Self reported identity and risk behaviors in men having sex with men (MSM) in India: implications for STI/HIV management
P.N. Vasudevan Potty1, A. Das1, P. Prabhakar1, A. Risbud2, R. Gangakhedkar2
1Family Health International, STI Capacity Raising, New Delhi, India, 2National AIDS Research Institute (ICMR), Pune, India
Background: MSM in India identify themselves as kothi, panthi, or double-decker, who are expected to take a receptive, insertive or versatile sexual role, respectively. This classification generally used by health care providers as the basis for management of sexually transmitted infection (STI) may not always reflect their sexual practice and related risks, leading to inappropriate STI management. For sake of clarity this abstract uses the term “penetrator”, “receptor”, and “versatile” to refer to sexual identity among Indian MSM.
Methods: In 2008 and 2009, all MSM (513) attending four NGO-operated clinics in two cities of India – Hyderabad and Mumbai – were recruited in a survey regardless of their motive for seeking consultation. Participants provided information on their sexual behaviors and STI related treatment seeking behaviors. Biological specimens were collected by a physician.
Results: Participants included: 59% “receptors”, 8% “penetrators”, and 33% “versatile”. In the last three months, receptive anal sex was reported by 97% of “receptors”, 20% of “penetrators” and 91% “versatiles”. Condom use at last receptive anal sex was reported by 84% of “receptors”, 86% of “penetrators” and 79% “versatiles”. Penetrative anal sex irrespective of partners’ gender was reported by 18% of “receptors”, all “penetrators” and 73% “versatiles”. Irrespective of MSM sexual identity, the prevalence of Neisseria gonorrhoeae (NG) and/or Chlamydia trachomatis (CT) was 15% for rectal and 2% for urethral infections. Rectal NG/CT prevalence was 10% among “receptors”, 20% among “penetrators” and 15% among “versatiles”. Urethral infection was detected among 2% “receptors”.
Conclusions: The study confirms that self-reported sexual identity does not reflect sexual behavior of MSM in India. Clinical procedures for STI management among MSM should include careful history taking on sexual practices and appropriate clinical examination. STI/HIV prevention programs need to focus on risk reduction for MSM, irrespective of their sexual identity.
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