Women partners of men who have sex with men (MSM) in India: preventing HIV transmission and promoting early HIV diagnosis and treatment

V. Chakrapani1, P. Boyce2, D. Dhanikachalam3, N.R. Manilal4

1Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India, 2University of Sussex, Brighton, United Kingdom, 3Futures Group International India Pvt. Ltd., New Delhi, India, 4National AIDS Control Organisation, New Delhi, India

Background: In India, many MSM either are married or expect to marry. The present study aimed to identify strategies for the national HIV programme to promote the health of women partners of MSM both in terms of preventing HIV transmission and in promoting early HIV diagnosis and treatment.

Methods: Qualitative field research used a collective case study design to collect data in 2010/11 from 11 sites in seven states among 401 MSM (HIV prevention outreach workers and beneficiaries) through 57 focus groups (n=364; 46% married) and 37 key informant interviews. Women partners of MSM could not be recruited for the study. Potential interventions proposed are based on the inferences drawn by synthesising both the literature review and qualitative data (thematic analysis).


Results: Both literature review and qualitative data showed that women partners of MSM can include wives, casual, regular, paid or paying partners, and they may be at higher risk of HIV due to their male partners' high-risk sexual behaviours, which include having a large number of male and/or female partners combined with inconsistent condom use. Field data revealed that self-identified MSM may enter into heterosexual marriage with willingness, under compulsion (e.g., family pressure) or with indifference. Importantly, qualitative data offer new insights into whether disclosure of sexuality and/or HIV status among MSM is significant in preventing HIV transmission to female partners.

Conclusions: HIV prevention messages aimed at MSM ought to explicitly promote awareness of the risks/vulnerabilities faced by female partners. Such strategies ought to particularly include counselling and HIV testing approaches that address the complexities of safer sex practices with both male and female sexual partners. Developing interventions for single MSM that raises awareness of the HIV risks faced by their women partners and implementing interventions that explicitly target married MSM and their wives are key to effective, future HIV prevention programming.