title: Sexual identity and behavior in an online sample of Indian men who have sex with men.
abstract: Indian men who have sex with men are disproportionately impacted by HIV. While prevention efforts to date have focused on men who visit drop-in centers or physical cruising sites, little is known about men who are meeting sexual partners on virtual platforms. This paper explores issues related to sexual identity and sexual behaviors in an online sample of men who identified as gay (n = 279) or bisexual (n = 123). There were significant differences in outedness between the two groups, with 48% of bisexually identified men reporting that they were out to "no one" and 82% stating that they present themselves as heterosexual to family and friends. Corresponding rates for gay-identified men were 15% and 41%, respectively (both p < .001). Twenty-nine percent of bisexually identified men reported being married, compared to only 3% of the gay-identified men (p < .001). Bisexually identified men were also more likely to report having exclusively insertive anal sex (49% vs 30% p < .001), while gay-identified men were more likely to report exclusively receptive anal sex (41% vs 13% p < .0001). Rates of unprotected anal sex (UAS) in the two groups were similar; however, married men were significantly more likely to report unprotected vaginal sex (76% vs 35%, p < .012). Positive attitudes toward UAS and lower self-efficacy were associated with sexual risk in both groups; however, substance use was associated with sexual risk only among bisexually identified men. These findings show that a large proportion of Indian bisexually identified men lead closeted lives, especially in their interactions with friends and family, with the vast majority presenting as heterosexual. The lower condom use with wives may be due to societal pressures to have children. The results suggest that bisexually identified men may benefit from targeted programs and non-directive, non-judgmental individual or couples counseling which emphasizes condom use with both male and female partners.
authors.affiliation: a Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA.|b St John's Research Institute, St John's National Academy of Health Sciences , Bengaluru , India.
authors.forename: Maria L
authors.identifier: 0000-0001-7587-2899
authors.initials: ML
authors.lastname: Ekstrand
authors.affiliation: c The Humsafar Trust , Mumbai , India.
authors.forename: Shruta
authors.identifier: 0000-0001-9248-0272
authors.initials: S
authors.lastname: Rawat
authors.affiliation: c The Humsafar Trust , Mumbai , India.
authors.forename: Pallav
authors.identifier: 0000-0002-2308-6738
authors.initials: P
authors.lastname: Patankar
authors.affiliation: a Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA.
authors.forename: Elsa
authors.initials: E
authors.lastname: Heylen
authors.affiliation: d The Tata Institute of Social Sciences , Mumbai , India.
authors.forename: Asha
authors.initials: A
authors.lastname: Banu
authors.affiliation: e Division of Epidemiology and Community Health , University of Minnesota , Minneapolis , MN , USA.
authors.forename: B R Simon
authors.initials: BRS
authors.lastname: Rosser
authors.affiliation: f School of Public Health , The University of Texas Health Sciences Center at Houston (UTHealth) Houston , TX , USA.
authors.forename: J Michael
authors.identifier: 0000-0003-0815-8577
authors.initials: JM
authors.lastname: Wilkerson
mesh_terms: D000328:Adult; D001727:Bisexuality; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D020010:Heterosexuality / Q000208:ethnology / Q000523:psychology; D018451:Homosexuality, Male / Q000208:ethnology* / Q000523:psychology; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data*
keywords: India; Sexual identity; bisexual; gay; men who have sex with men; sexual behavior