Indiana University to expand public health partnership aimed at promoting sexual health research, education, and training activities in India

Reducing the transmission of the Human Immunodeficiency Virus (HIV) and other sexually transmitted infections (STI), along with the broader promotion of sexual health and well-being, remain global public health priorities.

In India, a country of 1.24 billion people, of whom nearly 2.5 million are currently living with HIV, the need is even more urgent for public health interventions that are evidence-based, culturally congruent, and high impact in terms of their ability to promote sexual health. In India, sexual risk behavior remains the main mode of HIV transmission and men who have sex with men (MSM) are characterized by disproportionately high rates of HIV prevalence (ranging between 7% and 24%). Relatively high rates of bisexual behavior have also been found among Indian men. Traditional gender roles and segregation, cultural expectations of marriage, and stigma surrounding same-sex behavior may influence sexual norms and behaviors. Men who have sex with both men and women (MSMW), who may or may not self-identify as a “bisexual,” face unique psychosocial challenges but they remain understudied and underserved. Researchers have not explored how individual, social and community level factors associated with Indian bisexual men’s sexual risk behaviors with both male and female partners may be made “safer” using public health interventions.

“Based on our previous research with bisexual men in the United States, we were thrilled to have the opportunity to explore sexual health among bisexual men in India – and this has been the perfect starting point for what we intend will be a much broader agenda of public health research and action between our team at Indiana University and our academic and community partners in India,” said Dr. Brian Dodge, associate professor in the Department of Applied Health Science and associate director of the Center for Sexual Health Promotion in the Indiana University School of Public Health-Bloomington.

Dodge and his research colleague Dr. Swagata Banik, associate professor of and director of the public health program at Baldwin Wallace University in Ohio, traveled to Mumbai early last year. Based on Banik’s extensive history of community-based research and intervention development in India, they met with partners in India’s oldest and largest lesbian, gay, bisexual, and transgender (LGBT) health service and advocacy organization, The Humsafar Trust. This community-based nongovernmental agency began working in 1995, primarily with MSM in Mumbai, and has now expanded to include gay and bisexual men, lesbian and bisexual women, transgender individuals, hijras, and other sexual minority communities in Mumbai and throughout India. The team laid the groundwork for an exploratory study of sexual health among Indian bisexual men, which led to a series of focus groups, followed by in-depth interviews with 50 behaviorally bisexual men in Mumbai. They intend to use the pilot data for a subsequent grant proposal to the National Institutes of Health (NIH).

This summer, the team will return to India to share the preliminary findings of their first project and, in collaboration with several new colleagues from the IU School of Public Health-Bloomington, to launch a new initiative, the U.S.-India Partnership for Sexual Health Promotion. The primary goal of the partnership will be to facilitate new opportunities for advancing the field of sexual health through collaborative and community-based research, education and training initiatives among colleagues on both continents. With institutional support from the Office of the Vice President for International Affairs at Indiana University, the members of this unique initiative are hoping to expand their efforts to work with other sexual health issues and priority populations in other geographical areas throughout India. They will capitalize on resources available through the newly formed Indiana University India Gateway Office (located outside Delhi, India), starting with holding their next team meeting at the office.

“We are grateful to be able to bring together the skills and capacity of our colleagues at Indiana University, with their long and illustrious history of sexuality research and sexual health promotion practice, with the expertise and enthusiasm of our community-based partner on the ground in India. This is a unique US-India based academic–community collaboration for public health promotion in India,” noted Banik, a primary partner in the new initiative. His own research portfolio in India includes a recent NIH-funded project aimed at developing health promotion interventions for hijra, a local sub-group of male-to-female transgender individuals who, due to bias and discrimination, often have no other option but to engage in sex work, rendering them one of the highest risk groups of HIV infection and transmission.

“Given the unique context of India, the ways that sexuality is experienced and expressed does not easily map onto Western labels and categories. Same-sex behaviors are often hidden not only because of the social stigma but also because same-sexual contact is, once again, illegal.” He explained, “Indian culture also places heavy emphasis on family and much of society is organized around the need to have children for resource preservation, for continuing the family through material and financial resources, and upholding social status. Inequities in gender and power have also created a climate in which sexual violence against woman has exploded to such an extent that it is currently a public health crisis. We are hoping to be able to expand our focus in order to be able to help with a wider range of sexual health issues.”

The members of the U.S.-India Partnership for Sexual Health Promotion hope to collaborate with academic and community-based experts on both continents in order to identify sexual health priorities, explore innovative research and intervention opportunities, and use the principles of community-based participatory public health research for the benefit of all members of the partnership. Drs. Dodge and Banik, along with the Chief Executive Officer of The Humsafar Trust, Mr. Vivek Anand, are eager to map out the next wave of priority projects of the partnership. Other partners involved with the initiative from the IUB side include Dr. Michael Reece, professor and associate dean for research and graduate studies at the Indiana University School of Public Health-Bloomington; Dr. Debby Herbenick, associate research scientist in the Department of Applied Health Science; and Jessamyn Bowling, doctoral student in the Department of Applied Health Science.

“We are so fortunate to have the opportunity to collaborate with Baldwin Wallace University, The Humsafar Trust, and other with others across the IUB campus who are invested in promoting public health research and practice initiatives in India,” Dodge added. “It truly is a special place and we simply would not be able to do this work without the insight and expertise of our academic and community partners as well as the resources and institutional support from Indiana University.”