Extent of alcohol use and its association with inconsistent condom use among hijras/transgender (male-to-female) people in India: survey findings from urban and rural sites in Maharashtra and
Tamil Nadu

M. Shunmugam1,2, M. Sivasubramanian2, S. Roy Karmakar3, M. Samuel4, V. Chakrapani1,2

1Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India, 2The Humsafar Trust, Mumbai, India, 3Solidarity and Action Against The HIV Infection in India (SAATHII), Kolkata, India, 4Madras Christian College, Department of Social Work, Chennai, India,

Background: Available evidence indicates that alcohol consumption is associated with sexual risk behaviors. HIV prevention interventions among hijras/transgender people in India, however, do not explicitly address alcohol-related sexual risk behaviours. In this analysis from a multi-site study, we report findings on alcohol consumption and sexual risk behaviors of hijras/transgender people.

Methods: During the last quarter of 2011, we conducted a survey among hijras/transgender people (n=150) accessing sex work sites and drop-in centres of four community-based organizations in four cities (Chennai, Kumbakonam, Mumbai and Sangli) in Maharashtra and Tamil Nadu. We analysed frequency of alcohol consumption and its association with condom use in anal sex.


Results: Participants' (n=150) mean age was 31 years. Forty-four percent have completed high school; 43% completed primary education and 12% were illiterate. Nearly half (46%) earned less than INR 5000/month. About half (53%) were living alone. Over two-thirds (77%) self-identified as hijras, 17% as jogtas, and 7% as 'transgender'. More than two-thirds (70%) reported having had sex in exchange for money in past 3 months. About two-thirds (67%) reported having consumed alcohol in past 3 months, among which one-third (n=34/103) consumed alcohol more than 5 days a week. Ninety-six percent (n=144/150) reported having had anal sex in past month. Among those who did not use condom in the last anal sex (27%; n=37/144), more than half (62%; n=23/37) reported having consumed alcohol before sex (p< .001). That is, people who reported having consumed alcohol before last anal sex are more likely not to use condoms and more likely to have received money for sex in past 3 months (p< .05).

Conclusions: High prevalence of alcohol consumption and its association with inconsistent condom use among hijras/transgender people, especially those in sex work, call for addressing alcohol-related sexual risk behaviours in HIV interventions and link those who abuse alcohol to alcohol-dependence treatment.

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