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Correlates of paid sex among men who have sex with men in Chennai, India
  1. P A Newman1,
  2. V Chakrapani2,
  3. C Cook1,
  4. M Shunmugam2,
  5. L Kakinami3
  1. 1
    University of Toronto, Centre for Applied Social Research, Faculty of Social Work, Toronto, Ontario, Canada
  2. 2
    Indian Network for People Living with HIV, Chennai, India
  3. 3
    University of Rochester, Department of Community and Preventive Medicine, Rochester, New York, USA
  1. Dr P A Newman, University of Toronto, Centre for Applied Social Research, Faculty of Social Work, 246 Bloor Street West, Toronto, ON, Canada M5S 1A1; p.newman{at}


Objectives: To assess correlates of paid sex among men who have sex with men (MSM) in Chennai, India.

Methods: A randomised survey was conducted among 200 MSM recruited from public sex environments using time–space sampling. The association of predictors with paid sex was assessed with χ2 tests and multiple logistic regression.

Results: Participants’ mean age was 28.5 years (SD 8.7). Most (71.5%) were kothis; 60% had less than high school education and two-thirds had a monthly income less than 2000 Indian rupees. More than one-third (35.0%) reported daily/weekly harassment; 40.5% reported forced sex in the past year. The prevalence of paid sex was 59.5% (95% CI 52.7% to 66.3%). Univariate analyses indicated that paid sex was associated with kothi identity (χ2  =  14.46; p<0.01), less than high school education (χ2  =  4.79; p<0.05), harassment (χ2  =  11.75; p<0.01) and forced sex (χ2  =  3.98; p<0.05). Adjusted analyses revealed that paid sex was associated with kothi identity (adjusted odds ratio (AOR) 2.62, 95% CI 1.34 to 5.10) and harassment (AOR 2.34, 95% CI 1.16 to 4.72). MSM who engaged in paid sex (versus no paid sex) had a mean of 31 partners in the past month (versus 4, t  =  6.17, p<0.001) and 71.2% used condoms consistently (versus 46.4%, χ2  =  18.34; p<0.01). Overall, 32.5% were never tested for HIV.

Conclusions: Epidemic rates of harassment and sexual violence against MSM who engage in paid sex, predominantly kothis, suggest that interventions should target structural factors placing these men at increased risk of HIV/sexually transmitted infections and other health-compromising conditions. The effectiveness of individual-level, knowledge-based and condom-focused preventive interventions may be constrained in the context of poverty, low education, harassment and sexual violence.

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  • Funding: This study was funded in part by a grant from the Social Sciences and Humanities Research Council of Canada and the Canada Research Chairs Program.

  • Competing interests: None.

  • Ethics approval: Ethics approval was obtained.

  • Patient consent: Obtained.

  • Contributors: PAN was the principal investigator for the study and lead author for the paper; VC contributed to the design of the study; CC and LK performed the statistical analyses; and VC and MS supervised recruitment and survey administration and all authors contributed to the write up.

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