Sexual Behaviors and Condom Use among Behaviorally Bisexual Men in Mumbai, India: Priorities for HIV/STI Prevention

Introduction: The majority of previous HIV/STI research and prevention efforts have ignored unique issues specific to bisexual men, most notably their sexual behaviors with female partners. Previous studies have noted high rates of behavioral bisexuality among men in India but have not explored their specific sexual and risk behaviors with male and female partners. Methods: Constituents of our academic-community partnership delimited the study population to men who self-identify as "bisexual" and who have also engaged in penetrative sexual behavior with at least one male and female partner during the previous six months. Due to the exceptional sexual diversity in India, we sought to focus on bisexually-oriented men who actively seek out sexual behavior with both male and female partners. Following a series of four formative focus groups, we used a variety of purposeful and participant-driven sampling techniques to recruit a sample of 50 men from a range of venues in metropolitan Mumbai. Participants underwent an interviewer-administered survey. Results: Participants reported a high frequency of concurrent sexual activity with both male and female partners during the previous six months. Sexual experiences with "hijra," a culturally-specific "third gender" category, were also common and often conflated with "gay men" rather than women. Most female sexual partners were classified as "relationship partners" while male sexual partners were frequently "friends" or "just sex." Condom use during penetrative sex was common with male partners but relatively rare with female partners. Discussion: Our findings provide new insights into the unique experiences of self-identified behaviorally bisexual men in India. Risk reduction interventions should be tailored toward bisexually-oriented Indian men's risk behaviors and condom negotiation skills with female partners, in particular.