HIV Status Disclosure and Condom Use Among HIV-Positive Men Who Have Sex With Men and Hijras (Male-to-Female Transgender People) in India: Implications for Prevention

This mixed-methods investigation combines a quantitative survey, focus groups, and in-depth interviews to examine sexual risk behaviors and HIV status disclosure among HIV-positive hijras (male-to-female transgender people) and HIV-positive men who have sex with men (MSM) in Chennai and Mumbai, India. From the survey results, the authors found a relatively high prevalence of inconsistent condom use for anal sex with male partners—about one-fifth to almost one-half, depending on the type of partner (regular, casual) and sexual role (receptive, insertive). One-quarter of MSM and two-fifths of hijras reported having disclosed their HIV status to their male regular partner. The qualitative data helped in understanding social and structural factors that created barriers to disclosure of HIV status and to condom use. Disclosure was not uniformly followed by safer sex, and nondisclosure did not always lead to unprotected sex. Implications for practice and policies and potential interventions are discussed.