Archives of Sexual Behavior

, Volume 44, Issue 7, pp 2077–2086 | Cite as

Garnering an In-depth Understanding of Men Who Have Sex with Men in Chennai, India: A Qualitative Analysis of Sexual Minority Status and Psychological Distress

  • Matthew J. Mimiaga
  • Elizabeth F. Closson
  • Beena Thomas
  • Kenneth H. Mayer
  • Theresa Betancourt
  • Sunil Menon
  • Steven A. Safren
Original Paper

Abstract

Men who have sex with men (MSM) in India are a hidden and largely understudied population, and have an HIV prevalence 17 times higher than that of the general Indian population. Experiences of social marginalization and negative psychosocial conditions occur concurrent to HIV risk among Indian MSM. To better understand the contextual variables driving HIV risk and inform intervention development, five focus groups (n = 46) and nine key informant interviews were conducted with 55 MSM in Chennai in 2010. NVivo software was used to code the transcripts, and data were analyzed using qualitative descriptive analysis methodology. Participants described sources of psychological distress and low self-worth related to gender non-conformity and sexual minority status. These included stigma from society, pressure to marry, lack of familial acceptance, childhood sexual abuse, and the imperative to keep sexual minority status a secret. Participants’ personal evaluations revealed that self-acceptance may be an important resilience factor that can shield these psychosocial and HIV risk factors. In promoting health-seeking behavioral changes for Indian MSM at an individual level, our findings point to the potential strength of strategies that focus on self-acceptance of one’s sexual minority identity to foster better psychosocial and overall health.

Keywords

HIV Men who have sex with men Gay men Bisexual men Sexual orientation Stigma 

Notes

Acknowledgments

This project was supported by the Indo-U.S. Joint Working Group on Prevention of Sexually Transmitted Diseases and HIV/AIDS through U.S. National Institute of Mental Health grant #R21 MH085314-01 (Steven A. Safren, PI) and Indian Council of Medical Research grant #Indo-U.S./41/2007-ECD-II (Beena Thomas, PI).

References

  1. Aggarwal, O., Sharma, A. K., & Chhabra, P. (2000). Study in sexuality of medical college students in India. Journal of Adolescent Health, 26, 226–229.CrossRefPubMedGoogle Scholar
  2. Asthana, S., & Oostvogels, R. (2001). The social construction of male ‘homosexuality’ in India: Implications for HIV transmission and prevention. Social Science and Medicine, 52, 707–721.CrossRefPubMedGoogle Scholar
  3. Berlan, E. D., Corliss, H. L., Field, A. E., Goodman, E., & Austin, S. B. (2010). Sexual orientation and bullying among adolescents in the Growing Up Today Study. Journal of Adolescent Health, 46, 366–371.PubMedCentralCrossRefPubMedGoogle Scholar
  4. Beyrer, C., Trapence, G., Motimedi, F., Umar, E., Iipinge, S., Dausab, F., … Baral, S. (2010). Bisexual concurrency, bisexual partnerships, and HIV among Southern African men who have sex with men. Sexually Transmitted Infections, 86, 323–327.CrossRefPubMedGoogle Scholar
  5. Bontempo, D., & D’Augelli, A. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health, 30, 364–374.CrossRefPubMedGoogle Scholar
  6. Boyce, P. (2007). ‘Conceiving kothis’: Men who have sex with men in India and the cultural subject of HIV prevention. Medical Anthropology, 26, 175–203.CrossRefPubMedGoogle Scholar
  7. Catalano, R. F., Berglund, M. L., Ryan, J. A., Lonczak, H. S., & Hawkins, J. D. (2002). Positive youth development in the United States: Research findings on evaluations of positive youth development programs. Prevention & Treatment, 5, 15a.Google Scholar
  8. Chakrapani, V., Kavi, A. R., Ramakrishnan, L. R., Gupta, R., Rappoport, C., & Raghavan, S. S. (2002). HIV prevention among men who have sex with men (MSM) in India: Review of current scenario and recommendations. Jaipur, India: Solidarity and Action Against the HIV Infection in India, Working Group on HIV Prevention and Care among Indian GLBT/Sexuality Minority Communities.Google Scholar
  9. Chakrapani, V., Newman, P. A., Shunmugam, M., McLuckie, A., & Melwin, F. (2007). Structural violence against Kothi-identified men who have sex with men in Chennai, India: A qualitative investigation. AIDS Education and Prevention, 19, 346–364.CrossRefPubMedGoogle Scholar
  10. Closson, E. F., Sivasubramanian, M., Mayer, K. H., Srivastava, A., Safren, S. A., Anand, V. R., … Mimiaga, M. J.(2014). The other side of the bridge: Exploring the sexual relationships of men who have sex with men and their female partners in Mumbai, India. Culture Health & Sexuality, 16, 780–791.CrossRefGoogle Scholar
  11. D’Augelli, A. R., Grossman, A. H., & Starks, M. T. (2006). Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. Journal of Interpersonal Violence, 21, 1462–1482.CrossRefPubMedGoogle Scholar
  12. D’Augelli, A. R., Pilkington, N. W., & Hershberger, S. L. (2002). Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. School Psychology Quarterly, 17, 148–167.CrossRefGoogle Scholar
  13. Dey, S., Das, A., Raul, S., Sen, S., Shaw, T., Saha, D., … Chatterjee, D. (2011). The identities of gendered sexual subjectivity: A report on MSM performances in Kothi network in urban West Bengal. Journal of Department of Anthropology, 12, 167–177.Google Scholar
  14. Gore-Felton, C., Kalichman, S. C., Brondino, M. J., Benotsch, E. G., Cage, M., & DiFonzo, K. (2006). Childhood sexual abuse and HIV risk among men who have sex with men: Initial test of a conceptual model. Journal of Family Violence, 21, 263–270.CrossRefGoogle Scholar
  15. Herek, G. M. (2007). Confronting sexual stigma and prejudice: Theory and practice. Journal of Social Issues, 63, 905–925.CrossRefGoogle Scholar
  16. Herek, G. M., & Capitanio, J. P. (1996). “Some of my best friends”: Intergroup contact, concealable stigma, and heterosexuals’ attitudes toward gay men and lesbians. Personality and Social Psychology Bulletin, 22, 412–424.CrossRefGoogle Scholar
  17. Herrick, A. L., Lim, S. H., Wei, C., Smith, H., Guadamuz, T., Friedman, M. S., … Stall, R. (2011). Resilience as an untapped resource in behavioral intervention design for gay men. AIDS and Behavior, 15, 25–29.CrossRefGoogle Scholar
  18. Herrick, A. L., Stall, R., Goldhammer, H., Egan, J. E., & Mayer, K. H. (2014). Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: Theory and evidence. AIDS and Behavior, 18, 1–9.CrossRefPubMedGoogle Scholar
  19. Khan, S., Bondyopadhyay, A., & Mulji, K. (2005). From the front line, the impact of social, legal and judicial impediments to sexual health promotion, and HIV and AIDS related care and support for males who have sex with males in Bangladesh and India: A study report. London: Naz Foundation International.Google Scholar
  20. Krueger, R. A. (1988). Focus groups: A practical guide for applied research. London: Sage.Google Scholar
  21. Kumta, S., Lurie, M., Weitzen, S., Jerajani, H., Gogate, A., Row-kavi, A., … Mayer, K. H. (2010). Bisexuality, sexual risk taking, and HIV prevalence among men who have sex with men accessing voluntary counseling and testing services in Mumbai, India. Journal of Acquired Immune Deficiency Syndromes, 53, 227–233.PubMedCentralCrossRefPubMedGoogle Scholar
  22. Lindlof, T. R., & Taylor, B. C. (2002). Qualitative communication research methods (2nd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  23. Logie, C. H., Newman, P. A., Chakrapani, V., & Shunmugam, M. (2012). Adapting the minority stress model: Associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India. Social Science and Medicine, 74, 1261–1268.CrossRefPubMedGoogle Scholar
  24. Mann, M. M., Hosman, C. M., Schaalma, H. P., & de Vries, N. K. (2004). Self-esteem in a broad-spectrum approach for mental health promotion. Health Education Research, 19, 357–372.CrossRefPubMedGoogle Scholar
  25. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.PubMedCentralCrossRefPubMedGoogle Scholar
  26. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis (2nd ed.). Newbury Park, CA: Sage.Google Scholar
  27. Mimiaga, M. J., Biello, K. B., Sivasubramanian, M., Mayer, K. H., Anand, V. R., & Safren, S. A. (2013). Psychosocial risk factors for HIV sexual risk among Indian men who have sex with men. AIDS Care, 25, 1109–1113.PubMedCentralCrossRefPubMedGoogle Scholar
  28. Mimiaga, M. J., Noonan, E., Donnell, D., Safren, S. A., Koenen, K. C., Gortmaker, S., … Mayer, K. H. (2009). Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE study. Journal of Acquired Immune Deficiency Syndromes, 51, 340–348.PubMedCentralCrossRefPubMedGoogle Scholar
  29. Morgan, D. L., & Krueger, R. A. (1993). In D. L. Morgan (Ed.), Successful focus groups: Advancing the state of the art (pp. 3–19). Thousand Oaks, CA: Sage Publications.Google Scholar
  30. National AIDS Control Organization of India. (2013a). Annual report, 2012–2013. New Delhi: Indian Ministry of Health and Family Welfare.Google Scholar
  31. National AIDS Control Organization of India. (2013b). A technical brief, 2012–2013. New Delhi: Indian Ministry of Health and Family Welfare.Google Scholar
  32. Parker, R., Shivananda, K., & Aggleton, P. (1998). Conspicuous by their absence? Men who have sex with men in the developing countries: Implications for HIV prevention. Critical Public Health, 8, 329–346.CrossRefGoogle Scholar
  33. Paul, J. P., Catania, J., Pollack, L., & Stall, R. (2001). Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men’s Health Study. Child Abuse and Neglect, 25, 557–584.CrossRefPubMedGoogle Scholar
  34. Reston, V. (1991). HIV prevention education for exceptional youth: Why HIV prevention education is important. Washington: Office of Educational Research and Improvement.Google Scholar
  35. Roberts, A. L., Rosario, M., Corliss, H. L., Koenen, K. C., & Austin, S. B. (2012). Childhood gender nonconformity: A risk indicator for childhood abuse and posttraumatic stress in youth. Pediatrics, 129, 410–417.PubMedCentralCrossRefPubMedGoogle Scholar
  36. Rolf, J., & Johnson, J. (1993). The challenges of AIDS. In J. Rolf, A. S. Masten, D. Cicchetti, K. H. Nuechterlein, & S. Weintraub (Eds.), Risk and protective factors in development of psychopathology (pp. 384–404). Cambridge: Cambridge University Press.Google Scholar
  37. Safren, S. A., Reisner, S. L., Herrick, A. L., Mimiaga, M. J., & Stall, R. D. (2010). Mental health and HIV risk in men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 55, S74–S77.PubMedCentralCrossRefPubMedGoogle Scholar
  38. Safren, S. A., Thomas, B. E., Mimiaga, M. J., Chandrasekaran, V., Menon, S., Swaminathan, S., … Mayer, K. H. (2009). Depressive symptoms and human immunodeficiency virus risk behavior among men who have sex with men in Chennai, India. Psychology, Health & Medicine, 14, 705–715.CrossRefGoogle Scholar
  39. Sandelowski, M. (2000). Focus on research methods-whatever happened to qualitative description? Research in Nursing & Health, 23, 334–340.CrossRefGoogle Scholar
  40. Silverman, D. (2010). Doing qualitative research: A practical handbook (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar
  41. Sivasubramanian, M., Mimiaga, M. J., Mayer, K. H., Anand, V. R., Johnson, C. V., Prabhugate, P., … Safren, S. A. (2011). Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: Findings from a community-recruited sample. Psychology, Health & Medicine, 16, 450–462.CrossRefGoogle Scholar
  42. Solomon, S. S., Srikrishnan, A. K., Sifakis, F., Mehta, S. H., Vasudevan, C. K., Balakrishnan, P., … Celentano, D. D. (2010). The emerging HIV epidemic among men who have sex with men in Tamil Nadu, India: Geographic diffusion and bisexual concurrency. AIDS and Behavior, 14, 1001–1010.CrossRefPubMedGoogle Scholar
  43. Somali, A. M., Kelley, J. A., Heckman, T. G., Hackl, K., Runge, L., & Wright, C. (2001). Life optimism, substance use and AIDS-specific attitudes associated with HIV risk behavior among disadvantaged innercity women. Journal of Women’s Health and Gender-based Medicine, 9, 1101–1111.CrossRefGoogle Scholar
  44. Spencer, S. M., & Patrick, J. H. (2009). Social support and personal mastery as protective resources during emerging adulthood. Journal of Adult Development, 16, 191–198.CrossRefGoogle Scholar
  45. Stall, R., Friedman, M., & Catania, J. (2007). Interacting epidemics and gay men’s health: A theory of syndemic production among urban gay men. In R. J. Wolitski, R. D. Stall, & R. O. Valdiserri (Eds.), Unequal opportunity: Health disparities affecting gay and bisexual men in the United States (pp. 251–274). New York: Oxford University Press.CrossRefGoogle Scholar
  46. Thomas, B., Mimiaga, M. J., Kumar, S., Swaminathan, S., Safren, S. A., & Mayer, K. H. (2011). HIV in Indian MSM: Reasons for a concentrated epidemic and strategies for prevention. Indian Journal of Medical Research, 134, 920–929.PubMedCentralCrossRefPubMedGoogle Scholar
  47. Thomas, B., Mimiaga, M. J., Mayer, K. H., Closson, E. F., Johnson, C. V., Menon, S., … Safren, S. A. (2012). Ensuring it works: A community-based approach to HIV prevention intervention development for men who have sex with men in Chennai, India. AIDS Education and Prevention, 24, 483–499.PubMedCentralCrossRefPubMedGoogle Scholar
  48. Weber, R. P. (Ed.). (1990). Basic content analysis (2nd ed.). Newbury Park, CA: Sage Publications.Google Scholar
  49. Welles, S. L., Baker, A. C., Miner, M. H., Brennan, D. J., Jacoby, S., & Rosser, B. R. (2009). History of childhood sexual abuse and unsafe anal intercourse in a 6-city study of HIV-positive men who have sex with men. American Journal of Public Health, 99, 1079–1086.PubMedCentralCrossRefPubMedGoogle Scholar
  50. Williams, J. K., Wyatt, G. E., Resell, J., Peterson, J., & Asuan-O’Brien, A. (2000). Psychosocial issues among gay- and non-gay-identifying HIV-seropositive African American and Latino MSM. Cultural Diversity and Ethnic Minority Psychology, 10, 268–286.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Matthew J. Mimiaga
    • 1
    • 2
    • 3
  • Elizabeth F. Closson
    • 3
  • Beena Thomas
    • 4
  • Kenneth H. Mayer
    • 3
    • 5
    • 6
  • Theresa Betancourt
    • 6
  • Sunil Menon
    • 7
  • Steven A. Safren
    • 1
    • 3
  1. 1.Department of PsychiatryHarvard Medical School/Massachusetts General Hospital, Behavioral MedicineBostonUSA
  2. 2.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  3. 3.The Fenway InstituteFenway HealthBostonUSA
  4. 4.National Institute for Research in TuberculosisChennaiIndia
  5. 5.Division of Infectious DiseasesHarvard Medical School/Beth Israel Deaconess Medical CenterBostonUSA
  6. 6.Department of Global Health and PopulationHarvard School of Public HealthBostonUSA
  7. 7.SahodaranChennaiIndia

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