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A cross-sectional survey of 2910 rural Indian men aged 18-40 years from five rural districts in five different states revealed that nearly 10% of single and 3% of married men had had unprotected anal sex with a man in the past year. Homosexually active men are not a separate sexual category,and report extensive mixing with female partners. They have more female partners than other men and they practised anal intercourse in 11% of their heterosexual contacts.

The results suggest that sex workers and their clients commonly practice anal intercourse, but a relatively high proportion of clients do not consistently use condoms, leading to a greater risk of acquiring HIV and its further transmission to other male and female sexual partners. Given the multidirectional risk, safer sex communication on heterosexual anal intercourse must be incorporated into HIV prevention programmes.

Using data from a large scale multisite bio-behavioural survey, this paper discusses the prevalence and practice of unprotected anal intercourse among clients of sex workers in high HIV prevalent southern states of India.

For the current analysis, a conceptual framework (figure 1, illustrated below) was used as a device to explain and identify the different factors that may be associated with inconsistent condom use during anal intercourse with FSWs.

The independent variables included age in completed years; education (illiterate, can read only, can read and write); occupation (pre-coded as unemployed, student, domestic servant, agricultural labour, non-agricultural/casual labour, skilled/semiskilled labour, petty businessman/shop owner, large businessman/shop owner, bus/truck driver/helper, other transport worker, service and others); marital status (currently married, separated, divorced, widowed, never married, no answer); place of soliciting FSWs (pre-coded as bar/nightclub, public place, street, park, railway station, agent, brothel, hotel/lodge, home, dhaba, by telephone, other); number of FSWs they had sex with in the past month; number of sex acts with FSWs in the past month; ever had anal intercourse with a man/transgender (yes/no); self-risk perception (yes/no); alcohol consumption (every day, at least once a week, less than once a week, never, no answer); and having HIV or any STI (those having HIV, syphilis, gonorrhoea or chlamydia were grouped into positive and the rest as negative).

Descriptive statistics were calculated and used to measure the levels of inconsistent condom use (during anal intercourse) and other selected variables. χ2 Tests were used to assess the significance of bivariate


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