title: Predictors of bisexual behaviour among MSM attending intervention sites may help in prevention interventions for this bridge to the heterosexual epidemic in India: data from HIV sentinel surveillance.
abstract: BACKGROUND
  Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM.
  
  
  METHODS
  Between March-May 2011, 4682 men (15-49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites.
  
  
  RESULTS
  Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, 'being bisexual' was found to be independently associated with 'older age': 26-30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; 'reporting penetrative behaviour alone' with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and 'reporting both penetrative and receptive behaviour' [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual.
  
  
  CONCLUSIONS
  A substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population.
authors.affiliation: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India.
authors.forename: Sheela
authors.initials: S
authors.lastname: Godbole
authors.affiliation: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India.
authors.forename: Suvarna
authors.initials: S
authors.lastname: Sane
authors.affiliation: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India.
authors.forename: Pranil
authors.initials: P
authors.lastname: Kamble
authors.affiliation: Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India.
authors.forename: Yujwal
authors.initials: Y
authors.lastname: Raj
authors.affiliation: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India.
authors.forename: Nisha
authors.initials: N
authors.lastname: Dulhani
authors.affiliation: Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Venkatesh
authors.affiliation: World Health Organisation (India), New Delhi, India.
authors.forename: D C S
authors.initials: DC
authors.lastname: Reddy
authors.affiliation: Gujarat State AIDS Control Society, Ahmedabad, Gujarat, India.
authors.forename: Laxmikant
authors.initials: L
authors.lastname: Chavan
authors.affiliation: Department of Community Health Administration, National Institute of Health and Family Welfare, New Delhi, India.
authors.forename: Madhulekha
authors.initials: M
authors.lastname: Bhattacharya
authors.affiliation: Maharashtra State AIDS Control Society, Mumbai, Maharashtra, India.
authors.forename: Suchitra
authors.initials: S
authors.lastname: Bindoria
authors.affiliation: Mumbai District AIDS Control Society, Mumbai, Maharashtra, India.
authors.forename: Dilip
authors.initials: D
authors.lastname: Kadam
authors.affiliation: Madhya Pradesh State AIDS Control Society, Bhopal, Madhya Pradesh, India.
authors.forename: Savita
authors.initials: S
authors.lastname: Thakur
authors.affiliation: Rajasthan State AIDS Control Society, Jaipur, Rajasthan, India.
authors.forename: Prakash
authors.initials: P
authors.lastname: Narwani
authors.affiliation: Goa State AIDS Control Society, Panaji, Goa, India.
authors.forename: Elmira
authors.initials: E
authors.lastname: Pereira
authors.affiliation: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Paranjape
authors.affiliation: National AIDS Research Institute (Indian Council of Medical Research), Pune, Maharashtra, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Risbud
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D020010:Heterosexuality; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D021841:Safe Sex; D055815:Young Adult