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Impact of COVID-19 on economic well-being, mental health and HIV risk among MSM: a mixed methods study in a north Indian city

Title
Impact of COVID-19 on economic well-being, mental health and HIV risk among MSM: a mixed methods study in a north Indian city
Presenter
Aleena Sebastian
Authors
A. Sebastian * (1), V. Chakrapani (2), P. A. Newman (3), S. Rawat (4), M. Shunmugam (2), S. Mittal (5), V. Gupta (5), M. Kaur (6), G. Siddhant (4), D. Kumar (4), D. Singh (4), S. Romio (4)
Institutions
(1) National Institute of Advanced Studies (NIAS), Bangalore, India, (2) Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India, (3) University of Toronto, Factor-Inwentash Faculty of Social Work, Ontario, Canada, (4) The Humsafar Trust, Mumbai, India, (5) Chandigarh State AIDS Control Society (CSACS), Chandigarh, India, (6) Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

BACKGROUND: Limited empirical data are available on the impact of the COVID-19 pandemic on the lives of sexual and gender minority communities in the global south. We aimed to understand the pandemic's impact on economic well-being, mental health, health care access, and HIV risk among men who have sex with men (MSM) in India.
METHODS: In March 2020, we conducted a concurrent mixed-methods study among MSM in Chandigarh, North India. A convenience sample was recruited through three non-governmental organizations implementing HIV prevention interventions among MSM. Maximum diversity sampling (identity, sex work status and HIV status) was used to identify MSM for in-depth interviews. The survey assessed the impact of sexual minority stigma, internalized homonegativity and stress due to social distancing on depressive and anxiety symptoms. We used multivariable logistic regression to analyze survey data, and thematic analysis for qualitative data.
RESULTS: Among survey participants (n=132), most (61%) identified as Kothi (feminine/receptive role), were single (79%) and college graduates (64%). Mean monthly income was INR 8375 (USD 120). 43% engaged in sex work, 34% were unemployed and 8% HIV positive. Participants reported reduced access to condoms (19%), HIV testing (38%), and counseling services (74%) during COVID-19 lockdown. Social distancing stress was significantly associated with depressive (aOR=7.89, 95% CI 2.71'22.97, p<.001) and anxiety symptoms (aOR=5.69, 95% CI 2.73'11.86, p<.001). Internalized homonegativity was significantly associated with both depressive (aOR = 1.31, 95% CI 1.04'1.65, p=.04) and anxiety symptoms (aOR = 1.52, 95% CI 1.09'1.62, p<.001). MSM in sex work had higher odds (aOR=8.06, 95% CI 1.49'43.57, p <.001) of reporting depressive symptoms compared to those not involved in sex work. Qualitative data (n=10) highlighted how economic distress due to job loss or income reduction and survival sex contributed to mental health distress and HIV risk.
CONCLUSIONS: The COVID-19 pandemic has significantly impacted the economic well-being and mental health of lower socioeconomic status MSM. Limited access to HIV preventive interventions among MSM involved in sex work exacerbates HIV risk due to economic hardship. Tele-counseling/prescription, low-interest loans, and better access to mental health and HIV services are needed to support MSM in India.