1University of Calgary, Faculty of Social Work, Calgary, Canada,
2University of Toronto, Women's College Research Institute, Toronto, Canada, 3University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Canada, 4Indian Network of People Living with HIV, Chennai, India, 5Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India.
Background: Pervasive stigma and discrimination contribute to elevated HIV infection risks among men who have sex with men (MSM). Yet scant research has addressed the impact of stigma on sexual risk behaviors (SRB) among MSM in India, who have HIV infection rates sixteen times higher than the general population. The present study examined associations between sexual stigma, HIV-related stigma and SRB among MSM in South India.
Methods: We implemented a cross-sectional survey to a purposive sample of MSM in urban (Chennai) and semi-urban (Kumbakonam) locations in Tamil Nadu, India. Multiple linear regression (MLR) analyses were conducted to measure associations between independent (block-1: sexual stigma, HIV-related stigma; block-2: resilient coping, social support) and dependent variables (SRB: e.g. unprotected anal sex).
Results: The majority (96%) of participants (n=200) (mean age=30.9; median monthly income=78 USD) reported sexual and HIV-related stigma. Semi-urban participants (n=100) reported significantly higher HIV-related stigma and SRB, and lower resilient coping and social support, than urban participants (n=100). In Kumbakonam, kothis (MSM with feminine mannerisms/behaviors) had significantly higher SRB scores than non-kothi-identified MSM. The MLR model did not account for significant variance in SRB scores among the Chennai sample. In the Kumbakonam sample, sexual stigma and HIV-related stigma were associated with higher SRB, and resilient coping and social support accounted for significant variance in SRB after controlling for HIV-related and sexual stigma.
Conclusions: Stigma and discrimination were positively associated with SRB among MSM in South India; social support and resilient coping were associated with lower SRB. The influences of sexual stigma and HIV-related stigma on SRB are particularly pronounced outside of urban settings, where MSM have limited access to support services. HIV prevention initiatives in India tailored to urban/rural context and sexual identity should aim to strengthen protective factors, such as coping and social support, and challenge stigma associated with same-sex sexuality and HIV.
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