AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #65 - Male-to-male sex among migrant workers in South India
Authors: Presenting Author: Dr Maria Ekstrand - University of California
Additional Authors: Dr. Gopal Krishnan, Dr. Davidson Solomon, Mr. AK Srikrishnan, Mr. CK Vasudevan, Dr. N Kumarasamy,
Aim: This study examines sexual risk patterns, alcohol use and prevention implications among migrant men who have sex with men (MSM) in South India.
Method / Issue: We conducted face-to-face interviews in Calicut, Kerala with 563 migrant men working in construction, factories, hotels or as day laborers, assessing migration history, alcohol use, and sexual risk taking.
Results / Comments: Out of the 563 male migrants surveyed in Calicut, 156 (28%) reported sex with other men and 45% of them worked in the hotel industry. Compared to non-MSM migrants, MSM were significantly younger (31.2 vs. 35.2 years), better educated (63% vs. 40% reported at least a secondary education), more likely to be unmarried (63% vs. 38%), and Muslim (33% vs. 25%) (all p<.05). Virtually all (96%) men consumed alcohol; 44% drank at least 3 times weekly and 28% reported getting drunk the last time they drank. Almost half (47%) of the drinkers had an AUDIT score ≥8, suggesting problem drinking. The majority of MSM believed alcohol made them happy (72%), more outgoing (69%), less shy (71%) and able to talk more freely (71%). About half (51%) believed alcohol increased their sexual interest, pleasure (49%), or the duration of sex (49%). Sex under the influence was common with all sexual partners; 79% reported alcohol consumption prior to sex with another man, 86% before sex with a female sex worker (FSW) and 66% before sex with a casual female partner. Fifty-six percent said their sexual debut occurred with a man and the median number of male partners was 21. The most common same sex behavior was oral sex (78% receptive, 96% insertive). Receptive anal sex was reported by 29% and insertive anal sex by 44%, with only 7% reporting consistent condom use. Transactional sex was common: 46% reported having paid for sex and 56% reported having been paid. Almost all men (96%) reported having had sex with females, including 37% who reported sex with their wives. Twenty-three percent reported always using condoms with FSW, 12 % with female casual partners, and only 2% of married men reported always using a condom with their wives. Twenty-six percent were able to identify all major transmission routes and 57% believed HIV could be casually transmitted. The majority disliked condoms, stating that they felt unnatural (72%), uncomfortable (58%), reduced sexual pleasure (72%) and made it difficult to maintain an erection (52%). Forty percent reported that they found condoms messy and difficult, slipping off or breaking (34%) and embarrassing to buy (30%).
Discussion: There is a clear need to develop effective HIV prevention intervention for migrant men who have sex with other men. Given the stigma of homosexuality, migrant MSM need prevention interventions delivered in confidential settings, using messages tailored to their specific needs and delivered by individuals perceived as trustworthy and credible. Interventions need to include basic education about HIV transmission and prevention, both during sex with men and women. They also need to include a unit on the role of alcohol in sexual risk and incorporate skills training to reduce negative perceptions of condoms.
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