A cross-sectional survey to assess the relation between disclosure of samesex behavior, depression and risky sexual behavior among men who have sex with men (MSM) in Chennai, Tamil Nadu, India

Abstract

Introduction: It is estimated that there are some 2.5 million MSM in India. Various studies conducted in India serve as evidence that MSM are prone to high rates of depression compared to the general adult male population. This can be attributed to the fact that homosexuality was illegal in India until September 2018, and as a result, MSM in India have lived in secrecy due to the fear of rejection by their family members, friends, and society. Moreover, MSM also lack knowledge about practicing safe sex and often participate in unprotected anal intercourse (UAI) with multiple partners, consequentially infection with human immunodeficiency virus (HIV) and other sexually transmitted infections (STI) may result. Due to the fear of being disowned by their family members, MSM often choose, or are forced to enter into heterosexual marriages, which may serve as a bridge population that spreads HIV to their wives. As a result, the psychological health of the MSM population is affected, and evidence shows that there is an association between risky sexual behavior and depression amongst this vulnerable population. Objective: Firstly, to investigate if there was an association between disclosing one’s sexual orientation to different people (family, friends, wife, coworkers, community) and depression score, after adjusting for the confounders. Secondly, to see if there was an association between participation in risky sexual behaviors and one's depression score, after adjusting for confounders. Methods: A cross-sectional survey was conducted in Chennai, India amongst 155 beneficiaries of an MSM community based organization (CBO) organization called “Sahodaran” in January, 2019. The participants of this study were conveniently sampled, and an intervieweradministered survey was adopted. Validated instruments, including the Beck’s Depression Inventory-II (BDI-II) and Safe Sex Behavior Questionnaire (SSBQ), were used. To analyze the results of this study, descriptive statistics, Fisher’s Exact Test, univariate and multivariate linear regression were conducted. Results: In the overall sample of 155, MSM were very open about their sexual orientation to their friends (n = 99, 63.8%), followed by current workplace coworkers (n = 59, 38.0%) and siblings (n = 47, 30.3%). Most of the study participants were not open to their father (n = 80, 51.6%), or their neighbors (n = 73, 47.1%). After adjusting for confounders, this study revealed that those who were somewhat open to their father had a higher depression score than those who were not open to their father (p-value = 0.03, β = 5.93, CI: 0.567, 11.3); those who were very open to their siblings had less depression compared to those who were not open to their siblings (p-value = 0.025, β = -0.198, CI: -4.769, -0.612); those MSM whose disclosure to current workplace was not applicable had a lower depression score in comparison to those MSM who were not open to their workplace (p-value = 0.002, β = -12.729, CI: -20.757, -4.701). This study also found that there was a negative association between depression score and safe sex behavior score (p-value = 0.000, β = -0.311, CI: -0.453, -0.168) suggesting that depression was associated with unsafe sexual behavior. Conclusion: The findings of this study are consistent with existing literature, suggesting that MSM are vulnerable to depression, and as a maladaptive coping mechanism they practice UAI with multiple partners. Multifaceted interventions are of paramount importance that would educate MSM about the appropriate time to disclose their sexual orientation to others, address depression, educate about sexual practices to promote safe sex behavior, and destigmatize samesex relations.