Factors Associated with Mental Depression among Men Who Have Sex with Men in Southern India

"The study indicates that there is an urgent need to integrate mental health care within the behavioral change communication component of HIV prevention and other health programs."

Noting that mental health has been a largely neglected issue among men who have sex with men (MSM) across the world, this study examines the prevalence and correlates of depression among MSM in southern India. The authors of this study observe that, in India, the national HIV prevention programme in south India focuses on behavioural change communication, provision of sexually transmitted infection (STI) services and commodities, and the creation of a referral network for HIV testing and provision of antiretroviral (ARV) treatment and structural interventions. However, they contend, psycho-social needs, mental health problems, rehabilitation, and counselling services have not integrated into the HIV prevention programme. This is a particular concern among MSM in India, a marginalised group whose mental health issues have been largely understudied.

To fill this research gap, this study used data from the Behavioral Tracking Survey-2012 (BTS), a cross-sectional survey conducted among MSM between January and February 2012 in Andhra Pradesh, a state in southern India. The objective of the survey was to monitor the HIV prevention activities of Avahan, the India AIDS Initiative (see Related Summaries, below. The survey gathered information on condom use, HIV/AIDS knowledge, community mobilisation, and STI treatment, along with information on the mental health status of MSM using the Patient Health Questionnaire-2 (PHQ-2) depression scale. MSM were randomly recruited for the survey from 3 programme districts where the Avahan programme is implementing HIV prevention interventions for high-risk groups. Descriptive statistics, bivariate and multivariate logistic regression techniques were used for analysis.

More than one-third of MSMs (35%) in the survey reported to have depression. The likelihood of experiencing depression was 5 times higher among MSM who were mobile for sex work outside their place of residence (55% vs 17%, adjusted odds ratio (AOR): 5.2, 95% confidence interval (CI): 3.7 - 7.3) and had experienced physical or sexual violence (82% vs 33%, AOR: 6.0, 95% CI: 2.1 - 17.4) than their respective counterparts. Rates of depression were significantly higher among MSM who: had experienced STI symptoms; had knowledge of their HIV positivity; did not use condoms during anal sex with any clients/partners; consumed alcohol; and were in financial debt at the time of survey. Those who were associated with any community groups have significantly less chances of reporting depression, possibly because being a member of a self-help group or community-based organisation (CBO) or having community assistance provides MSM some amount of emotional and financial support. As a result, they may feel more confident in making decisions, seeking services from health facilities, and speaking about their rights in public. Further, their chances of engaging in risky sexual behaviour and reporting depression decrease.

As the authors observe in the discussion section, recognising the role of community groups and CBOs play in HIV prevention, the "Pehchan" programme is a community systems strengthening initiative funded by the Global Fund that has been working at a national scale since 2010 in India. It provides organisational development and technical and capacity building support to new and existing CBOs working with MSM-transgender-Hijra (MTH) communities. The programme leverages and complements the government's HIV prevention strategy for MTH by providing mental health and family health counselling. Furthermore, the recent Global Fund Round-9 HIV prevention programme for MSM in India has developed a specialised package of basic and advanced counselling sessions to address psycho-social, mental, and family issues in 19 states including Andhra Pradesh. "While there are signs of success in building capacities of communities in addressing mental health issues, increasing the awareness of mental health services at government health facility and community based organizations, still continuous access to these services are a real challenge for dispersed rural MSM population. It is reported that fewer than 20% of people who need mental health care have access to treatment because of lack of services in India..."

The study highlights that HIV prevention efforts with MSM in India require an integrated approach on addressing mental health issues. To support this, programmes and research-based evidence will be needed to ensure that mental health issues are properly addressed among MSM and other high-risk groups. The study recommends advocating for the inclusion of these issues in the National AIDS Control Program (NACP) guidelines, the national AIDS policy, and the Avahan programme.