Correlates of paid sex among men who have sex with men in Chennai, India

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Correlates of paid sex among men who have sex with men in Chennai,

India

P A Newman1, V Chakrapani2, C Cook1, M Shunmugam2, L Kakinami3

1 University of Toronto, Centre for Applied Social Research, Faculty

of Social Work, Toronto, Ontario, Canada

2 Indian Network for People Living with HIV, Chennai, India

3 University of Rochester, Department of Community and Preventive

Medicine, Rochester, New York, USA

Correspondence to:

Dr P A Newman, University of Toronto, Centre for Applied Social

Research, Faculty of Social Work, 246 Bloor Street West, Toronto, ON,

Canada M5S 1A1; p.newman@...

Sexually Transmitted Infections 2008;84:434-438;

doi:10.1136/sti.2008.031484

by the BMJ Publishing Group Ltd.

Objectives: To assess correlates of paid sex among men who have sex

with men (MSM) in Chennai, India.

Methods: A randomised survey was conducted among 200 MSM recruited

from public sex environments using time–space sampling. The

association of predictors with paid sex was assessed with 2 tests

and multiple logistic regression.

Results: Participants' mean age was 28.5 years (SD 8.7). Most (71.5%)

were kothis; 60% had less than high school education and two-thirds

had a monthly income less than 2000 Indian rupees. More than one-

third (35.0%) reported daily/weekly harassment; 40.5% reported forced

sex in the past year. The prevalence of paid sex was 59.5% (95% CI

52.7% to 66.3%).

Univariate analyses indicated that paid sex was associated with kothi

identity ( 2 = 14.46; p<0.01), less than high school education ( 2 =

4.79; p<0.05), harassment ( 2 = 11.75; p<0.01) and forced sex ( 2 =

3.98; p<0.05). Adjusted analyses revealed that paid sex was

associated with kothi identity (adjusted odds ratio (AOR) 2.62, 95%

CI 1.34 to 5.10) and harassment (AOR 2.34, 95% CI 1.16 to 4.72). MSM

who engaged in paid sex (versus no paid sex) had a mean of 31

partners in the past month (versus 4, t = 6.17, p<0.001) and 71.2%

used condoms consistently (versus 46.4%, 2 = 18.34; p<0.01).

Overall, 32.5% were never tested for HIV.

Conclusions: Epidemic rates of harassment and sexual violence against

MSM who engage in paid sex, predominantly kothis, suggest that

interventions should target structural factors placing these men at

increased risk of HIV/sexually transmitted infections and other

health-compromising conditions.

The effectiveness of individual-level, knowledge-based and condom-

focused preventive interventions may be constrained in the context of

poverty, low education, harassment and sexual violence.