HIV prevention for non gay-identified men who have sex with men in Mumbai, India

Background: A street intervention for males who have sex with males (MSM) funded by USAID was conducted by Population Services International (PSI) Mumbai from 2004-2006 to prevent STIs/HIV among homosexual and bisexual men. Baseline surveys were conducted at two PSI sites to gather data on population size, partner type, and risk behaviors. Methods: Trained field researchers screened 2, 152 men in Mumbai's main red-light district (Kamathipura) using time-location sampling. Men were screened regardless of appearance/mannerisms. Findings: In Kamathipura, 440 of the 2,152 men screened (20.4%) reported oral or anal sex with a male in the past 12 months, as did 350 men out of 1085 (32.3%) at Cotton Green truck stop. Despite strong societal disapproval of homosexuality, a surprising frequency and openness about same-sex behavior was observed in both locations. Over 75% of MSM surveyed reported concurrent sex with females in the past 12 months. Condom and lubricant use varied according to access, partner type, and sexual position. Conclusions: Straight-acting MSM who lack contact with gay social networks are likely to be overlooked or misclassified by MSM community-based organizations and mainstream HIV prevention agencies. Rather than focus on sexual identity, the intervention strategy pioneered by PSI focused on self-protection - regardless of type of sex (oral, anal, vaginal) or choice of partners (male, female or transgender). All agencies working with high-risk males could benefit from sensitization and field-based training on how to deliver safer sex messages to MSM (and their male & female partners) within their intervention areas.