sexual behaviour and hiv risk in men who - Karnataka Health ...

High risk concurrent non-commercial partnershipsIt seems that sex with NC partners was significantly under-reported in the FTFI, reported byhalf the sample, compared to 93% of the ICVI respondents, though why this is so is difficultto interpret. Those who did admit to having NC partners had on average 16 such lifetimepartners and 3.7 in the previous month. As well as there being many such NC partnerships,there was an indication that many were also long term relationships: the mean length of themost recent partner was 3.2 years, suggesting that many respondents (and more than issuggested from the FTFI) have several concurrent and long term NC relationships. Moreworrying is that the majority of respondents with NC partners thought their most recent onealso bought sex from other men. Less than half the respondents reported always using acondom with their last NC partner.High risk commercial sex and sexual mixingMost respondents had jobs but 16% named sex work as the main source of income.Altogether about half had received money for sex at some time, though this was sometimesgifts rather than money, and 36% had also bought sex at some time. This figure also likelyrepresents a gross under-reporting as almost three-quarters of ICVI respondents said they hadbeen paid at some time. Almost all the respondents were kothis, hijras and double deckersengaging in receptive anal sex. The respondents seem to be divided between those hijras andkothis who sold sex and also had NC partnerships, and those double deckers who mostly hadnon-commercial sex interspersed with occasional buying of sex. The respondents who soldsex did not sell sex very frequently, with a mean of 7.6 days a month (although a few did thismore than 15 days a month), but on those days, they entertained on average 3.4 clients abouthalf of whom were new paying clients. However, paying clients represented about half oftheir recent sexual partnerships; with the rest NC partnerships. Condom use with newcommercial partners, as reported in the FTFI was quite low at 42% using in all the last 10acts with new clients, which is consistent with the rate of condom use that the clientsthemselves report (57%). A large number of the male sex workers who had new clients, alsohad repeat clients; in fact the majority of their clients were repeat clients. The numberadmitting to having repeat clients might also be under-reported as this was reported by 76%of the those who admitted to selling sex in the FTFI and 95% in the ICVI. Sixty five percentof these respondents reported consistent condom use with these partners.Also, some men reported selling sex outside Mysore. Although they did not go frequently,they tended to have up to 4 clients during those trips and reported condom use 67% of thetime, which is likely an over-estimate. Forty percent of the men also lived outside Mysoreand came into town for sex at least once a week.Overall condom use rates as reported in the FTFI are likely over-estimates and reflect socialdesirability bias, which might be especially pronounced as the interviewers were keymembers of the NGO implementing agency. Forty four percent of the FTFI respondents saidthat they use condoms all the time with all partners; however this number was only 17.3%among the ICVI respondents. The possibly low condom use, considerable sexual mixingbetween men in both commercial and non-commercial relationships, mixing between partnersinside and outside the city, and unprotected sex with spouses, suggested a potentially veryvolatile situation in 2007.- 19 -