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.

KEYWORDS:

• Sexual identity
• sexual behavior
• men who have sex with men
• India
• gay
• bisexual

Acknowledgements

Research protocols were approved by The University of Texas Health Science Center at Houston (UTHealth) Committee for the Protection of Human Subjects and The Humsafar Trust, the University of Minnesota, and the University of California San Francisco Institutional Review Boards.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Maria L. Ekstrand http://orcid.org/0000-0001-7587-2899

Shruta Rawat http://orcid.org/0000-0001-9248-0272

Pallav Patankar http://orcid.org/0000-0002-2308-6738

J. Michael Wilkerson http://orcid.org/0000-0003-0815-8577

Additional information

Funding

The study, Internet-based HIV Prevention for Indian MSM (ISHKonnect), was funded by the Indian Council of Medical Research, Division of Epidemiology and Communicable Diseases, grant number INDO-US/84/2010-ECD-II and the National Institutes of Health, National Institute of Allergy and Infectious Diseases, grant number 1R21AI094676-01.