Differential HIV transmission risk behaviors among MSM subgroups engaging in transactional sex in Chennai, India
M. Mimiaga1,2, B. Thomas3, K. Mayer2,4, C. Johnson2, S. Menon5, V. Chandrasekaran3, P. Murugesan3, S. Swaminathan3, S. Safren1,2
1Harvard Medical School / Massachusetts General Hospital, Boston, United States, 2Fenway Health, The Fenway Institute, Boston, United States, 3Tuberculosis Research Centre / Indian Council of Medical Research, Chennai, India, 4Brown Medical School/Miriam Hospital, Providence, United States, 5Sahodaran, Chennai, India
Background: MSM in India have disproportionately high rates of HIV compared to the general population. Although MSM who engage in transactional sex (i.e., the exchange of sex for goods/money) are at particularly elevated risk for HIV-infection, limited research has been undertaken to identify their unique HIV risk behaviors and prevention needs.
Methods: In 2009, 210 MSM in Chennai completed an interviewer-administered assessment, including questions about engaging in transactional sex in the past year, sexual-risk, demographics, MSM-identities, and other psychosocial variables. Logistic-regression procedures were used to examine behavioral, pychosocial, and demographic associations to either being paid or paying money or goods in exchange for sex with another man in the prior year.
Results: Almost half of the sample (46%) reported being paid for sex, and 33% reported paying for sex. In a multivariable logistic-regression model adjusting for age, education and HIV status, significant unique predictors of being paid for sex by a man in the past year included: greater number of male sex partners (AOR=1.12; 95%CI=1.05-1.19); participation in an HIV prevention intervention in the prior year (AOR=2.62; 95%CI=1.05-6.78); being “out” about MSM status (AOR=4.32; 95%CI=1.01-6.78); having depressive symptoms (AOR=4.11; 95%CI=1.83-9.23); and greater condom use self-efficacy (AOR=1.54; 95%CI=1.12-2.11). Significant predictors of paying a man for sex in the past year included: identifying as panthi (masculine appearing, predominantly insertive partners) compared to kothi (feminine acting/appearing and predominantly receptive partners in anal sex) (AOR=4.01; 95%CI=1.81-8.88); engaging in unprotected vaginal sex in the prior 3-months (AOR=3.54; 95%CI=1.58-7.93); and engaging in UAS with another man in the prior 3-months (AOR=1.82; 95%CI=1.01-3.57).
Conclusions: Transactional sex was common among this sample of MSM in Chennai. These findings underscore the need for HIV prevention programs for Indian MSM who engage in transactional sex that address co-occurring psychosocial problems within a cultural context that is relevant to MSM-subgroup-identities and experiences.