HIV risk factors, immunologic profile and linkage to care amongst men who have sex with men (MSM) in Hyderabad, India
J. Schneider1,2, D. Rajender3, H. Snyder4, G. Oruganti5, C. Liao2, K. Mayer6, V. Yeldandi7
1University of Chicago, Medicine, Chicago, United States, 2University of Chicago, Health Studies, Chicago, United States, 3Mithrudu, Hyderabad, India, 4University of Chicago, Pritzker School of Medicine, Chicago, United States, 5SHARE-India, GYD Laboratory, Hyderabad, India, 6Brown University, Medicine, Providence, United States, 7SHARE-India, Hyderabad, India
Background: MSM represent a group with the highest rates of HIV infection in India, yet little is known about their specific HIV risk factors and immunologic profiles.
Methods: Study participants were recruited from an MSM clinic for HIV testing and linkage to care over a 12 month period. Participants completed an interviewer-administered survey, and rapid whole blood testing with confirmatory sequential ELISAs when appropriate. Multivariate logistic regression was performed to determine sociodemographic and risk factors for HIV infection, CD4 count and linkage to care.
Results: Of 1067 unique clients presenting, 37.9% consented for HIV testing and were included in the analysis of which 47.7% reported a health problem (46.6% with genital/anal complaint). Of the analytic sample, 34% were < 25 years, 33.2% Muslim, 29.5% married, and 65.9% reported engaging only in receptive anal sex. Overall 18.1% were HIV infected, with 82% newly diagnosed, and 60.3% received their CD4 test results (mean 339 cells, SD 230). The only association with not receiving CD4 testing was having last sex 1-2 days prior (p=0.004). There were no sociodemographic or risk variables associated with CD4 levels. In multivariate analyses including all variables from bivariate analyses (p< 0.05), predictors of HIV infection included being married (OR, 3.0; 95%CI 1.1-8.3), engaging only in receptive anal sex (OR, 5.3; 95%CI 1.1-26.3), sex 1-2 days ago (ref. >7 days ago) (OR, 9.4; 95%CI 1.6-55.3), and inconsistent condom use (OR, 4.3; 95%CI 1.8-10.7).
Conclusions: High HIV prevalence, risky behavior and concomitant marriage in this population suggest the need for focused prevention interventions. Linkage to CD4 testing was successful in the majority of cases. The relatively higher CD4 counts in this population detected through this community based screening program suggest that risky men were reached early in their disease, and such efforts should be scaled up and supported by governmental AIDS control organizations.