In response to RFA-AI-12-033, we propose a joint collaboration between the Johns Hopkins University in the US and the YR Gaitonde Centre for AIDS Research and Education to improve access to HIV counseling and testing (HCT) for wives of MSM. Dramatic progress over the past three decades has prompted discussions on the potential for eradication of HIV. However, for this to be realized, all persons living with HIV nee to be identified as early as possible and initiated on antiretroviral therapy (ART) for benefits at the individual and community-levels. However, some populations are more hidden than others and get commonly overlooked in the planning of HIV prevention and treatment programs. Wives of men who have sex with men (MSM) are one such population. HIV epidemics among MSM continue to emerge in developing and developed settings despite overall declines in HIV prevalence in most settings. For example, in India HIV prevalence has declined by >50%, but no change has been observed in HIV prevalence among MSM. Further in many settings, including India, large numbers of MSM remain hidden and many marry to satisfy social and cultural norms. India is home to ~2.35 million high risk MSM and approximately 40% are married to women. Further, HIV prevalence is higher among married vs. unmarried MSM. Though findings suggest that married MSM may be a "bridge population" no information exists on access to HCT or HIV/STI prevalence among wives of MSM. HCT is the crucial first step in the HIV treatment cascade. Accordingly, we seek to identify interventions to improve access to HCT for wives of married MSM in India through the following aims: 1) To characterize the context of disclosure of same-sex behavior among married MSM in India and its impact on HCT for spouses;2) To determine the prevalence and correlates of prior HCT and HIV/STIs among wives of married MSM;3) To evaluate the acceptability of interventions to improve HCT and linkage to care (LTC) among wives of married MSM. We will achieve these objectives using a mixed-methods epidemiological approach with focus group discussions, in-depth interviews and quantitative surveys including serologic testing for HIV, HSV and syphilis among two groups: 1) MSM couples (both husband and wife) where the husband has disclosed his MSM behavior to his wife;and 2) MSM (only husband) in couples where the husband has not disclosed to his wife. This study will be conducted across 3-5 states in India and will use the infrastructure of an ongoing cluster- randomized trial that will recruit 12,000 MSM for a baseline survey starting in September 2012. A total of 18 FGD and 30-45 IDI across these different groups and states will be conducted. In addition, 150 couples and 15o MSM who have not disclosed their MSM behavior will be sampled for the quantitative survey for a total of 450 participants. Given the dearth of knowledge on wives of MSM in India and in other developing and developed settings, the findings from this study could inform the development of interventions to improve HIV counseling and testing for wives of MSM in India and elsewhere.
This mixed-methods epidemiology study seeks to identify interventions to improve HIV testing among spouses of men who have sex with men in India. This study will also characterize prevalence and correlates of prior HIV testing, HIV and STIs among spouses of MSM in India.