The Relationship Between Stigma, Sexual Risk Behavior and HIV Testing Among Men Who Have Sex with Men (MSM) in Kolkata, India

Abstract

Men who have sex with men (MSM) are at high risk for HIV, because of engaging in risky sexual practices. In many countries, MSM remain a highly stigmatized and marginalized population, making them harder to reach for HIV prevention intervention. Until recently before the start of this study, homosexual practices in India were criminalized, which may be influential in establishing and upholding stigma towards the MSM community. The prevalence of HIV in MSM populations in India is higher than the Indian national prevalence rate. This study sought to examine the relationship between stigma and use of HIV preventive practices, HIV sexual risk practices, and HIV testing behaviors among MSM. Surveys were conducted with two samples of men in Kolkata, India. One sample was 43 MSM, drawn from an NGO in Kolkata. The other sample was 57 men who do not have sex with men, drawn from men in varying neighborhoods in Kolkata. Correlations, Fisher's exact tests, Wilcoxon rank sum tests, logistic regressions, and ordinary least squares regressions were used to compare the two samples and the relationships between the variables of interest among MSM. It was found that stigma surrounding homosexuality is present in Kolkata and that it is associated with increased sexual risk behavior among MSM. In addition, MSM reported accessing HIV testing more frequently than non-MSM, and greater stigma was in fact associated with increased testing behavior. MSM were also more knowledgeable about HIV and more sexually risky than non-MSM. These results suggest that there is a relationship between stigma, sexual risk behavior, and HIV testing that warrants further study.