Inconsistent use of condom has direct as well as indirect co-relation with internalised homo-negativity, anxiety and depression among population of men who have sex with other men (MSM), according to a study conducted by a group of public health experts, led by Dr Manmeet Kaur of the department of Community Medicine and Public Health at Post Graduate Medical College and Research (PGIMER).
The study, which was carried out by PGIMER in association with the Chandigarh State AIDS Control Society (CSACS), aims to investigate the prevention and treatment of AIDS in the MSM population, in a more holistic manner. “The idea is to understand the reasons why distributing condoms and conducting awareness workshops for MSM population has not worked out. We look at the issues that co-relate with the inconsistent use of condom in the MSM population,” says Dr Manmeet Kaur.
The term MSM is used to remain inclusive of all sexual and gender identities which are involved in sexual activity that puts them at high risk of contracting HIV. In India, the prevalence of HIV is found to be much higher in MSMs as compared to the rest of the population. Though the prevalence of HIV is 0.26 per cent in the general population, it ranges between 2.9-7 per cent in MSMs. One of the biggest cause for the high prevalence of AIDS among MSMs is inconsistent condom use. Around 45 per cent of the MSM population is inconsistent in using condoms during sexual activity.
Hence, most national agencies such as the National Aids Control Organization has worked on campaigns to promote the use of condoms and distribute them to high risk populations. However, the prevalence of AIDS remains significantly high in MSM populations. In Chandigarh, the overall prevalence of AIDS has reduced by more than six per cent between 2008 and 2019. “Yet the issue remains in the hidden population, such as MSMs, who are carrying the disease. Perhaps, they do not come out to get themselves screened and do not even avail treatment due to the stigma surrounding their identity,” says Dr Vanita Gupta from CSACS.
“That is why we are conducting this study in Chandigarh. We look at the syndemics associated with inconsistent use of condom, so that better policies can be implemented to prevent and treat the diseases among MSM populations,” says Dr Venkatesan Chakrapani, who was a part of the study. By “syndemics”, the doctors refer to synergised endemics, which is a term used for psycho-social epidemics such as internalised stigma, anxiety and depression.
Although the complete findings of the study are yet to be published, the team of researchers have gathered enough evidence to conclude that inconsistent condom use is associated with “syndemics” such as depression, anxiety and internalised homo-negativity. Homo-negativity refers to internalised homophobia, which brings about shame and despair, that in turn makes people participate in self-destructive practices such unprotected sex. “It is a vicious cycle, when people’s self esteem is low and they are depressed and ashamed of their sexuality, they tend to participate in self-harming behavior such as drug and alcohol abuse and also unprotected sex,” says Dr Chakrapani.
Out of the 300 MSMs surveyed in Chandigarh, who have been mobilised by community workers and activists from within the community, at least 10 per cent were inconsistent in using condoms while indulging in sexual activities with a male partner, and more than 25 per cent reported to have been inconsistent in condom use regardless of the gender of their sexual partner. Furthermore, 30 per cent reported that they had internalised homo-negativity and 5 per cent of the population suffered from severe depression.
The research was carried out with the aid of CSACS, the NGO workers familiar with the community and the peer mobilisers, who were given ten survey tools for registering data on different syndemics in the population. “At least two of these tools were on depression, three on alcohol use and the rest on anxiety and self-stigmatisation. The research team was also sensitised on the issue to ensure that the process is conducted in an appropriate and ethical manner, and team members are aware of the tools being used to collect data from the population,” says Dr Chakrapani.
The team hopes that the results of the data will lead to the upscaling of their research to establish a more concrete co-relation between social stigma, mental health and inconsistent condom use among MSM population. “This way, the treatment and awareness programmes will also be better informed and thus, they will tackle the problem from all fronts. People who have mental health issues would be given the right treatment along with creating awareness on the consequences of inconsistent use of condoms,” says Dr Kaur.
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