title: Sexual practices, HIV and sexually transmitted infections among self-identified men who have sex with men in four high HIV prevalence states of India.
abstract: OBJECTIVE
  To describe the sociodemographic characteristics, prevalence of high-risk sexual behaviours, HIV, sexually transmitted infections (STI), and perception of risk in self-identified men who have sex with men (MSM) in four south Indian states.
  
  
  METHODS
  A cross-sectional probability-based survey of 4597 self-identified MSM in selected districts from four states in south India was undertaken. Self-defined sexual identity, sexual behaviour, and STI/HIV knowledge were assessed using a structured questionnaire. Blood and urine samples were tested for HIV and STI. Recruitment criteria differed slightly across states.
  
  
  RESULTS
  When grouped by self-identity, the HIV prevalence was: hijra (transgender) 18.1%; bisexuals 15.9%; kothis (anal-receptive) 13.5%; double-deckers (both anal-insertive/anal-receptive) 10.5%; and panthis (anal-insertive) 7.6%. Reported condom use with last paid male partner was over 80% in all states and categories. Consistent condom use was overall low among self-identified MSM, with less than 29% with non-commercial non-regular male partners and less than 49% with regular male partners. The percentage of self-identified MSM with regular female partners was 4-43% and with commercial female partners was 14-36% across states, and consistent condom use differed by self-identity. Syphilis prevalence was high among kothis and hijras (15.8 and 13.6%, respectively). Urethral gonorrhoea prevalence was less than 1% and chlamydia prevalence ranged from 0.4 to 4.0%.
  
  
  CONCLUSIONS
  HIV prevalence and risk behaviour within these self-identified MSM communities in south India is high. Moreover, a significant proportion of them had female partners, both regular and commercial. The national programme's focus on HIV prevention services for these high-risk MSM is justified.
authors.affiliation: Division of Community Studies, National Institute of Nutrition (NIN), Hyderabad, India. gnvbrahmam@yahoo.com
authors.forename: Ginnela N V
authors.initials: GN
authors.lastname: Brahmam
authors.forename: Venkaiah
authors.initials: V
authors.lastname: Kodavalla
authors.forename: Hemalatha
authors.initials: H
authors.lastname: Rajkumar
authors.forename: Hari Kumar
authors.initials: HK
authors.lastname: Rachakulla
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Kallam
authors.forename: Shiva Prakash
authors.initials: SP
authors.lastname: Myakala
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Paranjape
authors.forename: Mohan D
authors.initials: MD
authors.lastname: Gupte
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Ramakrishnan
authors.forename: Anjalee
authors.initials: A
authors.lastname: Kohli
authors.forename: Banadakoppa M
authors.initials: BM
authors.lastname: Ramesh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017280:Condoms / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D012959:Socioeconomic Factors; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult