Cultural Patterns of Decision-Making Related to Condom Use Among Men Who Have Sex with Men in Mumbai, India

Wednesday, 1 August 2012: 8:50 AM

Usha Menon, PhD, RN, FAAN1
Laura Szalacha, EdD1
Abhijit Prabhughate, PhD2
Priti Prabhughate, PhD3
Murgesh Subramanian, MSc4
Vivek Anand, MA4
(1)College of Nursing, Ohio State University, Columbus, OH
(2)Field Office, Family Health International, New Delhi, India
(3)Health and Development, International Center for Research on Women, New Delhi, India
(4)II floor, Old BMC building, The Humsafar Trust, Mumbai, India

Learning Objective 1: The learner will be able to articulate reasons for using and not using condoms among MSM

Learning Objective 2: The learner will be able to discuss cultural processes to decision-making related to condom use among MSM

Purpose: The purpose of this qualitative study was to describe behaviors related to prevention and decision-making among men who have sex with men (MSM) in Mumbai, India, a core high risk group in a high HIV-prevalence area.  Current epidemiological trends suggest that without a resolute and harmonized HIV prevention initiative, India may eclipse all other countries in HIV burden.

Methods: Trained community interviewers, conducted in-depth interviews Hindi or Marathi 20 self-identified MSM. Audio-recorded interviews were transcribed verbatim and translated to English. Three initial transcripts were read to develop a coding list which was used to code the remaining interviews. An intensive 2-day meeting resulted in a final concept map with themes and connected sub-themes.

Results: Knowledge about risk prevention through condom use was high.  However, cultural patterns of decision-making regarding the use of condoms (sex partner from ‘good’ family; looks clean; introduced by a family member) dominated reasons for using or not using condoms. Primary sub-themes were abuse, violence, and sex work (forced sex with clients; emotional disempowerment) and beliefs about safe sex and partners (using herbs for prevention; withdrawal before ejaculation). Challenges to conducting community-based research in an international setting in different languages are myriad and lessons learned will also be presented (sustaining solid partnerships, extensive process evaluations and feasibility testing, and training processes to build capacity in the research setting.

Conclusion: Successful behavior change interventions must be built on foundations that leverage existing cultural norms to optimize effectiveness, rather than be drawn from heterosexual and Western cultural perspectives. In India, in many areas, nurses are the only healthcare providers, dispensing both community health interventions and acute medical care. Information on factors associated with safe sex behaviors, when confirmed in through quantitative studies as we anticipate, will be integral to building a community-centered nursing prevention intervention.