Men who have sex with men and women in Bangalore, South India, and potential impact on the HIV epidemic
- A E Phillips1,
- C M Lowndes2,3,
- M C Boily1,3,
- G P Garnett1,
- K Gurav4,
- B M Ramesh4,
- J Anthony4,
- S Moses5,
- M Alary3
- 1Imperial College, London, UK
- 2Health Protection Agency and London School of Hygiene and Tropical Medicine, London, UK
- 3Population Health Research Unit, Centre hospitalier affilié universitaire de Québec and Université Laval, Québec, Canada
- 4Karnataka Health Promotion Trust, Bangalore, India
- 5Departments of Medical Microbiology, Community Health Sciences and Medicine, University of Manitoba, Winnipeg, Canada
- Correspondence to Dr A Phillips, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College, London W2 1PG, UK;
- Accepted 22 January 2010
Objective The aim of this study was to quantify differences in patterns of sexual behaviour among men who have sex with men and women (MSMW) compared with men who have sex with men only (MSMO), and to examine the extent to which bisexual behaviour may act as a bridge for introducing HIV infection into the general population.
Methods A cross-sectional survey in Bangalore city in 2006, which sampled men seeking sex with men in public places and hammams (bath houses where transgender individuals sell sex to men).
Results Among a sample of 357 men reporting same-sex behaviour; 41% also reported sex with a woman in the past year and 14% were currently married to a woman, only two of whom had informed their wives about having sex with men. Condom use was very inconsistent with all male partners, while 98% reported unprotected vaginal sex with their wives. MSMW reported lower rates of risky behaviour with other men than MSMO: fewer reported selling sex (17% vs 58%), or receptive anal sex with known (28% vs 70%) or unknown (30% vs 59%) non-commercial partners.
Conclusion Bisexual behaviour was common among men seeking sex with men sampled in this survey. Although MSMW reported lower rates of risky sexual behaviour with male partners than MSMO, inconsistent condom use with both male and female partners indicates a potential means of HIV transmission into the general population. HIV prevention programmes and services should reach bisexual men who potentially expose their male and female partners to HIV.
Funding The research project was supported in part by the Bill & Melinda Gates Foundation. The India AIDS Initiative, including this study, is supported by a grant from the Bill & Melinda GatesFoundation. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill and Melinda Gates Foundation. MA is a national researcher of the Fonds de la Recherche en Santé du Québec, Canada (grant # 8722).
Competing interests None declared.
Patient consent Obtained.
Ethics approval This study was conducted with the approval of the Université Laval, Québec, Canada, Imperial College, London, UK and St Johns Medical College, Bangalore, India.
Provenance and peer review Not commissioned; not externally peer reviewed.