Marseille 2007
| Abstract #492 - Structural Violence and Vulnerability to HIV/AIDS among Men who have Sex with Men in Chennai, India: A Mixed-method Investigation | ||||
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Session: 22.9: Stigma (Parallel) on Monday @ 16.30-18.30 in Auditorium/Overflow Chaired by Heather Worth, Osman Malik Authors: Presenting Author: Prof Peter Newman - University of Toronto, Canada |
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| Additional Authors: Dr Venkatesan Chakrapani, Mr Murali Shunmugam, Mr Alan McLuckie, Ms Lisa Kakinami, Mr Fredrick Melwin, | ||||
| Aim: To explore the lived experiences, contexts and prevalence of discrimination, violence and stigma among high-risk, low-socioeconomic MSM in Chennai, India, and ramifications for HIV prevention. | ||||
| Method / Issue: A mixed-method design included: I) in-depth, semi-structured interviews (n=21) and, II) a survey (n=200). I) 18 MSM were recruited using purposive sampling from public sex environments and community-based programs, as well as 3 key informants, in Chennai. Interviews were audiotaped in Tamil, transcribed, translated into English, and analyzed using narrative thematic analysis and a constant comparative method. Prolonged engagement, member checking and triangulation of methods were used to increase trustworthiness of the findings. II) A 30-minute face-to-face survey (and VDRL-testing) of 200 high-risk MSM assessed HIV risk, harassment, violence and demographics. Participants were recruited using time-space sampling from 10 randomly selected public sex environments in Chennai. Chi-square tests were used to assess the associations between harassment, violence and demographics, respectively, and HIV-seropositivity. | ||||
| Results / Comments: Overall, participants mean age was 28.5 years. Average monthly income was 1500 Indian rupees ($34 USD) and 60% had less than high-school education. Qualitative findings indicate multiple intersecting social and institutional contexts and experiences of stigmatization, discrimination and violence, from: 1) police (e.g., harassment/arrest for carrying condoms), 2) community members (e.g., physical/verbal harassment), 3) family members (e.g., sibling violence, thrown out of house), 4) the healthcare system (e.g., refusal of service, negative epithets); and, 5) consequences of stigma and discrimination, including non-disclosure of HIV status, low social support, depression and suicidality. Survey data revealed one-third (35%) of MSM were harassed at least weekly (37% of those by police); 40% experienced forced sex within the last year. Over one-third (36%) reported inconsistent condom use in the past 3 months, 33% last receptive anal sex unprotected; and 40% received money for sex in the past 3 months. 12% tested VDRL-reactive. One-third had never been tested for HIV; 13% of those tested self-reported HIV-positive. Chi-square analyses indicated that HIV-positive status was significantly associated with being harassed at least weekly (chi-square=7.15, p<.01) and experiencing forced sex (chi-square=10.50, p<.01) in the last year. | ||||
| Discussion: Multiple interlocking systems of stigma, harassment and discrimination, abetted by federal laws criminalizing homosexual behavior, provide evidence of structural violence against MSM in Chennai that creates extreme vulnerability to HIV/AIDS. HIV preventive interventions must simultaneously target individual and structural levels, including social, political, legal and medical systems. Support for indigenous, grass-roots community-based organizations serving MSM in Chennai is vital to HIV prevention. | ||||
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