title: Male-to-male sex among men who inject drugs in Delhi, India: overlapping HIV risk behaviours.
abstract: BACKGROUND
  HIV among people who inject drugs (PWID) is a major public health challenge in India. This paper examines PWID in Delhi who also have male-to-male sex with a focus on overlapping HIV risk behaviours and the psychosocial correlates of a history of male-to-male anal sex.
  
  
  METHODS
  We analysed data collected in April-May of 2012 from a community-based sample of 420 male PWID in Delhi obtained using time location sampling.
  
  
  RESULTS
  One third (37%) of the men reported a history of anal sex with men, among whom just 16% used a condom at last anal sex. Almost all (93%) participants who had a history of anal sex with men also had sex with women. Chi-square tests revealed that a history of anal sex with men was associated with a higher number of female sexual partners and sharing of needles and syringes. Additionally, unprotected sex at last sex with a male partner was significantly associated with unprotected sex at last sex with regular and paid female partners. Multivariate binary logistic regression revealed that the psychosocial correlates of a history of anal sex with other men were: being aged 18-24 (OR = 2.4, p = 0.014), illiteracy (OR = 1.9, p = 0.033), having never been married (OR = 2.6, p = 0.007), a main source of income of crime/begging (OR = 3.1, p = 0.019), a duration of injecting drug use greater than 20 years (OR = 3.4, p = 0.035) and suicidal ideation (OR = 1.7, p = 0.048).
  
  
  CONCLUSIONS
  Male-to-male sex was associated with psychosocial vulnerability, including a longer history of injecting drug use, suicidal ideation and socio-economic disadvantage. Given the extent of overlapping HIV risk behaviours, HIV programs for PWID would benefit from a strong focus on prevention of sexual HIV transmission, especially among male injectors who also have sex with other men.
authors.affiliation: Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia. Electronic address: g.armstrong@unimelb.edu.au.
authors.forename: Gregory
authors.initials: G
authors.lastname: Armstrong
authors.affiliation: Population Mental Health Group, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Jorm
authors.affiliation: The Society for Service to Urban Poverty (SHARAN), Delhi, India.
authors.forename: Luke
authors.initials: L
authors.lastname: Samson
authors.affiliation: Department of Social Work, School of Health Sciences, University of Melbourne, Victoria, Australia.
authors.forename: Lynette
authors.initials: L
authors.lastname: Joubert
authors.affiliation: The Society for Service to Urban Poverty (SHARAN), Delhi, India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Singh
authors.affiliation: Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kermode
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology* / Q000635:transmission; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D020379:Risk Adjustment; D012307:Risk Factors; D012309:Risk-Taking; D011477:Sex Work; D060386:Sex Workers / Q000523:psychology; D012747:Sexual Partners; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology*; D059020:Suicidal Ideation; D047568:Unsafe Sex / Q000523:psychology*; D035862:Vulnerable Populations; D055815:Young Adult
keywords: India; Injecting drug use; Men who have sex with men; Overlapping HIV risks; Psychosocial context; Suicide