Sexual behaviour of men who have sex with men (MSM) and transgenders in Southern India

Abstract

Background The HIV epidemic in India remains predominantly concentrated in groups where individuals display high risk behaviours, including men who have sex with men (MSM). Widespread behavioural changes are crucial to the control of HIV, but need to be informed by an understanding of the risk factors for infection. However, reliability and validity of self-reported behaviour are difficult to determine. This thesis aims to contribute to the literature comparing innovative data collection modes for self-reported HIV risk behaviour in developing countries. Methods The Avahan programme is a large-scale HIV-prevention project that focuses on the six states in India with the highest HIV prevalence. The programme focuses on core and bridging groups, including MSM. This thesis presents the findings of one aspect of the monitoring and evaluation: behavioural data collected using face-to-face interviews (FTFI) and informal confidential voting interviews (ICVI) among MSM sampled in public place and Hammam cruising sites in Bangalore. Results A review of empirical data collected in developing countries comparing FTFI with new interviewing tools, found private data collection methods to have mixed success in reducing underreporting of risky behaviour. A comparison of ICVI and FTFI in India found that ICVI significantly increased reporting of stigmatised behaviours, but results did not adhere consistently to expectation. A number of self-identified categories of MSM are commonly applied in the intervention context in India, each of which was generally associated with different HIV-risk behaviours. Although there was evidence of role segregation and identity-specific behaviour, the categories were found to be more fluid than has previously been documented. Bisexual behaviour was common, and condom use with female partners was low, which suggests a potential bridge of HIV transmission into the general population. Conclusions The dataset provided a solid description of HIV risk behaviours among MSM cruising in public places in Bangalore, which has immediate implications for designing appropriate targeted HIV prevention programmes that address fluidity in risk behaviour between MSM identities and reach out to behaviourally bisexual men, rather than treating MSM as a homogenous group. Both the systematic review and the comparison of ICVI and FTFI highlighted difficulties in gathering ‘truthful’ self-reported behaviour, as determining the precise reasoning where individual responses departed from the presumed norm was impossible. Qualitative research might contribute to a better understanding of the motivations behind reporting biases amongst MSM.