Background
HIV incidence remains disproportionately high among men who have sex with men (MSM) globally and is increasing among MSM in India. To evaluate the feasibility of spatially tailored interventions to interrupt HIV transmission among Indian MSM, we explored the geospatial distribution of locations where MSM meet male sexual partners in Bhopal, India.
Methods
We enrolled 752 MSM (aged 18+ with ≥1 male sex partner in the last year) through respondent-driven sampling (RDS) in Bhopal between December 2023-April 2024 and conducted HIV rapid antibody and viral load testing. Participants completed a behavioral survey and identified their residence and up to four additional locations where they met sexual partners most often in the past year. We categorized meeting spaces and used kernel density estimation to identify areas where MSM with HIV viremia disproportionately met sexual partners. All analyses were weighted to account for RDS.
Results
Most enrolled MSM completed secondary school (99.5%) and were employed (98.0%). On average, MSM named 3.6 meeting locations, corresponding to 190 neighborhoods, 62 transportation-related locations, 30 commercial locations, 28 parks, and 18 other locations. The overall prevalence of HIV and HIV viremia was 11.6% and 4.4%, respectively. MSM meeting at transportation-related locations had the highest prevalence of HIV (14.9%) and HIV viremia (6.5%). MSM meeting at commercial locations had the lowest prevalence of HIV (6.8%) and HIV viremia (3.3%). We identified a 3.88 km2 area, west of the main railway station and south of the original 1984 Bhopal Gas Tragedy site, where 45.8% of all MSM with detectable viremia met partners. MSM who met within 1 km of the 1984 site had 14.1% (95% CI: 4.3%, 27.1%) higher HIV prevalence on the absolute scale, 4.3% (-0.6%,14.7%) higher HIV viremia prevalence, more sexual partners (median [IQR]: 15 [5, 28] vs 7 [3, 22]), and 5.3% (-4.8%, 9.2%) higher inconsistent condom use with casual partners, compared to MSM who did not meet within 2 km of the 1984 site.
Conclusions
MSM with HIV and HIV viremia disproportionately met in transportation-related locations and specific geographic areas, suggesting that spatially tailored interventions would be efficient in preventing HIV transmission among MSM in this urban Indian setting. Structural disparities, including poverty and stigma, may drive where MSM with HIV choose to meet partners for sex and may be associated with limited access to treatment and prevention services.
Table or Figure
