Ekstrand Maria L, Rawat Shruta, Patankar Pallav, Heylen Elsa, Banu Asha, Rosser B R Simon, Wilkerson J Michael
a Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA.
b St John's Research Institute, St John's National Academy of Health Sciences , Bengaluru , India.
AIDS Care. 2017 Jul;29(7):905-913. doi: 10.1080/09540121.2016.1271103. Epub 2016 Dec 27.
Indian men who have sex with men are disproportionately impacted by HIV. While prevention efforts to date have focused on men who visit drop-in centers or physical cruising sites, little is known about men who are meeting sexual partners on virtual platforms. This paper explores issues related to sexual identity and sexual behaviors in an online sample of men who identified as gay (n = 279) or bisexual (n = 123). There were significant differences in outedness between the two groups, with 48% of bisexually identified men reporting that they were out to "no one" and 82% stating that they present themselves as heterosexual to family and friends. Corresponding rates for gay-identified men were 15% and 41%, respectively (both p < .001). Twenty-nine percent of bisexually identified men reported being married, compared to only 3% of the gay-identified men (p < .001). Bisexually identified men were also more likely to report having exclusively insertive anal sex (49% vs 30% p < .001), while gay-identified men were more likely to report exclusively receptive anal sex (41% vs 13% p < .0001). Rates of unprotected anal sex (UAS) in the two groups were similar; however, married men were significantly more likely to report unprotected vaginal sex (76% vs 35%, p < .012). Positive attitudes toward UAS and lower self-efficacy were associated with sexual risk in both groups; however, substance use was associated with sexual risk only among bisexually identified men. These findings show that a large proportion of Indian bisexually identified men lead closeted lives, especially in their interactions with friends and family, with the vast majority presenting as heterosexual. The lower condom use with wives may be due to societal pressures to have children. The results suggest that bisexually identified men may benefit from targeted programs and non-directive, non-judgmental individual or couples counseling which emphasizes condom use with both male and female partners.
与男性发生性行为的印度男性受艾滋病毒影响的比例过高。尽管迄今为止的预防工作主要集中在光顾救助中心或实体寻欢场所的男性身上，但对于在虚拟平台上结识性伴侣的男性却知之甚少。本文探讨了一个在线样本中与性身份和性行为相关的问题，该样本中的男性自认为是同性恋者（n = 279）或双性恋者（n = 123）。两组在公开性方面存在显著差异，48% 自认为是双性恋的男性表示他们对 “任何人” 都未公开，82% 的人表示他们在家人和朋友面前表现为异性恋。自认为是同性恋的男性相应比例分别为15% 和41%（两者p <.001）。29% 自认为是双性恋的男性报告已婚，相比之下，自认为是同性恋的男性中只有3% 已婚（p <.001）。自认为是双性恋的男性也更有可能报告只进行插入式肛交（49% 对30%，p <.001），而自认为是同性恋的男性更有可能报告只进行接受式肛交（41% 对13%，p <.0001）。两组中无保护肛交（UAS）的比例相似；然而，已婚男性报告无保护阴道性行为的可能性显著更高（76% 对35%，p <.012）。对无保护肛交的积极态度和较低的自我效能感与两组中的性风险都相关；然而，药物使用仅与自认为是双性恋的男性中的性风险相关。这些发现表明，很大一部分自认为是双性恋的印度男性过着隐秘的生活，尤其是在与朋友和家人的交往中，绝大多数人表现为异性恋。与妻子使用避孕套较少可能是由于生育的社会压力。结果表明，自认为是双性恋的男性可能会从有针对性的项目以及强调与男性和女性伴侣都使用避孕套的非指导性、无评判性的个人或夫妻咨询中受益。
