title: Same-sex behavior and high rates of HIV among men attending sexually transmitted infection clinics in Pune, India (1993-2002).
abstract: OBJECTIVE
  To determine HIV/sexually transmitted infection (STI) prevalence, trends, and risk behaviors of men who have sex with men (MSM) and compare these with those of non-MSM attending STI clinics in Pune, India over a 10-year period.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  From 1993 through 2002, men attending 3 STI clinics in Pune underwent HIV/STI screening. Demographic, risk behavior, clinical, and laboratory data were collected using standardized questionnaires and laboratory procedures.
  
  
  RESULTS
  Of 10,785 men screened, 708 (6.6%) were MSM. Among these 708 MSM, 189 (31.7%) had 10 or more lifetime partners, 253 (35.7%) were married, 163 (23.1%) had sex with a hijra (eunuch), and 87 (13.3%) had exchanged money for sex. A total of 134 (18.9%) were HIV-positive, 149 (21.5%) had genital ulcer disease (GUD), 37 (5.8%) had syphilis, and 29 (4.3%) had gonorrhea (GC). Over the decade, neither HIV nor GC prevalence changed among MSM (P = 0.7), but syphilis and GUD decreased significantly (P < 0.0001). Compared with non-MSM, MSM were more likely to initiate sexual activity at age <16 years, to have >10 lifetime partners, to have sex with a hijra, and to use condoms regularly, but they did not differ significantly in HIV prevalence and had a lower prevalence of GC, GUD, and syphilis. Independent factors associated with HIV among MSM were employment (adjusted odds ratio [AOR] = 3.08; P = 0.02), history of GUD (AOR = 1.86; P = 0.003), and syphilis (AOR = 2.09; P = 0.05).
  
  
  CONCLUSIONS
  Same-sex and high-risk sexual behaviors are prevalent among men attending STI clinics in India. Although syphilis and GUD rates decreased, HIV prevalence remained high during the decade, highlighting the importance of additional targeted efforts to reduce HIV risk among all men, including MSM, in India.
authors.affiliation: Division of Infectious Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA. agupta25@jhmi.edu
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
authors.forename: Shruti
authors.initials: S
authors.lastname: Mehta
authors.forename: Sheela V
authors.initials: SV
authors.lastname: Godbole
authors.forename: Seema
authors.initials: S
authors.lastname: Sahay
authors.forename: Louise
authors.initials: L
authors.lastname: Walshe
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Manisha
authors.initials: M
authors.lastname: Ghate
authors.forename: Raman R
authors.initials: RR
authors.lastname: Gangakhedkar
authors.forename: Anand D
authors.initials: AD
authors.lastname: Divekar
authors.forename: Arun R
authors.initials: AR
authors.lastname: Risbud
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Mehendale
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D004196:Disease Outbreaks; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012309:Risk-Taking; D018571:Sentinel Surveillance; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control