Reducing sexual risk and promoting acceptance of men who have sex with men living with HIV in India: Outcomes and process evaluation of a pilot randomised multi-level intervention

ABSTRACT

HIV-positive men who have sex with men (HIV+MSM) in India need culturally-relevant interventions to promote safer sex. We tested a multi-level intervention among HIV+MSM that targeted individual, interpersonal, and community factors, based on the Social-Personal and Social Ecological Models. We conducted a 2 × 2 factorial RCT with 119 HIV+MSM randomised to receive either an individual-level intervention (ILI) using motivational interviewing to promote safer sex, a community-level intervention (CLI) to strengthen community norms toward safer sex and reduce stigma among MSM communities, a multi-level intervention combining the individual- and community-level interventions (ILI + CLI), or standard-of-care control. Participants completed pre- and post-intervention assessments of a composite sexual risk score and a process evaluation to assess fidelity and satisfaction. Out of the 119 HIV+MSM, 106 (89.0%) completed pre- and post-intervention assessments. Generalised Estimating Equation models showed that both CLI (Incidence Rate Ratio [IRR] = .67, 95% CI .47 to .96) and ILI + CLI (IRR = .66, 95% CI .48 to .91) groups had a statistically significant decrease in sexual risk compared to the standard-of-care. The interventions had high levels of fidelity and satisfaction. This pilot RCT demonstrated feasibility and potential effectiveness of a multi-level intervention that addresses individual, interpersonal and community-level contributors of sexual risk among HIV+MSM.

KEYWORDS:

• Men who have sex with men
• multi-level intervention
• safer sex
• discrimination
• India

Acknowledgements

We thank the study participants and collaborating partner agencies in Chennai (Social Welfare Association for Men, Sahodaran and Indian Community Welfare Organisation), Kumbakonam (Lotus Integrated AIDS Awareness Sangam) and Tiruvallur (Vidivelli Thirunangaigal Nalavazhvu Sangam) for their partnership in the successful implementation of this study. We thank Mr. Augustian James for excellent project coordination and Mr. Mahesh Rajan for his professional counselling.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Venkatesan Chakrapani http://orcid.org/0000-0001-9998-9135

Murali Shunmugam http://orcid.org/0000-0002-8852-6810

Additional information

Funding

This study was funded by Indian Council of Medical Research (RFC No.: HIV/INDO-US/133/9/2012-ECD-II). Dr. Venkatesan Chakrapani’s contribution was in part supported by the Wellcome Trust/DBT India Alliance Senior Fellowship (IA/CPHS/16/1/502667).