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Open Access Highly Accessed Research article

An exploration of elevated HIV and STI risk among male sex workers from India

Prakash Narayanan1*, Anjana Das1*, Guy Morineau2, Parimi Prabhakar3, Gururaj Rao Deshpande4, Raman Gangakhedkar4 and Arun Risbud4

Author Affiliations

1 FHI 360, India Country Office, New Delhi, India

2 FHI 360, Asia Pacific Regional Office, Bangkok, Thailand

3 India HIV/AIDS Alliance, Hyderabad, India

4 National AIDS Research Institute, Pune, India

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BMC Public Health 2013, 13:1059  doi:10.1186/1471-2458-13-1059

Published: 9 November 2013



Men who have sex with men (MSM) who also report transactional sex (male sex workers or MSWs) are known to be at higher risk for HIV and sexually transmitted infections (STIs). The study aimed to profile socio-demographic characteristics and risk factors associated with high HIV prevalence among MSWs.


A cross-sectional study was conducted in 2008–9 among 483 high-risk MSM who attended STI clinics at Mumbai and Hyderabad, two large cities in India.


About 70% of the MSM reported transactional sex. As compared to other MSM, MSWs had more male partners (8.9 versus 2.5, p < 0.001) and higher rates of receptive anal sex (96% versus 72%, p < 0.001). HIV prevalence among MSWs and other MSM was 43.6% and 18.1% respectively. HIV prevalence among MSWs was associated with the place of residence (MSWs from Hyderabad were 7.3 times more likely to be infected), positive syphilis serology (3.8 times) and duration of sex work (increased by 8% for every additional year).


The study showed that MSWs are at high risk for HIV acquisition/transmission, which highlights the need for intensified interventions for personalized risk-reduction counselling and STI screening. Newer biomedical interventions such as pre-exposure prophylaxis and treatment as prevention could also be considered.

Male sex worker; Men who have sex with men; HIV; India