. Methods Between March-May 2011, 4682 men (15–49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites. Results Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, ‘being bisexual’ was found to be independently associated with ‘older age’: 26–30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; ‘reporting penetrative behaviour alone’ with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and ‘reporting both penetrative and receptive behaviour’ [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual. Conclusions A substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population. |
| Audience | Academic |
| Author | Godbole, Sheela Thakur, Savita Paranjape, Ramesh Venkatesh, Srinivasan Risbud, Arun Dulhani, Nisha Raj, Yujwal Kadam, Dilip Bhattacharya, Madhulekha Narwani, Prakash Sane, Suvarna Chavan, Laxmikant Reddy, D C S Kamble, Pranil Bindoria, Suchitra Pereira, Elmira |
| AuthorAffiliation | 4 Maharashtra State AIDS Control Society, Mumbai, Maharashtra, India 6 Madhya Pradesh State AIDS Control Society, Bhopal, Madhya Pradesh, India University of Athens, Medical School, Greece 5 Mumbai District AIDS Control Society, Mumbai, Maharashtra, India 9 Goa State AIDS Control Society, Panaji, Goa, India 3 World Health Organisation (India), New Delhi, India 7 Rajasthan State AIDS Control Society, Jaipur, Rajasthan, India 10 Department of Community Health Administration, National Institute of Health and Family Welfare, New Delhi, India 2 Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India 1 National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India 8 Gujarat State AIDS Control Society, Ahmedabad, Gujarat, India |
| AuthorAffiliation_xml | – name: University of Athens, Medical School, Greece – name: 2 Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India – name: 5 Mumbai District AIDS Control Society, Mumbai, Maharashtra, India – name: 8 Gujarat State AIDS Control Society, Ahmedabad, Gujarat, India – name: 10 Department of Community Health Administration, National Institute of Health and Family Welfare, New Delhi, India – name: 1 National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India – name: 3 World Health Organisation (India), New Delhi, India – name: 6 Madhya Pradesh State AIDS Control Society, Bhopal, Madhya Pradesh, India – name: 9 Goa State AIDS Control Society, Panaji, Goa, India – name: 4 Maharashtra State AIDS Control Society, Mumbai, Maharashtra, India – name: 7 Rajasthan State AIDS Control Society, Jaipur, Rajasthan, India |
| Author_xml | – sequence: 1 givenname: Sheela surname: Godbole fullname: Godbole, Sheela organization: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India – sequence: 2 givenname: Suvarna surname: Sane fullname: Sane, Suvarna organization: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India – sequence: 3 givenname: Pranil surname: Kamble fullname: Kamble, Pranil organization: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India – sequence: 4 givenname: Yujwal surname: Raj fullname: Raj, Yujwal organization: Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India – sequence: 5 givenname: Nisha surname: Dulhani fullname: Dulhani, Nisha organization: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India – sequence: 6 givenname: Srinivasan surname: Venkatesh fullname: Venkatesh, Srinivasan organization: Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India – sequence: 7 givenname: D C S surname: Reddy fullname: Reddy, D C S organization: World Health Organisation (India), New Delhi, India – sequence: 8 givenname: Laxmikant surname: Chavan fullname: Chavan, Laxmikant organization: Gujarat State AIDS Control Society, Ahmedabad, Gujarat, India – sequence: 9 givenname: Madhulekha surname: Bhattacharya fullname: Bhattacharya, Madhulekha organization: Department of Community Health Administration, National Institute of Health and Family Welfare, New Delhi, India – sequence: 10 givenname: Suchitra surname: Bindoria fullname: Bindoria, Suchitra organization: Maharashtra State AIDS Control Society, Mumbai, Maharashtra, India – sequence: 11 givenname: Dilip surname: Kadam fullname: Kadam, Dilip organization: Mumbai District AIDS Control Society, Mumbai, Maharashtra, India – sequence: 12 givenname: Savita surname: Thakur fullname: Thakur, Savita organization: Madhya Pradesh State AIDS Control Society, Bhopal, Madhya Pradesh, India – sequence: 13 givenname: Prakash surname: Narwani fullname: Narwani, Prakash organization: Rajasthan State AIDS Control Society, Jaipur, Rajasthan, India – sequence: 14 givenname: Elmira surname: Pereira fullname: Pereira, Elmira organization: Goa State AIDS Control Society, Panaji, Goa, India – sequence: 15 givenname: Ramesh surname: Paranjape fullname: Paranjape, Ramesh organization: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India – sequence: 16 givenname: Arun surname: Risbud fullname: Risbud, Arun organization: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25211511$$D View this record in MEDLINE/PubMed |
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| Copyright | COPYRIGHT 2014 Public Library of Science 2014 Godbole et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2014 Godbole et al 2014 Godbole et al |
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| DOI | 10.1371/journal.pone.0107439 |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Current address: Department of Community Medicine, Seth GS Medical College, Mumbai, Maharashtra, India Competing Interests: The authors have declared that no competing interests exist. Current address: Independent Consultant, Lucknow, Uttar Pradesh, India Current address: World Health Organisation (India), New Delhi, India Conceived and designed the experiments: SG SS PK ND AR RP. Performed the experiments: SG AR SV YR DCSR LC ND MB SB EP PN DK ST. Analyzed the data: SG SS AR ND RP. Contributed reagents/materials/analysis tools: SG AR SV YR DCSR LC ND MB. Wrote the paper: SG AR RP PK SS. Current address: Jhpiego, Mumbai, Maharashtra, India Current address: Retired from State Health Service, Goa, India |
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| References | ref12 VF Go (ref7) 2004; 35 S Kumta (ref14) 2010; 53 A Gupta (ref13) 2006; 43 MS Setia (ref22) 2006; 72 ref2 ref1 ref17 ref16 VV Patel (ref10) 2012; 136 GNV Brahmam (ref20) 2008; 22 RK Verma (ref11) 2004; 18 ref24 D Heckathorn (ref29) 1997; 44 ref23 L Dandona (ref9) 2005; 19 ref26 SS Solomon (ref15) 2010; 13 ref25 ref21 ref28 ref27 MS Setia (ref18) 2008; 4 R Magnani (ref31) 2005; 19 SS Solomon (ref19) 2010; 14 ref4 ref3 ref6 ref5 SA Safren (ref8) 2006; 18 D Heckathorn (ref30) 2002; 49 |
| References_xml | – volume: 19 start-page: 611 year: 2005 ident: ref9 article-title: Sex behaviour of men who have sex with men and risk of HIV in Andhra Pradesh, India publication-title: AIDS doi: 10.1097/01.aids.0000163938.01188.e4 contributor: fullname: L Dandona – volume: 136 start-page: 563 year: 2012 ident: ref10 article-title: Men who have sex with men in India: a diverse population in need of medical attention publication-title: Indian J Med Res contributor: fullname: VV Patel – ident: ref1 – ident: ref3 – volume: 18 start-page: 323 year: 2006 ident: ref8 article-title: A survey of MSM HIV prevention outreach workers in Chennai, India publication-title: AIDS Educ Prev doi: 10.1521/aeap.2006.18.4.323 contributor: fullname: SA Safren – ident: ref5 – ident: ref24 – ident: ref25 – ident: ref27 – volume: 72 start-page: 425 year: 2006 ident: ref22 article-title: Men who have sex with men and transgenders in Mumbai, India: an emerging risk group for STIs and HIV publication-title: Indian J Dermatol Venereol Leprol doi: 10.4103/0378-6323.29338 contributor: fullname: MS Setia – ident: ref17 – volume: 53 start-page: 227 year: 2010 ident: ref14 article-title: Bisexuality, sexual risk taking, and HIV prevalence among men who have sex with men accessing voluntary counseling and testing services in Mumbai, India publication-title: Journal of acquired immune deficiency syndromes doi: 10.1097/QAI.0b013e3181c354d8 contributor: fullname: S Kumta – volume: 43 start-page: 483 year: 2006 ident: ref13 article-title: Same-sex behavior and high rates of HIV among men attending sexually transmitted infection clinics in Pune, India (1993–2002) publication-title: J Acquir Immune Defic Syndr doi: 10.1097/01.qai.0000243097.27029.b7 contributor: fullname: A Gupta – volume: 4 start-page: 51 year: 2008 ident: ref18 article-title: Men who have sex with men in India: a systematic review of the literature publication-title: J LGBT Health Res doi: 10.1080/15574090902913727 contributor: fullname: MS Setia – ident: ref4 – ident: ref2 – volume: 13 start-page: S7 year: 2010 ident: ref15 article-title: The impact of HIV and high-risk behaviours on the wives of married men who have sex with men and injection drug users: implications for HIV prevention publication-title: J Int AIDS Soc doi: 10.1186/1758-2652-13-S2-S7 contributor: fullname: SS Solomon – ident: ref6 – volume: 22 start-page: S45 year: 2008 ident: ref20 article-title: Sexual practices, HIV and sexually transmitted infections among self-identified men who have sex with men in four high HIV prevalence states of India publication-title: AIDS doi: 10.1097/01.aids.0000343763.54831.15 contributor: fullname: GNV Brahmam – volume: 49 start-page: 11 year: 2002 ident: ref30 article-title: Respondent driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations publication-title: Social Problems doi: 10.1525/sp.2002.49.1.11 contributor: fullname: D Heckathorn – volume: 14 start-page: 1001 year: 2010 ident: ref19 article-title: The emerging HIV epidemic among men who have sex with men in Tamil Nadu, India: geographic diffusion and bisexual concurrency publication-title: AIDS Behav doi: 10.1007/s10461-010-9711-2 contributor: fullname: SS Solomon – ident: ref28 – ident: ref21 – ident: ref23 – volume: 18 start-page: 1845 year: 2004 ident: ref11 article-title: Homosexual activity among rural Indian men: implications for HIV interventions publication-title: AIDS doi: 10.1097/00002030-200409030-00014 contributor: fullname: RK Verma – ident: ref26 – volume: 35 start-page: 314 year: 2004 ident: ref7 article-title: High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India publication-title: J Acquir Immune Defic Syndr doi: 10.1097/00126334-200403010-00014 contributor: fullname: VF Go – volume: 19 start-page: S67 year: 2005 ident: ref31 article-title: Review of sampling hard-to-reach and hidden populations for HIV surveillance publication-title: Aids doi: 10.1097/01.aids.0000172879.20628.e1 contributor: fullname: R Magnani – ident: ref16 – volume: 44 start-page: 174 year: 1997 ident: ref29 article-title: Respondent-driven sampling: a new approach to the study of hidden populations publication-title: Social Problems doi: 10.2307/3096941 contributor: fullname: D Heckathorn – ident: ref12 |
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| Snippet | Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV... Background Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate... BACKGROUNDIndian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate... Background Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate... |
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| Title | Predictors of bisexual behaviour among MSM attending intervention sites may help in prevention interventions for this bridge to the heterosexual epidemic in India: data from HIV sentinel surveillance |
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