Ensuring it works: a community-based approach to HIV prevention intervention development for men who have sex with men in Chennai, India
C. Johnson1, B. Thomas2, M. Mimiaga1,3, K. Mayer1,4, T. Betancourt5, S. Menon6, P. Murugesan2, M. Dilip2, S. Safren1,3
1Fenway Health, The Fenway Institute, Boston, United States, 2Tuberculosis Research Centre / Indian Council of Medical Research, Chennai, India, 3Harvard Medical School / Massachusetts General Hospital, Boston, United States, 4Brown Medical School/Miriam Hospital, Providence, United States, 5Harvard School of Public Health, Francois-Xavier Bagnoud Center for Health and Human Rights, Boston, United States, 6Sahodaran, Chennai, India
Background: In India men who have sex with men (MSM) have an HIV seroprevalence much greater than the country’s general population; yet research suggests that MSM may be underserved by current prevention efforts. The unique cultural context of being an MSM in India suggested that formative work would be required to develop an acceptable and culturally relevant HIV prevention intervention for this population.
Methods: In 2009, we conducted 5 focus group discussions, 9 key informant interviews and 4 community advisory board meetings among MSM, community leaders and advocates familiar with the population. Qualitative data were analyzed using NVIVO software.
Results: One-hundred-twelve individuals participated, including 56 MSM. Of the MSM participants 68% identified as kothi (feminine acting/appearing, predominantly receptive anal sex partners), 11% panthi (masculine acting/appearing, predominantly insertive partners) and 20% double decker (both receptive and insertive). Themes included:
1) high levels of message fatigue among recipients of current MSM HIV prevention services, which generally focused on condom promotion and distribution with little focus on co-occurring psychosocial concerns;
2) the importance of ensuring confidentiality, professionalism, sensitive facilitation whether or not by MSM, and a safe, non-judgmental setting; and
3) the importance of addressing psychosocial concerns such as self-acceptance, self-esteem, and pressures from family and society.
When asked about intervention format both group and individual components were recommended, with the general view that programmatic effectiveness would be augmented by providing separate groups for different MSM identities based on power differentials conferred through sex and gender roles.
Conclusions: The findings highlight the need for MSM HIV interventions to place HIV risk and HIV prevention services within a context that addresses broader psychosocial concerns, including skills building, family and social acceptance, and the need to foster social support and self-esteem.