Slam Orgies Among Indian Men Who Have Sex with Men Who Participated in the Ishkonnect Study: A Mixed Methods Exploration of Substance Use and HIV Risk

Introduction: In India, men who have sex with men (MSM) face unique social challenges. Partly due to Section 377 of the Indian penal code, which criminalizes male-to-male sexual activity, MSM are hidden, stigmatized, and understudied. Indian MSM are disproportionately impacted by HIV. In 2011, the estimated prevalence of HIV among MSM living in the State of Maharashtra was 9.9%, compared to 4.4% for the general population. Little is known about substance use among MSM in India or how substance use practices may contribute to HIV risk. This study used quantitative and qualitative data to examine substance use practices among MSM in the Mumbai-Thane region of Maharashtra.

Methods: The ISHKonnect study recruited MSM who used the internet to find male sex partners. Eligibility criteria were being 18 years or older, living in the Mumbai-Thane region, and having sex with a man in the past 90 days. Data collection occurred between September 2013 and May 2014 and consisted of an online survey (n = 449), focus groups with MSM (n = 24), and individual interviews with health care providers (n = 10). For this study, quantitative data underwent descriptive analysis. Qualitative data underwent thematic analysis.

Results: Approximately 16% of survey participants (n = 73) reported drug use for non-medical purposes in the past year. The most commonly used drugs were marijuana, amyl nitrite/poppers, and erectile enhancement medication. MSM and health care providers expressed concern about sex parties, locally referred to as slam orgies. They feared how quickly HIV could be transmitted when MSM were simultaneously engaged in substance use and sexual concurrency. They stated MSM needed to be educated about the importance of using condoms with each new partner during slam orgies, but they feared stigmatization around buying and possessing condoms would impede MSM from using them.

Conclusions: Results suggest substance use may be co-occurring with sexual activity. Amyl nitrite/poppers and erectile enhancement drugs are associated with sexual activity among MSM. To our knowledge, this is the first study to identify slam orgies as a public health concern among MSM in India. The use of the term “slam orgy” suggests participants may be “slamming” injectable drugs. More research is needed to determine which drugs are being used during slam orgies and to what extent safe injection practices are occurring. Because India’s social environment does not facilitate the use of pre-exposure prophylaxis (PrEP) among MSM at risk for HIV, nor viral suppression for persons living with the virus, HIV prevention interventions for this population should emphasize condom use to help prevent the transmission of HIV and co-occurring STI and include harm reduction strategies for substance users.