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Sexual practices, HIV and sexually transmitted infections among self-identified men who have sex with men in four high HIV prevalence states of India

Brahmam, Ginnela NVa; Kodavalla, Venkaiaha; Rajkumar, Hemalathaa; Rachakulla, Hari Kumara; Kallam, Srinivasand; Myakala, Shiva Prakasha; Paranjape, Ramesh Sb; Gupte, Mohan Dc; Ramakrishnan, Lakshmid; Kohli, Anjaleed; Ramesh, Banadakoppa Me; for the IBBA Study Team

doi: 10.1097/01.aids.0000343763.54831.15

Objective: To describe the sociodemographic characteristics, prevalence of high-risk sexual behaviours, HIV, sexually transmitted infections (STI), and perception of risk in self-identified men who have sex with men (MSM) in four south Indian states.

Methods: A cross-sectional probability-based survey of 4597 self-identified MSM in selected districts from four states in south India was undertaken. Self-defined sexual identity, sexual behaviour, and STI/HIV knowledge were assessed using a structured questionnaire. Blood and urine samples were tested for HIV and STI. Recruitment criteria differed slightly across states.

Results: When grouped by self-identity, the HIV prevalence was: hijra (transgender) 18.1%; bisexuals 15.9%; kothis (anal-receptive) 13.5%; double-deckers (both anal-insertive/anal-receptive) 10.5%; and panthis (anal-insertive) 7.6%. Reported condom use with last paid male partner was over 80% in all states and categories. Consistent condom use was overall low among self-identified MSM, with less than 29% with non-commercial non-regular male partners and less than 49% with regular male partners. The percentage of self-identified MSM with regular female partners was 4–43% and with commercial female partners was 14–36% across states, and consistent condom use differed by self-identity. Syphilis prevalence was high among kothis and hijras (15.8 and 13.6%, respectively). Urethral gonorrhoea prevalence was less than 1% and chlamydia prevalence ranged from 0.4 to 4.0%.

Conclusion: HIV prevalence and risk behaviour within these self-identified MSM communities in south India is high. Moreover, a significant proportion of them had female partners, both regular and commercial. The national programme's focus on HIV prevention services for these high-risk MSM is justified.

aNational Institute of Nutrition (NIN), Hyderabad, India

bNational AIDS Research Institute (NARI), Pune, India

cNational Institute of Epidemiology (NIE), Chennai, India

dFamily Health International (FHI), New Delhi, India

eKarnataka Health Promotion Trust (KHPT), Bangalore, India.

* Members of the IBBA study team are listed at the end of the paper.

Correspondence and requests for reprints to Ginnela N.V. Brahmam, Division of Community Studies, National Institute of Nutrition, Jamai-Osmania (PO), Hyderabad 500 007, India. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.