Thomas Beena, Mimiaga Matthew J, Mayer Kenneth H, Perry Nicholas S, Swaminathan Soumya, Safren Steven A
Tuberculosis Research Centre, Indian Council of Medical Research, Chennai, India.
AIDS Care. 2012;24(11):1401-6. doi: 10.1080/09540121.2012.672717. Epub 2012 Apr 23.
Stigma has been shown to increase vulnerability to HIV acquisition in many settings around the world. However, limited research has been conducted examining its role among men who have sex with men (MSM) in India, whose HIV prevalence is far greater than the general population. In 2009, 210 MSM in Chennai completed an interviewer-administered assessment, including questions about stigma, sexual risk, demographics, and psychosocial variables. More than one fifth of the MSM reported unprotected anal sex (UAS) in the past three months. Logistic regression procedures were used to examine correlates of having experienced stigma. The 11-item stigma scale had high internal consistency reliability (Cronbach's alpha=0.99). Almost 2/5 (39%) reported a high-level of experienced stigma (≥12 mean scale-score) in their lifetime, and the mean stigma scale score was 12 (SD=2.0). Significant correlates of having experienced prior stigma, after adjusting for age and educational attainment, included the following: identifying as a kothi (feminine acting/appearing and predominantly receptive in anal sex) compared to a panthi (masculine appearing, predominantly insertive) (AOR=63.23; 95% CI: 15.92-251.14; p<0.0001); being "out" about one's MSM behavior (AOR=5.63; 95% CI: 1.46-21.73; p=0.01); having clinically significant depressive symptoms (AOR=2.68; 95% CI: 1.40-5.12; p=0.003); and engaging in sex work in the prior three months (AOR=4.89; 95% CI: 2.51-9.51; p<0.0001). These findings underscore the need to address psychosocial issues of Indian MSM. Unless issues such as stigma are addressed, effective HIV prevention interventions for this hidden population remain a challenge.
在世界许多地方，耻辱感已被证明会增加感染艾滋病毒的易感性。然而，在印度男男性行为者（MSM）中，对耻辱感作用的研究有限，而印度男男性行为者的艾滋病毒流行率远高于普通人群。2009年，金奈的210名男男性行为者完成了一项由访谈员进行的评估，包括有关耻辱感、性风险、人口统计学和心理社会变量的问题。超过五分之一的男男性行为者报告在过去三个月中有过无保护肛交（UAS）。采用逻辑回归程序来检验经历耻辱感的相关因素。11项耻辱感量表具有较高的内部一致性信度（克朗巴哈系数=0.99）。近五分之二（39%）的人报告其一生中经历过高度耻辱感（平均量表得分≥12分），耻辱感量表平均得分为12分（标准差=2.0）。在调整年龄和教育程度后，经历过先前耻辱感的显著相关因素包括：与泛性者（外表男性化，主要为插入方）相比，自认为是科蒂（行为/外表女性化，在肛交中主要为接受方）（比值比=63.23；95%置信区间：15.92-251.14；p<0.0001）；公开自己的男男性行为（比值比=5.63；95%置信区间：1.46-21.73；p=0.01）；有临床显著的抑郁症状（比值比=2.68；95%置信区间：1.40-5.12；p=0.003）；以及在过去三个月从事性工作（比值比=
