Determinants of sexual risk behavior among men who have sex with men accessing public sex environments in Chennai, India.

We conducted structured interviews with 200 men who have sex with men (MSM) recruited using time-space sampling from public sex environments (PSEs) in Chennai, India. Predictors of sexual risk behavior were assessed with chi2 tests and multiple logistic regression. One-third reported unprotected receptive anal sex (URAS) last time and 36% inconsistent condom use in the past month. URAS was associated with younger age, less than high school education, low income, and low HIV transmission knowledge (adjusted odds ratio [AOR] = 2.1, 2.5, 3.7 and 2.5, respectively). Inconsistent condom use was associated with less than high school education (AOR = 3.2) and low HIV transmission knowledge (AOR = 3.5). Multilevel HIV prevention strategies tailored for low socioeconomic kothis and other MSM in PSEs in Chennai should include peer interventions to increase knowledge of HIV transmission risks and sexually transmitted infections (STIs), and structural interventions to expand economic and educational opportunities, and accessible STI testing and treatment.