Multi-level Intervention for HIV-Positive MSM in India

This study seeks to develop, implement, and assess an innovative multi-level intervention for HIV-positive MSM in India to promote their health, safer sex, and disclosure of HIV status. There have been few HIV prevention interventions for HIV-positive MSM in India, one of the most high-risk and vulnerable populations in the world. HIV-positive MSM have complex prevention and treatment needs that are subject to numerous individual, interpersonal, and community barriers. The MSM community in India is complex and fragmented with widespread stigma and discrimination within and outside the MSM community. There is a need for specific programs to help HIV-positive MSM in India manage their diagnosis, reduce HIV transmission risk to their partners, and improve their interpersonal and social connections.  We will develop a multi-level intervention with 2 components: 1) a 6-session individual-level intervention promoting safer sex, interpersonal communication skills, disclosure decision-making, social support and relationship building, and health care management and utilization, and 2) an MSM community-level intervention to improve social connections within the MSM community and to reduce stigma against HIV-positive MSM, and different subgroups of MSM. This will be achieved by conducting focus groups of HIV-positive and HIV-negative MSM to gather information about the content, structure and implementation of the intervention. We will use the results from the focus groups to develop and modify intervention content and delivery materials. Next, we will conduct a small pilot randomized controlled trial of HIV-positive MSM and randomize them to the individual-level intervention or the standard comparison control group prior to or after the start of the community-level intervention resulting in 4 groups (control, individual, control + community, individual + community). Participants will be assessed at baseline, 3-month, and 6-month follow-ups on sexual risk (unprotected sex, number of partners), health status, health care utilization, disclosure of HIV status, perceived stigma, and social isolation. Feasibility, acceptability, and fidelity will be evaluated using a comprehensive process evaluation. In order to assess the effectiveness of the community-level intervention, the process evaluation will include serial cross-sectional assessment of 50 MSM from the community, pre and post community-level intervention. 

Funding is pending.