title: Consistent condom use with regular, paying, and casual male partners and associated factors among men who have sex with men in Tamil Nadu, India: findings from an assessment of a large-scale HIV prevention program.
abstract: BACKGROUND
  Men who have sex with men (MSM) are a marginalized population at high risk for HIV infection. Promoting consistent condom use (CCU) during anal sex is a key risk reduction strategy for HIV prevention among MSM. To inform effective HIV prevention interventions, we examined the factors associated with CCU among MSM with their regular, paying, and casual partners, as well as with all three types of partners combined.
  
  
  METHODS
  Data for this analysis were from a large-scale bio-behavioural survey conducted during 2009-2010 in Tamil Nadu, India. MSM aged 18 years or older were recruited for the survey using time-location cluster sampling at cruising sites in four districts of Tamil Nadu. Binary logistic regression analyses were conducted to assess the association of CCU with selected socio-demographic characteristics and other contextual factors.
  
  
  RESULTS
  Among 1618 MSM interviewed, CCU during anal sex with regular, paying, and a casual male partner was 45.3%, 50.8% and 57.9%, respectively. CCU with all three types of partners combined was 52.6%. Characteristics associated with increased odds for CCU with MSM having all three types of partners combined were frequent receptive anal sex acts with regular partners (adjusted odds ratio [AOR] 2.17, 95% confidence interval [CI] 1.01-4.65), fewer number of casual partners (AOR 3.41, 95% CI 1.50-7.73) and membership in a community-based organization (CBO) for MSM (AOR 3.54, 95% CI 1.62-7.74). CCU with regular partners was associated with membership in a CBO (AOR 1.96, 95% CI 1.23-3.11), whereas CCU with paying, and casual male partners was associated with perceived higher risk of acquiring HIV (AOR 1.92, 95% CI 1.22-3.01) and exposure to any HIV prevention intervention (AOR 3.62, 95% CI 1.31-10.0), respectively. Being aged 26 years or older, being in debt, and alcohol use were factors associated with inconsistent condom use across partner types.
  
  
  CONCLUSIONS
  HIV interventions among MSM need to promote CCU with all types (regular, paying, and causal) of male partners, and need to reach MSM across all age groups. In addition to enhancing interventions that focus on individual level risk reduction, it is important to undertake structural interventions that promote social acceptance of same-sex sexuality and address contextual barriers to condom use such as alcohol use.
authors.affiliation: FHI 360 India, H-5 (Ground Floor), Green Park Extension, New Delhi 110016, India. sramanathan@fhi360.org.
authors.forename: Shreena
authors.initials: S
authors.lastname: Ramanathan
authors.forename: Venkatesan
authors.initials: V
authors.lastname: Chakrapani
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Ramakrishnan
authors.forename: Prabuddhagopal
authors.initials: P
authors.lastname: Goswami
authors.forename: Diwakar
authors.initials: D
authors.lastname: Yadav
authors.forename: Thilakavathi
authors.initials: T
authors.lastname: Subramanian
authors.forename: Bitra
authors.initials: B
authors.lastname: George
authors.forename: Ramesh
authors.initials: R
authors.lastname: Paranjape
mesh_terms: D000328:Adult; D000367:Age Factors; D017280:Condoms / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007194:India; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000458:organization & administration; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D021841:Safe Sex / Q000706:statistics & numerical data*; D060386:Sex Workers; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D055815:Young Adult
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