Intersections between sexual violence and HIV risk among men who have sex with men (MSM) in India: Prevention and Impact Mitigation of Sexual Violence

V. Chakrapani1, P. Boyce2, and D. Dhanikachalam3

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, 

Background: Violence against MSM in India is largely hidden, and along with HIV forms a 'syndemic' (co-existing problems) that needs to be effectively addressed. The present study explored interconnections between HIV risk and sexual violence.

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) and 37 key informant interviews. Potential interventions proposed are based on the inferences drawn by synthesising both the literature review and qualitative data (thematic analysis).

Results: Literature review provides evidence that sexual violence has direct and indirect association with HIV-related risks for MSM and has long-term mental health consequences. Field data showed that MSM who reported physical/sexual abuse often do not report the incidents to the police because police themselves are major perpetrators of violence. Long-term mental health consequences of sexual violence are often not addressed in the existing governmental/non-governmental service settings. Thus, many victims' self-esteem and sense of self are severely damaged with devastating consequences, such as increased sexual risk taking. Absence of condom use and lack of availability of or awareness about sexual post-exposure antiretroviral prophylaxis (sPEP) limits the opportunity to decrease the risk of HIV to victims.


Conclusions:  It is critical for national HIV programme to understand the intersections between sexual violence and HIV risk, and take decisive steps in collaboration with other government ministries/departments. Actions to prevent sexual violence against MSM include: violence prevention and mitigation education for MSM; advocacy meetings with police; creation of an enabling environment to prevent and report violence. Services to be provided for victims of sexual violence include: providing free sPEP at government hospitals; screening for HIV/STIs and providing empirical treatment for STIs; linking victims with legal support; and providing long-term mental health counselling support.

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