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. 2022 Sep;33(10):896-905.
doi: 10.1177/09564624221112815. Epub 2022 Jul 11.

Prevalence and correlates of human immunodeficiency virus infection among spouses of married men who have sex with men in India

Aylur K Srikrishnan  1 , Kavitha Ganesan  2 , Shruti H Mehta  3 , Cecilia Tomori  3   4 , Canjeevaram K Vasudevan  1 , David D Celentano  5 , Sunil S Solomon  1   3   5
Affiliations

Prevalence and correlates of human immunodeficiency virus infection among spouses of married men who have sex with men in India

Aylur K Srikrishnan et al. Int J STD AIDS. 2022 Sep.

Abstract

Background: Men who have sex with men (MSM) in low-to-middle-income countries bear a high burden of HIV and a significant proportion marry women to satisfy socio-cultural norms. It has previously been demonstrated that HIV prevalence is higher among married versus unmarried MSM, but limited data are available on HIV prevalence among their wives.

Methods: We recruited 149 married MSM couples where the husband disclosed his MSM behavior to his wife (disclosed MSM) and 150 married MSM who had not disclosed their MSM behavior to their wives (undisclosed MSM), in three Indian cities. All participants completed interviewer-administered surveys and underwent HIV testing. Multivariable logistic regression was used to assess correlates of HIV among wives of MSM. Descriptive statistics were used to compare characteristics of disclosed and undisclosed MSM.

Results: HIV prevalence in disclosed MSM, their wives, and undisclosed MSM was 46.9%, 27.9%, and 34.9%, respectively. In multivariable analysis, the strongest predictor of HIV prevalence among wives of MSM was husband's HIV positive status (adjusted odds ratio: 13.4; 95% confidence interval: 5.44-33.2). Both disclosed and undisclosed MSM reported high levels of risk behavior including infrequent condom use. Most undisclosed MSM reported that they did not intend to disclose MSM behavior due to stigma.

Conclusions: We observed an extremely high HIV prevalence among women married to MSM despite low levels of individual risk behavior. Interventions are urgently needed in this vulnerable population particularly given the challenges related to disclosure of same sex behavior among their husbands.

Keywords: India; human immunodeficiency virus; key populations; men who have sex with men; prevalence; wives of men who have sex with men.

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Figures

Figure 1.
Figure 1.. HIV prevalence by age and study population
Figure 2.
Figure 2.. HIV care continuum among disclosed married MSM, undisclosed MSM, and wives of disclosed MSM living with HIV*
* HIV care continuum outcomes between disclosed and undisclosed MSM were non-significant ** No couple concordance between married disclosed MSM and their wives
See this image and copyright information in PMC

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