Information, Motivation, and Self-Efficacy Among Men Who Have Sex With Men and Transgender Women in the State of Maharashtra, India

J. Michael Wilkerson, Jayson Michael Rhoton, Dennis Li, Shruta Amit Rawat, Pallav Patankar, B. R.Simon Rosser, Maria Ekstrand

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


BACKGROUND: India's National AIDS Control Programme calls for, among other things, targeted behavioral interventions that address determinants contributing to new infections among men who have sex with men (MSM) and hijras (transgender women).

AIM: To determine if the information-motivation-behavioral skills model was transferable to an Indian context.

METHODS: We recruited 442 MSM and 7 hijras into an online cross-sectional study that asked questions about condom use knowledge, motivation, self-efficacy, and sexual behavior. Structural equation modeling was used to test the overall information-motivation-behavioral skills structure.

RESULTS: Condom use and HIV risk knowledge did not significantly predict condom use self-efficacy or having condomless anal sex with more than one male partner in the past 3 months, and knowledge was not significantly correlated with attitudes toward barebacking. Despite this, the final structural model explained 14.4% of the variance in condom use self-efficacy and 20.0% of the variance in risky sexual behavior. Overall fit of the model was good: χ 2(201, N = 447) = 445.002, p < .0001, root mean square error of approximation = .052, 90% CI [.046, .059], comparative fit index = .989, Tucker-Lewis Index = .987.

CONCLUSION: The public health response to India's HIV epidemic is currently different than in the West due to differences in medication access and public health infrastructure. As Indian MSM and hijras learn more about the effectiveness of viral suppression and hopefully have greater access to preexposure prophylaxis, researchers should monitor for changing attitudes toward condoms and be prepared to collaborate with the public health infrastructure in order to develop interventions that reinforce positive attitudes toward condom use.

Original languageEnglish (US)
Pages (from-to)304-311
Number of pages8
JournalHealth Education and Behavior
Issue number2
StatePublished - Apr 1 2019

Bibliographical note

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study Internet-Based HIV Prevention for Indian MSM (ISHKonnect) was funded by the Indian Council of Medical Research, Division of Epidemiology and Communicable Diseases, grant number INDO-US/84/2010-ECD-II and the National Institutes of Health, National Institute of Allergy and Infectious Diseases, grant number 1R21AI094676-01.

Publisher Copyright:
© 2018 Society for Public Health Education.


  • HIV prevention
  • Internet-based survey
  • behavior change
  • gay men
  • structural equation modeling

PubMed: MeSH publication types

  • Journal Article


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