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HIV prevalence and associated factors among Injecting and Non-Injecting men who have sex with men in India.
ABSTRACT
Background:
Men who have sex with men (MSM) and also inject drugs represent a subgroup facing compounded risks through both sexual transmission networks and parenteral exposure via contaminated injection equipment and acts as a risk factor and increase the vulnerability to Sexual Transmitted Diseases, including Human Immunodeficiency Virus.
Objective:
This study aims to estimate the HIV prevalence and associated factors among injecting drug MSM (ID- MSM) and non- injecting drug MSM (NID-MSM) in India.
Methods:
This is secondary data analysis of MSM data from the National Integrated Biological and Behavioral Surveillance (IBBS) survey. MSM-specific data collected in 2014-15 from 24 of the 36 States and Union Territories (UTs). Respondents who reported injecting drugs for non-medical reasons in the last 12 months were classified as injecting drug MSM (ID- MSM), others as non –injecting MSM (NID-MSM).
Results:
A total 23,081 MSM were included in the analysis. Out of which, 3.9 % MSM reported injecting drug use. Factors like increasing age (aOR = 1.70, 95% CI: 1.26–2.29 for 25–34 years), who aged ≥35 years (aOR = 2.75, 95% CI: 2.00–3.78), widowed/divorced/separated (aOR = 0.52, 95% CI: 0.29–0.93), involvement in sex work (aOR = 2.73, 95% CI: 1.68–4.42), first sex before the age of 18 years (OR = 1.42, 95% CI: 1.11–1.82) and selling sex to men ( aOR = 1.38, 95% CI: 1.10–1.72) were associated with ID- MSM. While, currently married (aOR = 2.16, 95% CI: 1.10–4.27), sex work odds (aOR = 3.41, 95% CI: 1.33–8.78), experienced physical violence (aOR = 1.57, 95% CI: 0.82–3.00), associated with NID – MSM.
Conclusions:
The findings of this study demonstrate ID-MSM experiencing a modest but non-significant elevation in prevalence compared with NID-MSM. More importantly, the determinants of HIV differed between these groups. While sex work and marital status were key predictors of HIV among ID-MSM; increasing age, early sexual debut, transactional sex, and inconsistent condom use were major drivers among NID-MSM. These findings highlight that targeted harm-reduction services for ID-MSM and strengthened behavior-focused interventions, including condom promotion, PrEP access, and early sexual health education for NID-MSM, are essential. Addressing structural barriers such as stigma and economic vulnerability remains critical for reducing HIV transmission within these diverse MSM populations.
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