Tracking changes in HIV-related risk behaviour among men aged 15–54 in high HIV prevalence states in India: evidence from NFHSs

Aim The paper aims to track the changes in HIV-related risk behaviour among men aged 15–54 in high HIV prevalence states in India using three consecutive rounds of the Indian Demographic Health Survey in 2005–06, 2015–16 and 2019–21. Methods Findings are based on a nationally representative sample of 30,110, 16,822 and 19,517 men aged 15–54 during the periods 2005–2006, 2015–2016 and 2019–21, respectively, from the high HIV prevalent states in India, namely Maharashtra, Manipur, Mizoram Nagaland, Karnataka and Andhra Pradesh (including Telangana). Descriptive statistics, bivariate and multivariate analyses were used. Results High-risk sexual behaviour increased from 4.5% in 2005–06 to 6.4% in 2015–16 to 7.3% in 2019–21. The prevalence of high-risk sexual behaviour and HIV testing remains disproportionately higher among men with ≥10 years of schooling, residing in urban areas, belonging to economically better-off households, and perceiving that women do not have any sexual rights in all three-consecutive surveys of NFHS. The random part of the multilevel logistic regression revealed that variation in the high-risk sexual behaviour among men was higher at the household level than the community level in all three consecutive surveys of NFHS. Conclusions The study concluded that high-risk sexual behaviour and HIV testing increased over the past 15 years and remain disproportionately higher among younger, unmarried and urban men, who are mainly from economically better-off households. Men must be the focus and priority of HIV/AIDS research and education, which may strengthen the idea that men are solely responsible for sexual decision-making.