Symposia
Health Psychology / Behavioral Medicine - Adult
Brett Dolotina, B.S.
Massachusetts General Hospital
Somerville, Massachusetts
Jasper S. Lee, M.S.
Predoctoral Fellow
Harvard Medical School / Massachusetts General Hospital
BOSTON, Massachusetts
Steven A. Safren, Ph.D., ABPP
Professor of Psychology
University of Miami
University of Miami, Florida
Beena Thomas, PhD
Scientist
National Institute for Research in Tuberculosis
Chennai, Tamil Nadu, India
Alpana Dange, MS
Consultant research Director
The Humsafar Trust
Mumbai, Maharashtra, India
Shruta Rawat, MS
Research Manager
The Humsafar Trust
Mumbai, Maharashtra, India
Vinoth Balu, MS
Project Director
National Institute for Research in Tuberculosis
Chennai, Tamil Nadu, India
Senthil Kumar, MS
Senior Technical Officer
National Institute for Research in Tuberculosis
Chennai, Tamil Nadu, India
Matthew Mimiaga, ScD
Professor
University of California Los Angeles
Los Angeles, California
Kenneth Mayer, MD
Professor and Co-chair
The Fenway Institute
Boston, Massachusetts
Conall O'Cleirigh, Ph.D.
Director, Behavioral Medicine
Harvard Medical School/ Massachusetts General Hospital,
Boston, Massachusetts
Men who have sex with men (MSM) in India experience high rates of psychosocial difficulties compared to the general Indian population. These conditions may interact synergistically (syndemics) to result in increased vulnerability for HIV. There is a dearth of research on the relationship between syndemics and sexual risk behavior by MSM subgroup identity in India: Kothi (often feminine, receptive sex role), Double Decker (often insertive and receptive sex roles), Panthi (often masculine, insertive sex role). This study sought to:
Data for this study come from a multi-city randomized clinical trial of 608 MSM at risk of HIV in India. The syndemics sum score (0-4) consisted of 4 indicators: depression, post-traumatic stress, alcohol use, and substance use. ANOVA models were used to examine Aim 1. Multivariate negative binomial regression models were employed to examine Aims 2 and 3, adjusting for sex work and income. Panthis were not included in this trial.
Kothis had significantly higher levels of CAS (F(2,598)=27.36,p< 0.001) and sex work (F(2,598)=58.39,p< 0.001), as well as lower levels of income (F(2,598)=6.334,p=0.0019) and employment (F(2,598)=3.248,p=0.0396) compared to Double Deckers and Gay-identified MSM. Higher levels of syndemics were significantly associated with higher levels of CAS (β=0.2,p=0.011). The interaction effect of syndemics and MSM subtype on CAS was also significant (β=-0.35,p=0.027); higher levels of syndemics were associated with markedly higher levels of CAS for Kothis compared to Double Deckers and Gay-identified MSM.
These findings indicate that Kothis appear to face socioeconomic disadvantages and substantial sexual health risk compared to Double Deckers and Gay MSM. Kothis may benefit from pre-exposure prophylaxis (PrEP) augmented by culturally informed behavioral interventions to support PrEP use.