title: Burden and correlates of HIV risk among men who have sex with men in Nagaland, India: analysis of sentinel surveillance data.
abstract: BACKGROUND
  Dynamics of HIV epidemic are largely understudied among men having sex with men (MSM) in India, while their potentially critical role in HIV spread is often stressed. Unfortunately, the epidemic has probably concentrated in this hard-to-reach population in the north-eastern high HIV-prevalent areas, especially in the bordering state of Nagaland, where HIV prevalence among MSM was found to be 2nd highest in the whole country. Dearth of information regarding the socio-behavioral correlates of HIV acquisition among MSM in this remote hilly region thus called for detailed analyses of the HIV Sentinel Surveillance (HSS) data.
  
  
  METHODS
  During the first ever conducted HSS among MSM in Nagaland, between March and May, 2011, as per the operational guideline of Indian National AIDS Control Program, 243 MSM were recruited, interviewed and tested for HIV. Anonymous data on socio-demographics, sexual behavior and laboratory results were analyzed using SAS version-9.2 to conduct descriptive and logistic regression analyses.
  
  
  RESULTS
  Among the recruited MSM, mean age was 28.30 years, 46.09% were illiterate, 27.16% were unemployed, 57.02% identified them as Kothi (predominantly receptive anal sex partner), 14.81% were bisexual, 19.75% exchanged money for sex (within last 1 year) with men and 13.58% were HIV sero-positive. Increasing age (for 25-34yrs, adjusted odds ratio: AOR = 3.89, p = 0.046; reference = <25yrs), middle school (AOR = 3.44, p = 0.046) or higher (AOR = 4.47, p = 0.034) education (reference = illiterate), being Kothi [AOR = 3.60, p = 0.026; reference = double-decker: (involved in both insertive and receptive roles)] and having paid and received money for sex with a man (AOR = 7.32, p = 0.026; reference = didn't exchange money) were strongly associated with higher risk of HIV in both bivariate and multivariate analyses.
  
  
  CONCLUSIONS
  HIV burden was found to be alarmingly high among MSM in Nagaland. Targeted interventions for high-risk MSM, especially those who were older, educated, self-identified as kothis and involved in paid sex, seemed to be the need of the hour.
authors.affiliation: Virology Division, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
authors.forename: Malay Kumar
authors.initials: MK
authors.lastname: Saha
authors.affiliation: Epidemiology Division, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Mahapatra
authors.affiliation: Virology Division, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
authors.forename: Subrata
authors.initials: S
authors.lastname: Biswas
authors.affiliation: Virology Division, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
authors.forename: Piyali
authors.initials: P
authors.lastname: Ghosh
authors.affiliation: Monitoring and Evaluation Division, Nagaland State AIDS Control Society, Kohima, Nagaland, India.
authors.forename: Medo
authors.initials: M
authors.lastname: Kire
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003710:Demography; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018571:Sentinel Surveillance; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D055815:Young Adult