Advertisement

AIDS and Behavior

, Volume 14, Issue 5, pp 1001–1010 | Cite as

The Emerging HIV Epidemic among Men Who have Sex with Men in Tamil Nadu, India: Geographic Diffusion and Bisexual Concurrency

  • Sunil Suhas Solomon
  • Aylur K. Srikrishnan
  • Frangiscos Sifakis
  • Shruti H. Mehta
  • Canjeevaram K. Vasudevan
  • Pachamuthu Balakrishnan
  • Kenneth H. Mayer
  • Suniti Solomon
  • David D. Celentano
Original Paper

Abstract

In India, men who have sex with men (MSM) remain hidden because anal intercourse was criminalized and marriage socially required. We characterize HIV/STI prevalence among MSM in Tamil Nadu. Eligible participants were recruited using respondent-driven sampling in eight cities (n = 721). Median age was 28, 34% were married and 40% self-identified as homosexual. Median number of male partners in the prior year was 15; 45% reported any unprotected anal intercourse (UAI). HIV, herpes simplex virus-2 (HSV-2), chronic hepatitis B virus (HBV) and syphilis prevalence were 9, 26, 2 and 8%, respectively; among married men, all were higher: 14, 32, 3 and 11% (p < 0.01 for HIV and HSV-2). Less education, HSV-2, more male partners, UAI and not having a main male partner were associated with HIV prevalence. The high STI and UAI prevalence may lead to a burgeoning HIV epidemic among MSM, reinforcing the need for focused preventive measures incorporating complex circumstances.

Keywords

Men who have sex with men India HIV STIs Sexual concurrency 

Notes

Acknowledgments

Sunil S. Solomon was supported in part by the Fogarty International Center/USNIH: (Grant # 2D 43 TW000010-20-AITRP). We would also like to thank the YRGCARE staff and the local NGO collaborators from the various sites who helped with the implementation of the study and recruitment of the study participants. Lastly, and most importantly, our sincere thanks to the study participants without whom this would not have been possible.

References

  1. 1.
    Pneumocystis pneumonia–Los Angeles. MMWR Morb Mortal Wkly Rep. 1981;30(21):250–2.Google Scholar
  2. 2.
    UNAIDS. 2008 report on the global AIDS epidemic. 2008. 8-1-2009.Google Scholar
  3. 3.
    Baral S, Sifakis F, Cleghorn F, Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review. PLoS Med. 2007;4(12):e339.CrossRefPubMedGoogle Scholar
  4. 4.
    Simoes EA, Babu PG, John TJ et al. Evidence for HTLV-III infection in prostitutes in Tamil Nadu (India). Indian J Med Res. 1987;(85):335–8.Google Scholar
  5. 5.
    Gangakhedkar RR, Bentley ME, Divekar AD, et al. Spread of HIV infection in married monogamous women in India. JAMA. 1997;278(23):2090–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Newmann S, Sarin P, Kumarasamy N, et al. Marriage, monogamy and HIV: a profile of HIV-infected women in south India. Int J STD AIDS. 2000;11(4):250–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Arora P, Kumar R, Bhattacharya M, Nagelkerke NJ, Jha P. Trends in HIV incidence in India from 2000 to 2007. Lancet. 2008;372(9635):289–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Kumar R, Jha P, Arora P, et al. Trends in HIV-1 in young adults in south India from 2000 to 2004: a prevalence study. Lancet. 2006;367(9517):1164–72.CrossRefPubMedGoogle Scholar
  9. 9.
    National AIDS Control Organization. HIV Sentinel Surveillance and HIV Estimation in India. 2007. A Technical Brief. 10-1-2008.Google Scholar
  10. 10.
    National AIDS Control Organization. HIV Sentinel Surveillance 2006 India Country Report, 2006. http://www.nacoonline.org/Quick_Links/HIV_Data/. Accessed 12 Dec 2006.
  11. 11.
    Herget G. India: UNAIDS claims law criminalizing homosexuality hinders HIV prevention. HIV AIDS Policy Law Rev. 2006;11(1):35–6.PubMedGoogle Scholar
  12. 12.
    Asthana S, Oostvogels R. The social construction of male ‘homosexuality’ in India: implications for HIV transmission and prevention. Soc Sci Med. 2001;52(5):707–21.CrossRefPubMedGoogle Scholar
  13. 13.
    Nandi J, Kamat H, Bhavalkar V, Banerjee K. Detection of human immunodeficiency virus antibody among homosexual men from Bombay. Sex Transm Dis. 1994;21(4):235–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Gupta A, Mehta S, Godbole SV, et al. Same-sex behavior and high rates of HIV among men attending sexually transmitted infection clinics in Pune, India (1993–2002). J Acquir Immune Defic Syndr. 2006;43(4):483–90.PubMedGoogle Scholar
  15. 15.
    Hernandez AL, Lindan CP, Mathur M, et al. Sexual behavior among men who have sex with women, men, and Hijras in Mumbai, India––multiple sexual risks. AIDS Behav. 2006;10(4 Suppl):S5–16.CrossRefPubMedGoogle Scholar
  16. 16.
    Setia MS, Lindan C, Jerajani HR, et al. Men who have sex with men and transgenders in Mumbai, India: an emerging risk group for STIs and HIV. Ind J Dermatol Venereol Leprol. 2006;72(6):425–31.CrossRefGoogle Scholar
  17. 17.
    Shinde S, Setia MS, Row-Kavi A, Anand V, Jerajani H. Male sex workers: are we ignoring a risk group in Mumbai, India? Ind J Dermatol Venereol Leprol. 2009;75(1):41–6.CrossRefGoogle Scholar
  18. 18.
    Nilajana Bose. Closet thrown open: gay community overjoyed at high courts judgement, 7-2-2009. http://ibnlive.in.com/news/closet-opens-gay-community-overjoyed-at-hc-order/96193-3.html. Accessed 1 Aug 2009.
  19. 19.
    Heckathorn D. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44(2):174–99.CrossRefGoogle Scholar
  20. 20.
    Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Social Probl. 2002;(49):11–34.Google Scholar
  21. 21.
    Behrens T, Taeger D, Wellmann J, Keil U. Different methods to calculate effect estimates in cross-sectional studies. A comparison between prevalence odds ratio and prevalence ratio. Methods Inf Med. 2004;43(5):505–9.PubMedGoogle Scholar
  22. 22.
    National AIDS Control Organization. Observed HIV prevalence levels statewise: 1988–2004. 2005. at:http://www.nacoonline.org/facts_statewise.htm . Accessed 26 Feb 2006.
  23. 23.
    Go VF, Srikrishnan AK, Sivaram S, et al. High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India. J Acquir Immune Defic Syndr. 2004;35(3):314–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Brahmam GN, Kodavalla V, Rajkumar H, et al. Sexual practices, HIV and sexually transmitted infections among self-identified men who have sex with men in four high HIV prevalence states of India. AIDS. 2008;22(Suppl 5):S45–57.CrossRefPubMedGoogle Scholar
  25. 25.
    Chakrapani V, Newman PA, Shunmugam M, McLuckie A, Melwin F. Structural violence against Kothi-identified men who have sex with men in Chennai, India: a qualitative investigation. AIDS Educ Prev. 2007;19(4):346–64.CrossRefPubMedGoogle Scholar
  26. 26.
    Verma RK, Collumbien M. Homosexual activity among rural Indian men: implications for HIV interventions. AIDS. 2004;18(13):1845–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Srikrishnan AK, Solomon S, Vasudevan CK, Sethulakshmi CJ, Solomon S. Qualitative assessment of HIV risks among MSM in South India. 5th IAS conference on HIV pathogenesis treatment and prevention. Cape Town, South Africa, 2009 [abstract MOPEC034].Google Scholar
  28. 28.
    Morris M, Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS. 1997;11(5):641–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Watts CH, May RM. The influence of concurrent partnerships on the dynamics of HIV/AIDS. Math Biosci. 1992;108(1):89–104.CrossRefPubMedGoogle Scholar
  30. 30.
    Panda S, Kumar MS, Lokabiraman S, et al. Risk factors for HIV infection in injection drug users and evidence for onward transmission of HIV to their sexual partners in Chennai, India. J Acquir Immune Defic Syndr. 2005;39(1):9–15.CrossRefPubMedGoogle Scholar
  31. 31.
    Panda S, Chatterjee A, Bhattacharya SK, et al. Transmission of HIV from injecting drug users to their wives in India. Int J STD AIDS. 2000;11(7):468–73.CrossRefPubMedGoogle Scholar
  32. 32.
    Looker KJ, Garnett GP, Schmid GP. An estimate of the global prevalence and incidence of herpes simplex virus type 2 infection. Bull World Health Organ 2008;86(10):805–12.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sunil Suhas Solomon
    • 1
  • Aylur K. Srikrishnan
    • 1
  • Frangiscos Sifakis
    • 2
  • Shruti H. Mehta
    • 2
  • Canjeevaram K. Vasudevan
    • 1
  • Pachamuthu Balakrishnan
    • 1
  • Kenneth H. Mayer
    • 3
  • Suniti Solomon
    • 1
  • David D. Celentano
    • 2
  1. 1.YR Gaitonde Centre for AIDS Research and Education (YRGCARE)ChennaiIndia
  2. 2.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Warren Alpert School of MedicineBrown University, Providence, USA and Fenway HealthBostonUSA

Personalised recommendations