title: Sex behaviour of men who have sex with men and risk of HIV in Andhra Pradesh, India.
abstract: OBJECTIVE
  To obtain information on sex behaviour of a large sample of men who have sex with men (MSM) in India that would assist in planning HIV prevention.
  
  
  METHODS
  Homosexual/bisexual behaviour of 6661 MSM at 62 urban-rural locations of various sizes in the Indian state of Andhra Pradesh was assessed through detailed interview. Multivariate analyses were performed to understand the associations with unprotected penetrative sex and barriers to condom use assessed.
  
  
  RESULTS
  The average number of different male sex partners in past 4 weeks was six. In last three sex encounters with men, totalling 19 640, anal sex occurred in 16 769, at least once by 6121 (91.9%) MSM of which 3423 [55.9%; 95% confidence interval (CI), 51.7-60.1%] did not use condom at least once. A total of 2785 (41.8%) were currently married to women and 3354 (50.4%) had had vaginal/anal sex with women in the past 3 months, of which 2818 (84%; 95% CI, 81.1-86.9%) did not use a condom. Furthermore, 1585 (25.9%; 95% CI, 22.7-29.1%) had anal sex without a condom with men and also vaginal/anal sex without a condom with women. This was prevalent across urban-rural locations and its strongest association was with currently married MSM (odds ratio 15.1; 95% CI, 12.5-18.2). The predominant reason for not using a condom with women was 'do not use with regular partner' (68.4%).
  
  
  CONCLUSIONS
  This high rate of unprotected penetrative sex by MSM with both men and women suggests that HIV prevention efforts in India should include a focus on MSM as well as their wives across many urban-rural locations and not only in large cities.
authors.affiliation: Centre for Public Health Research, Administrative Staff College of India, Hyderabad, India. dandona@asci.org.in
authors.forename: Lalit
authors.initials: L
authors.lastname: Dandona
authors.forename: Rakhi
authors.initials: R
authors.lastname: Dandona
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Gutierrez
authors.forename: G Anil
authors.initials: GA
authors.lastname: Kumar
authors.forename: Sam
authors.initials: S
authors.lastname: McPherson
authors.forename: Stefano M
authors.initials: SM
authors.lastname: Bertozzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001727:Bisexuality / Q000523:psychology / Q000706:statistics & numerical data; D017280:Condoms / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012423:Rural Health; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners; D047568:Unsafe Sex; D014504:Urban Health