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Gao Q, Antfolk J, Santtila P. An Experiment Using a Sexual Strategies Explanation to Alleviate Internalized Homophobia Among Men Who Have Sex With Men in China. EVOLUTIONARY PSYCHOLOGY 2023; 21:14747049231179151. [PMID: 37272073 PMCID: PMC10355304 DOI: 10.1177/14747049231179151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Some men who have sex with men (MSM) having more casual sex and sexual partners is interpreted to be a sign of mental disorder and used to justify negative attitudes toward them by some. MSM may internalize this attitude causing internalized homophobia (IH). According to the sexual strategies theory, MSM having more casual sex is the result of differences between men's and women's sexual strategies and is unrelated to sexual orientation. We investigated whether this explanation would reduce IH and improve mental health in MSM. We recruited 255 Chinese MSM online using Wenjuanxing, Douban, Weibo, Tieba, and Blued and divided them using simple randomization into an experimental group (n = 77; sexual strategies explanation provided), an active control group (n = 99; minority stress explanation provided), and a control group (n = 79; no intervention) with pretest (N = 255); a 1 week post-test (n = 195); and a 1 month follow-up test (n = 170) of outcome measures. IH, mental distress (MD), sort-term mating orientation, and risky sexual behaviors were measured online. The data were analyzed by SPSS 28. IH was associated with MD while being married was associated with IH and sexual contact with women with both more IH and MD as were not being masculine and self-identifying as straight. The sexual strategies explanation reduced IH related to pathologizing sexual behaviors and high-risk sexual behaviors while the minority stress explanation reduced MD. Providing a sexual strategies explanation may be used to de-stigmatize casual sex among MSM.
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Affiliation(s)
- Qianhui Gao
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Jan Antfolk
- Faculty of Arts, Psychology, and Theology, Åbo Akademi University, Turku, Finland
| | - Pekka Santtila
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- New York University Shanghai, Shanghai, China
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2
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Adverse childhood experiences, sexual minority stigma, social support and depressive symptoms among Chinese men who have sex with men: A moderated mediation modelling analysis. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Ma H, Bu M, Zhai H, Li B, Xiong L. New Insight into HIV-Related Psychological Distress: A Concept Analysis. Clin Nurs Res 2023; 32:60-72. [PMID: 35259946 DOI: 10.1177/10547738221081002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Psychological distress is a frequently reported outcome measure in HIV research. However, because of its poor conceptualization, many studies only partially capture it because they focus solely on depression or anxiety based on symptoms. This study undertook a concept analysis of HIV-related psychological distress (HRPD) using Walker and Avant's method. The findings include HRPD's (a) attributes, including changes to emotional status, symptom burden, HIV disclosure distress and HIV-related stigma; (b) antecedents, including HIV-related stressors, cognitive appraisal of stressors and difficulty coping with the disease or treatment; and (c) consequences, including poor health outcomes and posttraumatic growth. Lazarus and Folkman's theory and the conservation of resources theory were adapted to further understand HRPD. This article provides insight into HRPD and increases the awareness of how to screen and assess HRPD at an early stage. The findings indicate the need to develop specific and rigorous measures and to provide appropriate interventions.
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Affiliation(s)
- Haiqi Ma
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Mengru Bu
- Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Huimin Zhai
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Bing Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Xiong
- Nanfang Hospital, Southern Medical University, Guangzhou, China
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Pan H, Lin B, Shi G, Ma Y, Zhong X. Anxiety and Depression Status and Influencing Factors of MSM in the Post-COVID-19 Epidemic Period: A Cross-Sectional Study in Western China. Am J Mens Health 2021; 15:15579883211057701. [PMID: 34836469 PMCID: PMC8649104 DOI: 10.1177/15579883211057701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study aimed to explore the psychological status and influencing factors of men who have sex with men (MSM) during the stable period of the COVID-19 epidemic, to provide a reference for the mental health counseling of MSM, and to provide a scientific basis for this group to actively respond to public health emergencies. A cross-sectional survey was conducted on the demographic characteristics, epidemic experiences, risk perception, and COVID-19-related attitudes of MSM in western China, and MSM anxiety and depression were assessed by using the Anxiety Self-Rating Scale and the Center for Epidemiological Studies Depression (CES-D) Scale. The incidences of MSM anxiety and depression in the post-COVID-19 epidemic period are 21.7% and 38.0%, respectively. Logistic regression analysis showed that in terms of anxiety, high controllability of the epidemic (OR = 0.7616) is a protective factor. Thinking that they are more susceptible to COVID-19 (OR = 1.6168) and worrying about another outbreak of the epidemic (OR = 1.4793) are risk factors. In terms of depression, being able to protect themselves from being infected with COVID-19 (OR = 0.6280) is a protective factor. The role of anal sex as “0”/“0.5,” and believing that they are more susceptible to COVID-19 (OR = 1.3408) are risk factors. The sudden outbreak affected the psychological state of MSM and even caused negative feelings of anxiety and depression. These findings suggest that prevention and education should be strengthened, and effective intervention measures should be taken as soon as possible, to improve the mental health of MSM.
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Affiliation(s)
- Hong Pan
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Bing Lin
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Guiqian Shi
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yingjie Ma
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
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Septarini NW, Hendriks J, Maycock B, Burns S. Methodologies of Stigma-Related Research Amongst Men Who Have Sex With Men (MSM) and Transgender People in Asia and the Pacific Low/Middle Income Countries (LMICs): A Scoping Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:688568. [PMID: 36304052 PMCID: PMC9580832 DOI: 10.3389/frph.2021.688568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022] Open
Abstract
Much stigma-related research focuses on marginalized populations, including men who have sex with men (MSM) and transgender people. The importance of research in this area is widely recognized, however methodologies and measures vary between studies. This scoping review will collate existing information about how stigma-related research has been conducted in low/middle income countries (LMICs) within the Asia Pacific region, and will compare research designs, sampling frameworks, and measures. Strengths and limitations of these studies will inform recommendations for future stigma-related health research. A methodological framework for scoping studies was applied. Searches of Psych INFO, Scopus, ProQuest, Global Health and PubMed were used to identify articles. Stigma-related research amongst MSM and transgender communities, published between 2010 and 2019 in LMICs within the Asia Pacific region were included. A total of 129 articles based on 123 different studies were included. Of the 129 articles 51.19% (n = 66) were quantitative; 44.96% (n = 57) were qualitative and 3.88% (n = 5) were mixed methods studies. The majority of studies (n = 57; 86.36%) implemented a cross sectional survey. In-depth interviews (n = 20, 34.48%) were also common. Only 3.88% of studies utilized mixed-methods design. Non-probabilistic and probabilistic sampling methods were employed in 99.22 and 0.78% of studies respectively. The most common measures used in quantitative studies were the Center for Epidemiological Study on Depression (CES-D) (n = 18) and the Self Stigma Scale (SSS) (n = 6). Strengths and limitations proposed by researchers included in this review are summarized as lesson learnt and best practices in stigma-related research.
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Affiliation(s)
- Ni Wayan Septarini
- School of Population Health, Curtin University, Perth, WA, Australia
- Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- *Correspondence: Ni Wayan Septarini ;
| | - Jacqueline Hendriks
- School of Population Health, Curtin University, Perth, WA, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, WA, Australia
| | - Bruce Maycock
- European Center for Environmental and Human Health, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth, WA, Australia
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Pufahl J, Rawat S, Chaudary J, Shiff NJ. Even Mists Have Silver Linings: Promoting LGBTQ+ Acceptance and Solidarity through Community-Based Theatre in India. Public Health 2021; 194:252-259. [PMID: 33991810 DOI: 10.1016/j.puhe.2021.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This project aimed to assess the effectiveness of a community-based theatre intervention to improve attitudes towards and increase knowledge about LGBTQ+ communities among audiences in Mumbai, India. STUDY DESIGN This study was a program evaluation using pre- and post-show surveys that incorporated an adapted version of The Riddle Scale: Attitudes Towards Difference and questions assessing self-reported knowledge about LGBTQ+-related issues to assess changes in attitudes and knowledge after viewing the theatre intervention. METHODS An original 90-min devised play was created by a company of Indian, American, and Canadian theatre artists using Participatory Action Research methods and was designed to bring audiences to a deeper understanding of LGBTQ+ identity. The show was performed four times in Mumbai, India, and pre-/post-show surveys were collected at each performance. Audience survey responses were analysed using parametric and non-parametric descriptive statistics as appropriate, and Likert scale questions were compared using Wilcoxon Signed Rank for non-parametric data. RESULTS A total 184 surveys were completed across four performances between March 7 and 14, 2020. Significant increases in audiences' self-reported knowledge of LGBTQ+ identity, impacts of discrimination, and struggles faced by LGBTQ+ communities were reported after viewing the show. Furthermore, attitudes towards LGBTQ+ rights, understanding of the challenges of being LGBTQ+ in India, and recognition of the contributions LGBTQ+ individuals make to society improved significantly among our audiences after test. The play further fostered increased acceptance of prosocial behaviours towards LGBTQ+ individuals with higher percentages of audiences recognizing the importance of standing up to homophobia and anti-gay attitudes. While these observations were seen across audiences, they were particularly pronounced among cisgender heterosexual men and audiences ages 18-24. CONCLUSION Community-based theatre intervention is highly acceptable and effective as a medium for informing positive attitudes, improving knowledge, and promoting acceptance of and solidarity towards LGBTQ+ communities among young adult heterosexual audiences.
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Affiliation(s)
- J Pufahl
- Center for Arts in Medicine, University of Florida, USA.
| | - S Rawat
- The Humsafar Trust, Mumbai, India
| | | | - N J Shiff
- Department of Community Health and Epidemiology, University of Saskatchewan, Canada
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Safren SA, Thomas B, Biello KB, Mayer KH, Rawat S, Dange A, Bedoya CA, Menon S, Anand V, Balu V, O'Cleirigh C, Klasko-Foster L, Baruah D, Swaminathan S, Mimiaga MJ. Strengthening resilience to reduce HIV risk in Indian MSM: a multicity, randomised, clinical efficacy trial. Lancet Glob Health 2021; 9:e446-e455. [PMID: 33740407 PMCID: PMC8091574 DOI: 10.1016/s2214-109x(20)30547-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention. METHODS We did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resilience-related mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294. FINDINGS Between Sept 4, 2015, and June 28, 2018, we enrolled 608 participants; 305 (50%) were assigned to the psychosocial intervention condition and 303 (50%) were assigned to the control condition. 510 (84%) of 608 men completed an assessment at 4 months after randomisation, 483 (79%) at 8 months, and 515 (85%) at 12 months. 512 (99%) of 515 men had STI data from the 12-month assessment. The intervention condition had a 56% larger reduction in condomless anal sex acts (95% CI 35-71; p<0·0001) from baseline to 4-month follow-up, 72% larger reduction (56-82; p<0·0001) from baseline to 8-month follow-up, and 72% larger reduction (53-83; p<0·0001) from baseline to 12-month follow-up, compared with the standard-of-care control condition (condition by time interaction; χ2=40·29, 3 df; p<0·0001). Improvements in self-esteem and depressive symptoms both mediated 9% of the intervention effect on condomless anal sex acts. Bacterial STI incidence did not differ between study conditions at 12-month follow-up. INTERPRETATION A resilience-based psychosocial intervention for MSM at risk of HIV acquisition or transmission in India was efficacious in reducing condomless anal sex acts, with evidence for mediation effects in two key target resilience variables. HIV prevention programmes for MSM in India should address mental health resilience to augment reductions in the risk of sexually transmitted HIV. FUNDING National Institute of Mental Health.
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Affiliation(s)
- Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA; Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Beena Thomas
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Katie B Biello
- Department of Behavioural and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H Mayer
- Fenway Institute, Fenway Health, Boston, MA, USA; Department of Infectious Diseases, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - C Andres Bedoya
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Vinoth Balu
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Conall O'Cleirigh
- Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Lynne Klasko-Foster
- Department of Psychiatry and Human Behaviour, Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Soumya Swaminathan
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Matthew J Mimiaga
- Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioural Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Camp J, Vitoratou S, Rimes KA. LGBQ+ Self-Acceptance and Its Relationship with Minority Stressors and Mental Health: A Systematic Literature Review. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2353-2373. [PMID: 32504233 PMCID: PMC7497468 DOI: 10.1007/s10508-020-01755-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 05/27/2023]
Abstract
Many individuals who identify as lesbian, gay, bisexual, queer, and with other non-heterosexual orientations (LGBQ+) experience stigma, prejudice, and/or discrimination because of their sexuality. According to minority stress and identity development theories, these experiences can contribute to difficulties with self-acceptance of sexuality. Lower self-acceptance is considered a risk factor for adverse mental health outcomes. The current review aims to investigate whether self-acceptance of sexuality is associated with minority stressors or difficulties with mental health in LGBQ+ individuals, as well as whether there are differences in self-acceptance between different sexual orientations. Five bibliographic databases were searched. Thirteen studies were identified which used quantitative methodology to investigate associations between self-acceptance, minority stressors, and/or mental health within LGBQ+ samples, or differences in self-acceptance between different sexual orientations. The results from these cross-sectional studies suggested that lower self-acceptance of sexuality was associated with higher levels of self-reported minority stressors, including a lack of acceptance from friends and family, a lack of disclosure to others, and internalized heterosexism. Lower self-acceptance of sexuality was associated with poorer mental health outcomes, including greater global distress, depression symptoms, and lower psychological well-being. There was no significant relationship with suicidality. Studies also found that LGBQ+ individuals had lower general self-acceptance compared to heterosexual participants, bisexual individuals had lower sexuality self-acceptance compared to lesbian/gay individuals, and lesbian women had lower sexuality self-acceptance compared to gay men. Given the potential importance of self-acceptance for LGBQ+ populations, further research is required with more robust methodology. Self-acceptance could be a potential target in clinical interventions for LGBQ+ individuals.
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Affiliation(s)
- Jake Camp
- Department of Psychology, Henry Wellcome Building, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Department of Psychology, Henry Wellcome Building, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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Tan RKJ, Kaur N, Chen MIC, Wong CS. Developing a Typology of HIV/STI Testing Patterns Among Gay, Bisexual, and Queer Men: A Framework to Guide Interventions. QUALITATIVE HEALTH RESEARCH 2020; 30:610-621. [PMID: 31517590 PMCID: PMC7322924 DOI: 10.1177/1049732319870174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although factors associated with HIV/sexually transmitted infection (STI) testing among gay, bisexual, and queer (GBQ) men are well-established in the literature, few studies have attempted to delineate the processes underlying different patterns of testing. We conducted a qualitative study involving 35 semistructured interviews with a purposive sample of GBQ men in Singapore from October 2017 to July 2018. Topics explored included formative sexual experiences, relationships, and experiences of HIV/STI testing. Interviews were audio-recorded, transcribed, coded, and analyzed through inductive thematic analysis. A typology comprising four distinct HIV/STI testing patterns was identified from the data, categorized based on the regularity of testing, relative to internal or external factors that motivate testing behaviors. These include triggered episodic testing, influenced episodic testing, institutionalized regular testing, and value-based regular testing. The typology highlights the preconditions that underlie different testing patterns and provides a framework for developing interventions that promote HIV/STI testing among GBQ men.
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Affiliation(s)
- Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Health System, Singapore
| | | | - Mark I-Cheng Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Health System, Singapore
- National Centre for Infectious Diseases, Singapore
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Miedema SS, Haardörfer R, Keyes CLM, Yount KM. Does Socio-structural Context Matter? A Multilevel Test of Sexual Minority Stigma and Depressive Symptoms in Four Asia-Pacific Countries. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:416-433. [PMID: 31771346 DOI: 10.1177/0022146519877003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the Asia-Pacific region, individual sexual stigma contributes to elevated rates of depression among sexual minority men. Less well understood is the role of socio-structural sexual stigma despite evidence that social context influences the experience of stigma. We use data from the United Nations Multi-country Study on Men and Violence to conduct a multilevel test of associations between individual- and cluster unit-level indicators of sexual stigma and depressive symptoms among sexual minority men (n = 562). In the full model, individual-level sexual stigma is not associated with depressive symptoms, although there is significant variation in the association between individual stigma and depressive symptoms across clusters. Contrary to expectation, at the community level, homophobic injunctive norms are negatively associated with depressive symptoms. We discuss the implications for policies, programs, and future research to improve mental health among sexual minority men in the region.
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Affiliation(s)
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Kathryn M Yount
- Department of Sociology, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Chakrapani V, Kaur M, Newman PA, Mittal S, Kumar R. Syndemics and HIV-related sexual risk among men who have sex with men in India: influences of stigma and resilience. CULTURE, HEALTH & SEXUALITY 2019; 21:416-431. [PMID: 30025511 PMCID: PMC6430415 DOI: 10.1080/13691058.2018.1486458] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Using syndemics theory as a framework, we explored the experience of men who have sex with men in India in relation to four syndemic conditions (depression, alcohol use, internalised homonegativity and violence victimisation) and to understand their resilience resources. Five focus groups were conducted among a purposive sample of diverse men along with seven key informant interviews with HIV service providers. Participants' narratives suggested various pathways by which syndemic conditions interact with one another to sequentially or concurrently increase HIV risk. Experiences of discrimination and violence from a range of perpetrators (family, ruffians and police) contributed to internalised homonegativity and/or depression, which in turn led some men to use alcohol as a coping strategy. Stigma related to same-sex sexuality, gender non-conformity and sex work contributed to the production of one or more syndemic conditions. While rejection by family and male regular partners contributed to depression/alcohol use, support from family, regular partners and peers served as resources of resilience. In India, HIV prevention and health promotion efforts among men who have sex with men could be strengthened by multi-level multi-component interventions to reduce intersectional/intersecting stigma, address syndemic conditions and foster resilience - especially by promoting family acceptance and peer support.
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Affiliation(s)
- Venkatesan Chakrapani
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Corresponding Author: Manmeet Kaur
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
| | - Sandeep Mittal
- Chandigarh State AIDS Control Society, Chandigarh, India
| | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lim SH, Brown SE, Shaw SA, Kamarulzaman A, Altice FL, Beyrer C. "You Have to Keep Yourself Hidden": Perspectives From Malaysian Malay-Muslim Men Who Have Sex With Men on Policy, Network, Community, and Individual Influences on HIV Risk. JOURNAL OF HOMOSEXUALITY 2018; 67:104-126. [PMID: 30307803 DOI: 10.1080/00918369.2018.1525946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Malay-Muslim men who have sex with men (MSM) are marginalized and hidden in Malaysia, a predominantly Muslim country in southeast Asia. We explored the policy, network, community, and individual factors related to HIV infection among Malay-Muslim MSM through 26 in-depth interviews and one focus group discussion (n = 5) conducted in Kuala Lumpur and Kota Bharu between October 2013 and January 2014. As religion plays an important role in their lives, participants viewed homosexuality as a sin. Low risk perception and misconceptions about HIV/AIDS were common, and most participants expressed reluctance to consult a doctor unless they had symptoms. Additionally, buying condoms was embarrassing and anxiety-producing. Fear of discrimination by health care providers and community hindered participants from disclosing sexual behaviors and accessing health services. Homophobic comments and policies by the government and religious leaders were concerns of participants. A safe and enabling environment is needed to reduce HIV risks among Malay-Muslim MSM.
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Affiliation(s)
- Sin How Lim
- Centre of Excellence for Research in AIDS (CERiA), Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Stacey A Shaw
- Department of Social Work, Brigham Young University, Provo, Utah, USA
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, Connecticut, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Choudhry V, Dayal R, Pillai D, Kalokhe AS, Beier K, Patel V. Child sexual abuse in India: A systematic review. PLoS One 2018; 13:e0205086. [PMID: 30300379 PMCID: PMC6177170 DOI: 10.1371/journal.pone.0205086] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 09/19/2018] [Indexed: 01/06/2023] Open
Abstract
Objective Child Sexual Abuse (CSA) is a pressing human right issue and public health concern. We conducted a systematic review of quantitative and qualitative studies published in the past decade on CSA in India to examine the distribution of the prevalence estimates for both genders, to improve understanding of the determinants and consequences of CSA and identify gaps in the current state of research. Methods For this systematic review, we searched electronic literature databases (PubMed, POPLINE, and PsycINFO) for articles published in English on Child Sexual Abuse in India between January 1, 2006 and January 1, 2016 using 55 search terms. Data were extracted from published articles only. Findings Fifty-one studies met inclusion criteria for the review. The review indicates that prevalence rates of CSA is high among both boys and girls in India. Due to heterogeneity of study designs and lack of standardised assessments, reported prevalence estimates varied greatly among both genders in different studies. There is a need to conduct representative studies using a validated instrument to obtain valid epidemiological estimates. Commercial sex workers, men who have sex with men, and women with psychiatric disorders were at higher risks for sexual abuse during childhood. In addition, the synthesis of qualitative data across studies included in the review suggests that exposure and perpetration of CSA is a multifaceted phenomenon grounded in the interplay between individual, family, community, and societal factors. The review indicates poor physical, behavioural, social, and mental health outcomes of CSA in India. We conclude with a research agenda calling for quantitative and qualitative studies to explore the determinants and perpetration of child sexual abuse in India from an ecological lens. This research agenda may be necessary to inform the development of a culturally tailored primary prevention and treatment strategy for CSA victims in India.
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Affiliation(s)
- Vikas Choudhry
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
- Sambodhi Research and Communications Pvt. Ltd., Noida, Uttar Pradesh, India
- * E-mail:
| | - Radhika Dayal
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
| | - Divya Pillai
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
| | - Ameeta S. Kalokhe
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
| | - Klaus Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstraße, Berlin, Germany
| | - Vikram Patel
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
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Xu W, Zheng L, Song J, Zhang X, Zhang X, Zheng Y. Relationship Between Childhood Sexual Abuse and HIV-Related Risks Among Men Who Have Sex with Men: Findings from Mainland China. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1949-1957. [PMID: 29134421 DOI: 10.1007/s10508-017-1104-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/12/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
Men who have sex with men (MSM) carry the burden of HIV infection in China. Outside of China, a history of childhood sexual abuse (CSA) has been associated with HIV-related risks (behavioral, sexual, and mental health outcomes) among MSM. We therefore evaluated the relationship between CSA and these HIV-related risks among MSM in China. Cross-sectional data were collected via a survey from gay websites and social networking applications from MSM in 30 provinces in mainland China during a 3-month period in 2014 and 2015. Overall, 999 screened MSM who responded to questions on CSA were included. Multinomial logistic regression models-adjusted for sociodemographic confounders-showed that men who reported experiencing regular CSA and contact CSA, respectively, were more likely to use substances (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI] 1.39-2.62 and AOR, 1.70; 95% CI 1.25-2.31), had a history of sexually transmitted infections (AOR, 1.81; 95% CI 1.29-2.55 and AOR, 1.65; 95% CI 1.18-2.96), had more male sexual partners (AOR, 1.06; 95% CI 1.04-1.09 and AOR, 1.05; 95% CI 1.03-1.08), engaged in more condomless sex with men (AOR, 1.89; 95% CI 1.39-2.56 and AOR, 1.72; 95% CI 1.29-2.30), and experienced more psychological distress (AOR, 1.05; 95% CI 1.02-1.08 and AOR, 1.05; 95% CI 1.03-1.08). Both frequent and contact forms of CSA were positively associated with HIV-related risks among MSM, suggesting that general CSA prevention strategies and interventions are needed to support this population.
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Affiliation(s)
- Wenjian Xu
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Lijun Zheng
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Jingjing Song
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Xing Zhang
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Xuemeng Zhang
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Yong Zheng
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China.
- Faculty of Psychology, Southwest University, Chongqing, 400715, China.
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Dayal R, Kalokhe AS, Choudhry V, Pillai D, Beier K, Patel V. Ethical and definitional considerations in research on child sexual violence in India. BMC Public Health 2018; 18:1144. [PMID: 30261867 PMCID: PMC6161376 DOI: 10.1186/s12889-018-6036-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While critically important, child sexual violence (CSV) research poses numerous ethical and safety challenges. Recently, the studies dedicated to understanding and addressing CSV in India have been on the rise, but no published ethical guidelines to direct such research currently exist. To help inform ethical and safety recommendations for the design, conduct, and reporting of future CSV research in India and similar settings, we systematically reviewed the ethics and safety practices reported in recent Indian CSV literature. METHODS A multi-tiered approach was used to understand current ethical practices and gaps: 1) systematic review of Indian CSV studies published over the past decade, 2) examination of existing guidelines on related topics to develop an ethical framework, 3) development of an ethics checklist based on the recommendations from the surveyed guidelines, and 4) application of the checklist to each of the reviewed studies. RESULT Our search yielded 51 eligible studies. From each, data from 6 major thematic areas was extracted: informed consent, confidentiality, selection, training, and protection of study team members, validity of CSV measurement methods, measures to minimize participant harm, and participant compensation. Several gaps were noted: only two-thirds reported approval by ethics committees, obtaining informed consent, and assured participants of confidentiality. Only 25% (13/51) reported assessing ongoing CSV risk and providing necessary support services, none noted whether ongoing CSV was reported to authorities (required by Indian law), and none reported safeguards to protect staff from the effects of conducting CSV research. Further, 43% (22/51) limited surveillance of CSV to one form of abuse and/or used a "loaded term," increasing the potential for underreporting. CONCLUSIONS Through enhancing understanding of current ethical practices and gaps in CSV research in India, this systematic review informs reporting protocols and future guidelines for CSV research in India and other similar settings.
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Affiliation(s)
- Radhika Dayal
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002 Haryana India
| | - Ameeta S. Kalokhe
- Emory University School of Medicine Division of Infectious Diseases and Rollins School of Public Health Department of Global Health, Atlanta, USA
| | - Vikas Choudhry
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002 Haryana India
- Sambodhi Research and Communications Pvt. Ltd., C-126, Sector- 2, Noida, 201301 Uttar Pradesh India
| | - Divya Pillai
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002 Haryana India
| | - Klaus Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstraße 57, 10117 Berlin, Germany
| | - Vikram Patel
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002 Haryana India
- Department of Global Health and Social Medicine, Harvard Medical School, MA Boston, 02115 USA
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16
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Mimiaga MJ, Thomas B, Mayer KH, Regenauer KS, Dange A, Andres Bedoya C, Rawat S, Balu V, O’Cleirigh C, Biello KB, Anand V, Swaminathan S, Safren SA. A randomized clinical efficacy trial of a psychosocial intervention to strengthen self-acceptance and reduce HIV risk for MSM in India: study protocol. BMC Public Health 2018; 18:890. [PMID: 30021566 PMCID: PMC6052541 DOI: 10.1186/s12889-018-5838-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) in India are a key group at risk for HIV acquisition and transmission. They are also an extremely marginalized and stigmatized population, facing immense psychosocial stressors including, but not limited to, stigma, homophobia, discrimination, criminalization, low self-esteem, low self-acceptance, distress, and, as a result, high rates of mental health problems. Although these multi-level psychosocial problems may put MSM at high risk for HIV acquisition and transmission, currently HIV prevention interventions in India do not address them. This paper describes the design of a psychosocial intervention to reduce HIV risk for MSM in India. METHODS Funded by the National Institute of Mental Health, this study is a two-arm randomized clinical efficacy trial of a self-acceptance based psychosocial HIV prevention intervention, informed by the minority stress model and syndemic theory, that was developed with extensive community-based formative work and input from the Indian MSM community and key informants who are knowledgeable about the experiences faced by MSM in India. Participants are MSM in Chennai and Mumbai who endorsed recent sexual behaviors placing them at high risk for HIV/sexually transmitted infection (STI) acquisition and transmission. Enrolled participants are equally randomized to either 1) the experimental condition, which consists of four group and six individual counseling sessions and includes standard of care HIV/STI testing and counseling, or 2) the standard of care condition, which includes HIV/STI testing and counseling alone. The primary outcomes are changes in the frequency of condomless anal sex acts and STI incidence (syphilis seropositivity and urethral, rectal, and pharyngeal gonorrhea and chlamydia infection. Major study assessment visits occur at baseline, 4-, 8-, and 12-months. DISCUSSION HIV prevention interventions that address the psychosocial stressors faced by MSM in India are needed; this study will examine the efficacy of such an intervention. If the intervention is successful, it may be able to reduce the national HIV/AIDS burden in India while empowering a marginalized and highly stigmatized group. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02556294 , registered 22 September 2015.
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Affiliation(s)
- Matthew J. Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI USA
- Center for Health Equity Research, Brown University, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI USA
| | - Beena Thomas
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Beth Israel Deaconness Medical Center, Boston, MA USA
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Kristen S. Regenauer
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | | | - C. Andres Bedoya
- Harvard Medical School, Boston, MA USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | | | - Vinoth Balu
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Katie B. Biello
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI USA
| | | | | | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychology, University of Miami, Coral Gables, FL USA
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Tomori C, Srikrishnan AK, Ridgeway K, Solomon SS, Mehta SH, Solomon S, Celentano DD. Perspectives on Sexual Identity Formation, Identity Practices, and Identity Transitions Among Men Who Have Sex With Men in India. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:235-244. [PMID: 27393039 PMCID: PMC5219953 DOI: 10.1007/s10508-016-0775-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 04/08/2016] [Accepted: 05/17/2016] [Indexed: 05/31/2023]
Abstract
Men who have sex with men (MSM) remain at high risk for HIV infection. Culturally specific sexual identities, encompassing sexual roles, behavior, and appearance, may shape MSM's experiences of stigmatization and discrimination, and affect their vulnerability to HIV. This multi-site qualitative study (n = 363) encompassing 31 focus group discussions (FGDs) and 121 in-depth interviews (IDIs) across 15 sites in India investigated sexual identity formation, identity practices, and transitions and their implications for HIV prevention. IDIs and FGDs were transcribed, translated, and underwent thematic analysis. Our findings document heterogeneous sexual identity formation, with MSM who have more gender nonconforming behaviors or appearance reporting greater family- and community-level disapproval, harassment, violence, and exclusion. Concealing feminine aspects of sexual identities was important in daily life, especially for married MSM. Some participants negotiated their identity practices in accordance with socioeconomic and cultural pressures, including taking on identity characteristics to suit consumer demand in sex work and on extended periods of joining communities of hijras (sometimes called TG or transgender women). Participants also reported that some MSM transition toward more feminine and hijra or transgender women identities, motivated by intersecting desires for feminine gender expression and by social exclusion and economic marginalization. Future studies should collect information on gender nonconformity stigma, and any changes in sexual identity practices or plans for transitions to other identities over time, in relation to HIV risk behaviors and outcomes.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.
| | | | - Kathleen Ridgeway
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | - Suniti Solomon
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
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Chakrapani V, Vijin PP, Logie CH, Newman PA, Shunmugam M, Sivasubramanian M, Samuel M. Understanding How Sexual and Gender Minority Stigmas Influence Depression Among Trans Women and Men Who Have Sex with Men in India. LGBT Health 2017; 4:217-226. [PMID: 28422615 DOI: 10.1089/lgbt.2016.0082] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Few studies have assessed how sexual and gender minority stigmas affect the mental health of trans women and self-identified men who have sex with men (MSM) in India, populations with a high HIV burden. We tested whether social support and resilient coping act as mediators of the effect of sexual and gender minority stigmas on depression as proposed by Hatzenbuehler's psychological mediation framework, or as moderators based on Meyer's minority stress theory. METHODS We conducted a cross-sectional survey among trans women (n = 300) and MSM (n = 300) recruited from urban and rural sites in India. Standardized scales were used to measure depression (outcome variable), transgender identity stigma/MSM stigma (predictor variables), and social support and resilient coping (tested as moderators and parallel mediators). The mediation and moderation models were tested separately for trans women and MSM, using Hayes' PROCESS macro in SPSS. RESULTS Participants' mean age was 29.7 years (standard deviation 8.1). Transgender identity stigma and MSM stigma were significant predictors (significant total and direct effects) of depression, as were social support and resilient coping. Among trans women and MSM, social support and resilient coping mediated (i.e., significant specific indirect effects), but did not moderate, the effect of stigma on depression, supporting the psychological mediation framework. CONCLUSION Sexual and gender minority stigmas are associated with depression, with social support and resilient coping as mediators. In addition to stigma reduction interventions at the societal level, future interventions should focus on improving social support and promoting resilience among trans women and MSM in India.
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Affiliation(s)
- Venkatesan Chakrapani
- 1 Centre for Sexuality and Health Research and Policy (C-SHaRP) , Chennai, India .,2 The Humsafar Trust , Mumbai, India .,3 Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
| | | | - Carmen H Logie
- 4 Factor-Inwentash Faculty of Social Work/Centre for Applied Social Research, University of Toronto , Toronto, Canada .,5 Women's College Research Institute, Women's College Hospital, University of Toronto , Toronto, Canada
| | - Peter A Newman
- 4 Factor-Inwentash Faculty of Social Work/Centre for Applied Social Research, University of Toronto , Toronto, Canada
| | - Murali Shunmugam
- 1 Centre for Sexuality and Health Research and Policy (C-SHaRP) , Chennai, India
| | | | - Miriam Samuel
- 6 Department of Social Work, Madras Christian College , Chennai, India
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Tomori C, McFall AM, Srikrishnan AK, Mehta SH, Nimmagadda N, Anand S, Vasudevan CK, Solomon S, Solomon SS, Celentano DD. The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India. BMC Public Health 2016; 16:784. [PMID: 27520978 PMCID: PMC4983056 DOI: 10.1186/s12889-016-3446-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/25/2016] [Indexed: 12/22/2022] Open
Abstract
Background Childhood sexual abuse (CSA) is a significant global public health problem, which is associated with negative psychosocial outcomes and high-risk sexual behaviors in adults. Men who have sex with men (MSM) often report higher prevalence of CSA history than the general population, and CSA may play a key role in MSM’s greater vulnerability to HIV. Methods This study examined the prevalence of CSA history and its impact on the number of recent HIV-related risk behaviors (unprotected anal intercourse, high number of male and female sexual partners, alcohol use, drug use, and sex work in prior 6 months) and lifetime risk behaviors and experiences (high number of lifetime male and female sexual partners, early sexual debut, injection drug use, sex work, and intimate partner violence) among 11,788 adult MSM recruited via respondent driven sampling across 12 sites in India, with additional insights from thematic analysis of qualitative research with 363 MSM from 15 sites. Results Nearly a quarter (22.4 %) of participants experienced CSA, with substantially higher prevalence of CSA in the South and among kothis (feminine sexual identity). Qualitative findings revealed that older, trusted men may target young and, especially, gender nonconforming boys, and perpetrators’ social position facilitates nondisclosure. CSA may also initiate further same-sex encounters, including sex work. In multivariable analysis, MSM who experienced CSA had 21 % higher rate of recent (adjusted rate ratio [aRR = 1.21], 95 % confidence interval [CI]: 1.14–1.28), and 2.0 times higher lifetime (aRR = 2.04, 95 % CI: 1.75–2.38) HIV-related behaviors/experiences compared with those who did not. Conclusion This large, mixed-methods study found high overall prevalence of CSA among MSM (22.4 %), with substantially higher prevalence among MSM residing in the South and among more feminine sexual identities. Qualitative findings highlighted boys’ vulnerabilities to CSA, especially gender nonconformity, and CSA’s role in further sexual encounters, including sex work. Additionally, CSA was associated with an elevated rate of recent, and an even higher rate of lifetime HIV-related risk factors. Our results suggest an acute need for the development of CSA prevention interventions and the integration of mental health services for MSM with histories of CSA as part of HIV-prevention efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3446-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | | | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - Suniti Solomon
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.,YR Gaitonde Centre for AIDS Research and Education, Chennai, India.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Tomori C, Srikrishnan AK, Ridgeway K, Solomon SS, Mehta SH, Solomon S, Celentano DD. Friends, Sisters, and Wives: Social Support and Social Risks in Peer Relationships Among Men Who Have Sex With Men (MSM) in India. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:153-164. [PMID: 27459166 PMCID: PMC4966165 DOI: 10.1521/aeap.2016.28.2.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Globally, men who have sex with men (MSM) are at high risk for HIV. Many HIV-prevention efforts rely on community outreach and mobilization to engage MSM. This study examines peer relationships and their potential role in HIV prevention through 31 focus group discussions (FGDS) and 121 in-depth interviews (IDIs) with 363 MSM across 15 sites in India. Results indicate that MSM receive social support in friendships, sex-worker collaborations, constructed kin relationships, and romantic partnerships. Access to these relationships, however, is uneven across MSM, and can carry risks of disclosure of same-sex behavior and exclusion based on HIV- positive status. Positive peer relationships can serve as the basis of community empowerment, education, and couple-based interventions for MSM, and peer counselors can also provide a buffer against the social risks of peer relationships and facilitate linkage to care and continued engagement in treatment. These insights can improve HIV interventions for MSM in India and elsewhere.
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Affiliation(s)
- Cecilia Tomori
- Johns Hopkins Bloomberg School of Public Health, Department of
Epidemiology, Baltimore, Maryland, USA
| | | | - Kathleen Ridgeway
- Johns Hopkins Bloomberg School of Public Health, Department of
International Health, Baltimore, Maryland, USA
| | - Sunil S. Solomon
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore,
Maryland, USA
| | - Shruti H. Mehta
- Johns Hopkins Bloomberg School of Public Health, Department of
Epidemiology, Baltimore, Maryland, USA
| | - Suniti Solomon
- YR Gaitonde Centre for AIDS Research and Education, Chennai,
India
| | - David D. Celentano
- Johns Hopkins Bloomberg School of Public Health, Department of
Epidemiology, Baltimore, Maryland, USA
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21
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Tomori C, McFall AM, Srikrishnan AK, Mehta SH, Solomon SS, Anand S, Vasudevan CK, Solomon S, Celentano DD. Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study. AIDS Behav 2016; 20:304-16. [PMID: 26386592 DOI: 10.1007/s10461-015-1201-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Poor psychosocial health contributes to HIV risk behavior and reduced engagement in treatment and care. This study investigates depression and its correlates among 11,992 MSM recruited via respondent driven sampling in 12 cities across India using the Patient Health Questionnaire-9 and supplemented by analysis of qualitative research from 15 sites with 363 MSM. Overall prevalence of depression was 11 %, with substantial variation across sites and subgroups of MSM, and high prevalence of suicidal thoughts among depressed MSM. In multivariable analyses identification as a kothi (feminine sexual identity) [adjusted odds ratio (aOR) = 1.91], disclosure of being MSM to non-family (aOR = 1.7) and family (aOR = 2.4), disclosure of HIV-status (aOR = 5.6), and substance use were associated with significantly higher odds of depression. Qualitative results emphasized dire social consequences of disclosing MSM- and HIV-status, especially to family, including suicidality. Combination prevention interventions should include mental health services that address disclosure, suicidality, and substance use.
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Sahay S, Deshpande S, Bembalkar S, Kharat M, Parkhe A, Brahme RG, Paranjape R, Bollinger RC, Mehendale SM. Failure to Use and Sustain Male Condom Usage: Lessons Learned from a Prospective Study among Men Attending STI Clinic in Pune, India. PLoS One 2015; 10:e0135071. [PMID: 26270464 PMCID: PMC4535957 DOI: 10.1371/journal.pone.0135071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/16/2015] [Indexed: 01/25/2023] Open
Abstract
Background Sustained or consistent use of condoms by men remains a challenge. A study was carried out to identify factors associated with failure to use condoms consistently by men attending STD clinics in Pune, India. Method Among 14137 STI clinic attendees, 8360 HIV sero-negative men were enrolled in a cohort study. The changes in condom usage behavior were studied among 1284 men who returned for first scheduled quarterly follow up, 309 reported consistent condom use at the time of enrollment in the cohort. Data pertaining to heterosexual men practicing high risk behavior were analyzed to identify factors associated with change in condom use behavior using logistic regression model. Demographic, behavioral and biological factors observed to be associated with condom use were fitted in five Cox proportional hazards models to calculate hazard ratios and their 95% confidence intervals to identify independent predictors of failure to sustain condom use behavior. Results The univariate analysis showed that men who were 30 years or older in age (p = 0.002) and those who did not have contact female sex worker (FSW) were more likely to fail to sustain consistent condom use. However both these factors did not show significant association in multivariable analysis. Marital status and contact with Hijra (eunuch) in lifetime were associated with failure to change in their condom use behavior [AOR 0.33 (CI 0.13–0.82; p = 0.017)]. During the follow up of 2 years, 61 events (15.5 per 100 person years, 95% CI 12.3–19.5 years) of ‘failure of condom use’ were recorded despite counseling. Older age, contact with non CSW partner and presence of genital ulcer disease / discharge syndrome were significant predictors of failure to sustain condom use. Discussion Married monogamous older men, who report contact with sex worker and present with genital ulcer disease are at risk of failure to use condom after first exposure to voluntary HIV counseling and testing. This is a scenario of primary prevention program. Condom promotion and counseling needs to be reinforced through follow up counseling among this population.
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Affiliation(s)
- Seema Sahay
- National AIDS Research Institute, Pune, India
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