HIV epidemic among men who have sex with men in India: national scenario of an unfinished agenda

Figures & data

Table 1 Human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevalence among men who have sex with men (MSM) in India

States	MSM population characteristics	HIV prevalence among MSMa	Most recent (2010–11) HIV prevalence among MSMb	STI prevalence (%)
Group Ii	MSM size =208,744 % with no formal education =12.4 Average age =29.0 years % panthi = 17.2 % kothi =50.9 % double-decker =31.9 % ever married =18%–53%	[5.24%–23.6%] [AP: 23.6%, KA: 12.52%, MH: 11.97%,TN: 5.24%]	[2.41%–10.14%] AP: 10.14%, KA: 5.36%, MH: 9.91%, TN: 2.41%	[5%–19%]c,h [2%–13%]d,h [1.8%–12.9%]d,g = [5.3%–18.8%c,g [AP: 17.4%, KA: 33.7%, MH: 11.9%, TN: 18. 1%]e,g [AP: NA, KA: 11%, MH: NA, TN: 5.3%]f,g
Group IIi	MSM size =3,334 % with no formal education =0.8 Average age =28.7 years % panthi =16.0 % kothi =83.6 % double-decker =0.4 % ever married =NA	17.21% [MN: 17.21%, MZ: NA, NG: NA]	[10.53%–13.58%] MN: 10.53%, MZ: NA, NG: 13.58%	[MN: 10.73%]f,g
Group IIIi	MSM size =128,225 % with no formal education =8.3 Average age =27.0 years % panthi =19.8 % kothi =54.0 % double-decker =26.1 % ever married =24%–56%	[0.75%–7.87%] [DL: 7.87%, GA: 6.4%, GJ: 5.48%, KE: 0.75%, PD: NA, WB: 4.9%]	[0.36%–5.34%] [DL: 5.34% GA: 4.53%, GJ: 3%, KE: 0.36%, PD: 1.21%, WB: 5.09%]	[DL: 57%, GJ: 38.5%, GA: 27.2%, WB: 10.4%, KE: 15.6%]e,g
Group IVi	MSM size =93,584 % with no formal education =13.8 Average age =27.5 years % panthi =39.0 % kothi =34.1 % double-decker =26.9 % ever married =38	[0.86%-25%] [BH: 1.64%, CH: 2.79%, HR: 3.2%, HP: 0.4%, JK: NA, OD: 4.19%, PN: 3%, UP: 4.07%, UK: NA] [CG: NA, DD: NA, DNH: NA, JH: 2%, MP: NA, RJ: NA] [AR: NA, AS: 0.41%, MG: NA, SK: NA, TR: NA]	[0.4%–14.98%] [BH: 4.2%, CH: 0.4%, HR: 3.05%, HP: 1.23%, JK: NA, OD: 3.79%, PN: 2.18%, UP: 1.56%, UK: NA] [CG: 14.98%, DD: NA, DNH: NA, JH: 0.4%, MP: 7.94%, RJ: NA] [AR: NA, AS: 1.4%, MG: NA, SK: NA, TR: NA]	[UP: 32.1%] [UP: 6%]f,g

Notes:

a HIV Sentinel Surveillance (HSS) 2008–09;⁴³

b HSS 2010–11;²

c integrated behavioral and biological assessment (IBBA) 2005–06;²¹

d IBBA 2009–10;²¹

e Behavioral Surveillance Survey (BSS) 2006;²⁰

f BSS 2009;²²

g self-report of at least one symptom of STI in the last 12 months;

h clinically diagnosed STI;

i group I includes Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu; group II includes Manipur, Mizoram, and Nagaland; group III includes Kerala, Gujarat, Goa, West Bengal, Pondicherry, and Delhi; group IV includes: north, central, and parts of the northeast.

Abbreviations: NA, not available; AP, Andhra Pradesh; KA, Karnataka; MH, Maharashtra; TN, Tamil Nadu; MN, Manipur; MZ, Mizoram; NG, Nagaland; KE, Kerala; GJ, Gujrat; GA, Goa; WB, West Bengal; PD, Puducherry; DL, Delhi; BH, Bihar; CH, Chandigarh; HR, Haryana; HP, Himachal Pradesh; JK, Jammu and Kashmir; OD, Odisha; PN, Punjab; UP, Uttar Pradesh; UK, Uttarakhand; CG, Chhatigarh; DD, Daman and Diu; DNH, Dadra Nagar Haveli; JH, Jharkhand; MP, Madhya Pradesh; RJ, Rajasthan; AR, Arunachal Pradesh; AS, Assam; MG, Meghlaya; SK, Sikkim; TR, Tripura; panthi, penetrative partner in oral and anal sex; kothi, receptive partner in oral and anal sex typically having effeminate mannerisms; double-decker, both penetrative and receptive partner in oral and anal sex

Figure 1 Trend of mean human immunodeficiency virus prevalence (%) among men who have sex with men in India.

Figure 2 State-wise trend of human immunodeficiency virus (HIV) prevalence (%) of men who have sex with men from consistent HIV surveillance sites in India.

Table 2 Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome knowledge and sexual risk behaviors of men who have sex with men (MSM) in India

State categories	Proportion of respondents with comprehensive correct knowledge about HIV transmission and prevention (%)	Condom use during the last time they had sex with paying commercial male partner (%)	Condom use during the last time they had sex with noncommercial male partner (%)	Mean number of commercial male partnerse	% MSM reported sex with women during last 6 months
Group If	BSS 2006 [AP: 51.1%, KA: 27.4%, MH: 42.6%, TN: 54.4%]a BSS 2009 [AP: 57%, KA: 22%, MH: NA, TN: 32%]b IBBA 2009–10 [AP: 27.4,MH: 50.4, TN: 71.7]c	BSS 2006 [AP: 85.5%, KA: 56.4%, MH: 62.5%, TN: 49.8%]a BSS 2009 [AP: 100%, KA: 100%, MH: 91.4%, TN: 97.9%]b	BSS 2006 [AP: 81.6%, KA: 51.5%, MH: 88.2%, TN: 66.8%]a BSS 2009 [AP: 97%, KA: 94%, MH: 89.3%, TN: NA]b	BSS 2006 [AP: 8, KA: 25.2, MH: 3.6 TN: 11.8]a BSS 2009 [AP: 21.1, KA: 20, MH: 5.4]b	BSS 2006 [AP: 54.8%, KA: 16.7%, MH: 25.9%, TN: 12.6%]a HSS 2008–09 [AP: 64%,TN: 39%, KA: 52%, MH: 49%]d
Group IIf	BSS 2009 [MN: 30.27%]b	BSS 2009 [MN: 72.03%]b	BSS 2009 [MN: 69.51%]b		BSS 2009 [MN: 5%]b
Group IIIf	BSS 2006 [DL: 22.6%, GJ: 30.8%, GA 74.6%, WB: 43.7%, KE: 41.9]a	BSS 2006 [DL: 40.5%, GJ: 62.1%, GA: 87%, WB: 63.8%, KE: 67.6%]a	BSS 2006 [DL: 45.8%, GJ: 70.4%, GA: 87.7%, WB: 67.1%, KE: 58.1%]a	BSS 2006 [DL: 3.1, GJ: 4.6, GA: 4.0, WB: 5.8, KE: 4.5]a	BSS 2006 [DL: 69.6%, GJ: 42.7%, GA: 31.4%, WB: 19.3%, KE: 30.4%]a HSS 2008–09 [KE: 26%, GJ: 58%, GA: 48%, WB: 29%, PD: 56%, DL: 21%]d
Group IVf	BSS 2006 [UP: 16%]a	BSS 2006 [UP: 13.3%]a	BSS 2006 [UP: 13.8%]a	BSS 2006 [UP: 4.5]a	BSS 2006 [UP: 51.5%]a
	BSS 2009 [UP: 21%]b	BSS 2009 [UP: 92%]b	BSS 2009 [UP: 76%]b	BSS 2009 [UP: 11]b	BSS 2009 [UP: 69%]b

Notes:

a Behavioral Surveillance Survey (BSS) 2006;²⁰

b BSS 2009;²²

c integrated behavioral and biological assessment (IBBA) 2009–10;²¹

d HIV Sentinel Surveillance (HSS) 2008–09;⁴³

e mean no of paying male partners last 1 month;

f group I includes: Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu; group II includes Manipur, Mizoram, and Nagaland; group III includes Kerala, Gujarat, Goa, West Bengal, Pondicherry, and Delhi; group IV includes north, central, and parts of the northeast. BSS 2006 has been done only in Mumbai for Maharashtra, Chennai for Tamil Nadu, Bangalore for Karnataka, and Kolkata for West Bengal.

Abbreviations: NA, not available; AP, Andhra Pradesh; KA, Karnataka; MH, Maharashtra; TN, Tamil Nadu; UP, Uttar Pradesh; MN, Manipur; KE, Kerala; GJ, Gujarat; GA, Goa; WB, West Bengal; PD, Puducherry; DL, Delhi.

Table 3 Program coverage of men who have sex with men (MSM) and estimated human immunodeficiency virus (HIV) infection by categories of states

	Number of targeted interventionsa,b	% coverage of MSM populationf	% condom distributed among MSM	% went for regular medical check-up for STI	% visited ICTC for HIV testing
Group Ig	NACO 2005 program data[15]a	NACO 2005 program data [8%–63%]a	NACO 2009–10 program data [10.4%–44.9%]d [AP: 44.9%, KA: 22.5%, MH: 10.4%, TN: 24.2%]d	NACO 2009–10 program data [2%–53%]d [AP: 53%, KA: 20%, MH: 2%, TN: NA]d	NACO 2009–10 program data [6.5%–28%]d [AP: 24%, KA: 28%, MH: 6.5%, TN: 16.5%]d
	NACO Annual Report 2010–11 [35]c	NACO 2010–11 program data [37.5%–100%]c [AP: 76.1%, KA: 92.9%, MH: 37.5%, TN: 100%]e	NACO 2010–11 program data [12.7%–93.8%]e [AP: 93.8%, KA: 56.6%, MH: 12.7%, TN: 80%]e	NACO 2010–11 program data [22.8%–100%]e [AP: 100%, KA: 91.3%, MH: 22.8%, TN: 90%]e	NACO 2010–11 program data [13.3%–61.3%]e [AP: 25.9%, KA: 21%, MH: 13.3%, TN: 61.3%]e
Group IIg	NACO 2005 program data [1]a	NACO 2005 program data [not clear, likely low]a	NACO 2009–10 program data [9.7%–43.2%]d [MN: 43.2%, MZ: 9.7%, NG: 18.6%]d	NACO 2009–10 program data [3%–%]d	NACO 2009–10 program data [23.7%–31.8%]d [MN: 28.6%, MZ: 31.8%, NG: 23.7%]d
	NACO Annual Report 2010–11 [6]c	NACO 2010–11 program data [76.2%–100%]e [MN: 76.2%, MZ: 100%, NG: 85.8%]e	NACO 2010–11 program data [17.4%–45.7%]e [MN: 45.7%, MZ: 17.4%, NG: 25.3%]e	NACO 2010–11 program data [74.5%–100%]e [MN: 74.5%, MZ: 100%, NG: 84.8%]e	NACO 2010–11 program data [19.8%–29.7%]e [MN: 19.8%, MZ: 29.7%, NG: 25.7%]e
Group IIIg	NACO 2005 program data[12]a	NACO 2005 program data [likely low]a	NACO 2009–10 program data [10%–15.6%]d	NACO 2009–10 program data [9%–23%]d	NACO 2009–10 program data [0.3%–91.5%]d [KE: 91.5%, WB: 25.1%, PD: 0.3%, DL: 20, 1%, GA: 31.5%, GJ: 46.1%]d
	NACO Annual Report 2010–11 [63]c	NACO 2010–11 program data [32.2%–100%]e	NACO 2010–11 program data [15.5%–100%]e	NACO 2010–11 program data [0.8%–95.2%]e	NACO 2010–11 program data [9.3%–63.4%]e
		[DL: 52.9%, GA 93.7%, GJ: 87.1%, KE: 87.6%, PD: 100%, WB: 32.2%]e	[DL: 21.8%, GA: 28.5%, GJ: 95.2%, KE: 24.4%, PD: 100%, WB: 15.5%]e	[DL: 48.7%, GA: 61.1%, GJ: 95.2%, KE: 41.9%, PD: 0.8%, WB: 31.5%]e	[DL: 20.6%, GA: 29.6%, GJ: 63.4%, KE: 48.2%, PD: 29.9%, WB: 9.3%]e
Group IVg	NACO 2005 program data [3]a	NACO 2005 program data [coverage number unclear]a	NACO 2009–10 program data [2.8%–34.6%]d	NACO 2009–10 program data [2.9%–47.6%]d	NACO 2009–10 program data [5.9%–51.8%]d
	NACO Annual Report 2010–11	NACO 2010–11 program data [51% (0–100%)]e	NACO 2010–11 program data [0%–56.1%]e	NACO 2010–11 program data [0%–91.4%]e	NACO 2010–11 program data [0%–56.8%]e
	[51]c 24 21 6	[BH: 72.2%, CH: 92.4%, HR: 100%, HP: 20.7%, JK: 41.3%, OD: 92.7%, PN: 47.7%,UP: 55.5%, UK: 52.5%]e	[BH: 5.6%, CH: 28%, HR: 23.3%, HP: 14.9%, JK: 0.1%, OD: 56.1%, PN: 15.6%, UP: 33.6%, UK: 11.7%]e	[BH: 9.7%, CH: 33.2%, HR: 40.1%, HP: 14.4%, JK: 11.7%, OD: 91.4%, PN: 53.8%, UP: 79.6%, UK: 10.2%]e	[BH: 1.4%, CH: 37.2%, HR: 34.6%, HP: 13.3%, JK: 0.2%, OD: 47.6%, PN: 18.5%, UP: 22%, UK: 6.1%]e
		[CG: 100%, DD: 0%, DNH: 0%, JH: 14.9%, MP: 33.1%, RJ: 24.8%]e	[CG: 12.8%, DD: 0%, DNH: 0%, JH: 3%, MP: 14.3%, RJ: 8.6%]e	[CG: 11.3%, DD: 0%, DNH: 0%, JH: 16.3%, MP: 17.4%, RJ: 7.7%]e	[CG: 8.8%, DD: 0%, DNH: 0%, JH:4.4%, MP: 16%, RJ: 5.4%]e
		[AR: 0%, AS: 100%, MG: 100%, SK: 0%, TR: 27.6%]e	[AR: 0%, AS: 40.3%, MG: 9.4%, SK: 0%, TR: 7.7%]e	[AR: 19.9%, AS: 90.1%, MG: 0%, SK: 0, TR: 4.8%]e	[AR: 5.6%, AS: 56.8%, MG: 0%, SK: 0%, TR: 7.6%]e

Notes:

a National AIDS Control Organization (NACO) Program data, 2005;

b state-wise number of nongovernmental organizations and AIDS prevention centers functioning in India;²⁹

c Annual Report 2010–11, National AIDS Control Organization;

d National AIDS Control Organization Program data 2009–10;

e National AIDS Control Organization Program data 2010–11;

f coverage calculated by estimated number of beneficiaries served through program over the total size estimation of the population subgroup in the state. Where estimates were considered unreliable or coverage numbers not available, no coverage estimates were made. Judgments of low coverage are based on the small number of funded targeted interventions to cover the high-risk group;

g group I includes Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu; group II includes Manipur, Mizoram, and Nagaland; group III includes Kerala, Gujarat, Goa, West Bengal, Pondicherry, and Delhi; group IV includes north, central, and parts of the northeast.

Abbreviations: AP, Andhra Pradesh; KA, Karnataka; MH, Maharashtra; TN, Tamil Nadu; MN, Manipur; MZ, Mizoram; NG, Nagaland; KE, Kerala; GJ, Gujrat; GA, Goa; WB, West Bengal; PD, Puducherry; DL, Delhi; BH, Bihar; CH, Chandigarh; HR, Haryana; HP, Himachal Pradesh; JK, Jammu and Kashmir; OD, Odisha; PN, Punjab; UP, Uttar Pradesh; UK, Uttarakhand; CG, Chhatigarh; DD, Daman and Diu; DNH, Dadra and Nagar Haveli; JH, Jharkhand; MP, Madhya Pradesh; RJ, Rajasthan; AR, Aurnachal Pradesh; AS, Assam; MG, Meghlaya; SK, Sikkim; TR, Tripura; STI, sexually transmitted infection; ICTC, integrated counseling and testing center.

National AIDS Control Orgainsation, Ministry of Health and Family Welfare, Government of IndiaAnnual HIV Sentinel Surveillance Country Report 2008–09New DelhiNACO2008–2009

 Google Scholar

National AIDS Control Orgainsation, Department of AIDS Control, Ministry of Health and Family Welfare, Government of IndiaHIV Sentinel Surveillance 2010–2011: A Technical BriefNew DelhiGovernment of India2011

 Google Scholar

National AIDS Research Institute, FHI 360AVAHAN, Round 2, National Summary Report, Integrated Behavioral and Biological Assessment (IBBA) 2009–2010New DelhiNational AIDS Research Institute, FHI 3602009–2010

 Google Scholar

National AIDS Control Organization (NACO) Deparatment of AIDS Control, Ministry of Health and Family Welfare, Government of IndiaBehavioral Surveillance Survey (BSS) 2006New DelhiNACO, Ministry of Health and Family Welfare, Government of India2006

 Google Scholar

National AIDS Control Organization (NACO) Ministry of Health and Family Welfare, Government of IndaBehavioral Surveillance Survey (BSS) 2009New DelhiNACO, Ministry of Health and Family Welfare, Government of India2009

 Google Scholar

National AIDS Control Organization (NACO)State-wise Number of NGOs and AIDS Prevention Centres Functioning in IndiaNew Delhi82005

 Google Scholar