Gay and bisexual men in India lack vital HIV and STI information and testing rates are low

A study with gay and bisexual men in India suggests many lack information and services about HIV and STIs, while mental health issues and experiences of stigma and discrimination are common.  

What is the research about? 

The study involved 300 men (aged 18+) from six Indian cities (Delhi, Mumbai, Kolkata, Bengaluru, Ahmedabad and Lucknow) who identified as gay or bisexual. Through questionnaires and interviews, researchers assessed the men’s physical and mental health and their awareness about HIV and sexually transmitted infections (STIs). 

Why is this research important? 

UNAIDS reports that gay men and other men who have sex with men are 28 times more at risk of getting HIV than other men. This vulnerability is driven by stigma and discrimination. This puts gay men and bisexual men at heightened risk not only of HIV but other health issues, including mental health conditions and STIs. Despite the health risks that gay and bisexual men experience, there is a lack of research on men who have sex with men, particularly in low- and middle-income countries. 

What did they find out? 

HIV and STIs 

Most study participants had heard of HIV. And only a small minority had misconceptions about how HIV is transmitted. For example, 13% wrongly thought that a healthy-looking person cannot have HIV. 

Only half (50%) had ever taken an HIV test. HIV testing was linked with being older, being married, divorced or widowed, having a high income or education level. 

More than half (55%) did not know about antiretroviral treatment (ART) or had incorrect information about it.  

Two-thirds (63%) had heard of PEP and PrEP. But only 4% were using it due to its cost.  

Awareness of STIs was low. Around 43% had not heard of syphilis, gonorrhoea or herpes.  

Healthcare access  

More than half of participants said they did not get satisfactory healthcare, they experienced delays in getting health services or they could not afford healthcare.  

Stigma, discrimination and fear were some of the reasons participants struggled to access health services. Describing an HIV test, a 22-year-old said: “I know the importance of early diagnosis but it is so embarrassing to face the staff and get the test done.” 

Mental health  

Around one-third of participants had negative or pessimistic thoughts. And 19% had suicidal thoughts directly linked to their sexuality. 

Around one in three experienced a ‘disordered eating behaviour’, such as over-eating or under-eating. More than one-third experienced mood swings or anxiety. 

Participants with supportive family members and those with access to medical support were able to cope better with mental health issues. 

Social isolation and stigma  

Around one in four participants felt disconnected from the general (heterosexual) community and kept social interactions as limited as possible.  

Participants said they were often treated like lower-class citizens. This led to internalised homophobia. For example, a 25-year-old said: “I always feel very insecure about my personality when I see straight guys. Deep within, I know that I’m inferior and they are superior.”  

Other health conditions 

A quarter of participants had a long-term illness, such as diabetes or liver disease. Around four out of ten had a short-term illnesses. Around 80% of participants with long-term illness also experienced frequent short-term illnesses. 

What does this mean for HIV and sexual health services? 

HIV and STI awareness campaigns are needed, designed by or with the input of gay and bisexual men. One of the key pushes should be around HIV and STI testing, given the low testing rates found in this study. There is a particular need to target young gay and bisexual men who are the least likely to test. 

There is also an urgent need to address mental health issues and internalised homophobia. Peer-supported counselling for gay and bisexual men could be provided online, one-to-one or in groups. This could improve people’s quality of life, and it could change their health seeking and risk taking behaviours. The finding that participants with supportive family members were able to cope better with mental health issues shows the importance of developing support networks for gay and bisexual men, particularly those who feel socially isolated.   

The study also shows that Indian gay and bisexual men continue to experience stigma and discrimination in healthcare settings and the wider community. Working to reduce this should be a key part of any HIV, STI or other health programme.