Research That Matters (January 17 - 20, 2008)

Purpose: India has the highest number of persons living with HIV/AIDS (5.7 million) in the world. Although HIV/AIDS in India is predominantly a heterosexual epidemic (National AIDS Control Organization, 2005), men who have sex with men (MSM), a highly marginalized group in India, are at high risk for HIV (Dandona et al., 2005). HIV testing is a cornerstone of HIV prevention and care. This study examined HIV testing among high-risk MSM in Chennai, India, and identified variables associated with participating in HIV testing.

Methods: A cross-sectional study was conducted among 200 MSM in Chennai who were recruited from 10 cruising and sex trading areas using time-space sampling (Steuve et al., 2001). This involved randomly selecting the sites, day and time, and finally participants. Structured interviews in Tamil were conducted by trained field researchers in a local community agency. The survey instrument explored demographics and knowledge and behaviors related to HIV/AIDS, including testing behaviors. To determine knowledge of HIV transmission, a 10-item scale was developed measuring knowledge of HIV transmission routes. Responses were binary (yes/no), with higher cumulative scores representing greater knowledge of HIV transmission. Chi-square tests were performed to explore relationships between testing behavior and predictors. A logistic regression analysis was conducted to examine the predictors of being tested for HIV. The covariates in the model are age, education, income, knowledge score for HIV transmission, and knowing a person with HIV.

Results: Participants' average age was 29 years (SD=9 yrs). Highest level of education varied, with 71% having completed at least elementary school. 70% knew someone with HIV. The average score for the knowledge of HIV transmission scale was 8.36. Nearly 40% of the participants had never been tested for HIV. The knowledge score for HIV transmission and knowing someone with HIV were the only statistically significant predictors of being tested for HIV (n=197). Specifically, having a low knowledge score concerning HIV reduces one's odds of being tested by just over 55% (OR=0.44; p<.05). Knowing someone with HIV means the person is more than twice as likely to be tested (OR=2.07; p<.05).

Implications: As HIV prevalence in India continues to escalate, prevention programming is increasingly critical. The results reinforce the value of education efforts, indicating that low levels of knowledge contribute to reductions in the probability of being tested. Therefore, to increase testing, prevention efforts must ensure that MSM become knowledgeable of all HIV transmission routes. The relationship found between being tested and knowing someone with HIV highlights the importance of efforts to promote the full participation of people living with HIV in their communities. Not only would this greatly benefit the person with HIV, but as this study suggests, knowing someone living with HIV may increase motivations to be tested.