AEGiS-14IAC: Men who have sex with men (MSM) and male-to-female transgender (TG) in Mumbai: a critical emerging risk group for HIV and sexually transmitted infections (STI) in India.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Men who have sex with men (MSM) and male-to-female transgender (TG) in Mumbai: a critical emerging risk group for HIV and sexually transmitted infections (STI) in India.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. TuOrC1149)

Kumta S, Setia M, Jerajani HR, Mathur MS, RaoKAvi A, Lindan CP
Sion LTMG Hospital and Medical School, Mumbai, India

OBJECTIVES: MSM are an important emerging risk group in India and have received scant attention. MSM include gay and heterosexual-identified men and transgender (TG) who often sell sex and may be castrated. Systematically collected data on these groups are limited. We evaluated MSM accessing the Humsafar Trust, a male-health NGO and one of only 2 MSM sentinel surveillance sites in India. We present data on HIV and STI.

METHODOLOGY: We report on the first 150 (122 MSM and 28 TG) enrolled since 3/2001. We evaluated gonorrhea (GC) with urethral and rectal swabs for smear/culture; we used urine PCR (Roche) to detect GC and chlamydia (CT). We collected blood for syphilis (VDRL/TPHA), HSV2 IgG, hepatitis B surface antigen (HBsAg) and hepatitis C (HCV); we confirmed HIV+ EIA results with a 2nd test.

RESULTS: 17% of men and 68% of TG were HIV+. 19/95 (20%) uncircumcised men vs. 2/27 (7%) circumcised men were HIV+. HIV was associated with age (25-29), being married and receptive anal sex. STI prevalence rates were: THPA HBsAg HCV HSV-2 CT Men 17% 10% 8% 40% 11% TG 57% 21% 22% 71% 0% Only 4% presented with active genital ulcers, urethritis, or proctitis HIV was significantly associated with TPHA, HCV, HSV2 in TG and men; HIV prevalence was 48% in TPHA+ men and 88% in TPHA+ TG; 62% in HCV+ men and 100% in HCV+ TG ; and 38% in HSV+ men and 80% in HSV2+ TG.

CONCLUSIONS: Extremely high rates of HIV are present in these men, particularly TG, and are associated with syphilis and HSV. High HCV+ rates may indicate transmission through traumatic anal sex and self-treatment of STD's with injections. Circumcision may decrease the risk of HIV but is confounded by religion. Many MSM are married and may pass HIV and STIs to their wives. These groups can no longer be ignored but must be the focus of intensive education and prevention programs.

Keywords: AEGIS, HIV, HIV Infections, Sex Behavior, Homosexuality, Male, Sexually Transmitted Diseases, Coitus, Prevalence, Heterosexuality, Gonorrhea, Urethritis, HIV Seropositivity, Syphilis, Chlamydia Infections, Homosexuality, Demography, India, Human, Male, Female

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TuOrC1149