Exploring Sexual Relational Satisfaction and HIV Transmission Risk among Youth in Low Income Communities of Mumbai

Research Article

Austin J HIV/AIDS Res. 2016; 3(2): 1025.

Exploring Sexual Relational Satisfaction and HIV Transmission Risk among Youth in Low Income Communities of Mumbai

Sharma B¹*, Siddhanta A² and Singh SK³

¹Masters in Population Studies, IIPS, Mumbai, India

²PhD Scholar, IIPS, Mumbai, India

³Department of Mathematical Demography and Statistics, IIPS, Mumbai, India

*Corresponding author: Sharma B, Masters in Population Studies, IIPS, Mumbai, India

Received: July 20, 2015; Accepted: May 31, 2016; Published: June 02, 2016


Sexual satisfaction has been highlighted as a metaphorical barometer of relationship satisfaction in the West influenced society including India [1]. This craving for intercourse not in terms of romantic relationship but in terms of casual sex has led to multiple partner relationship and risky sexual behaviour including the transmission of HIV. The present study report findings derived from a survey in the slums of Mumbai with a randomized cluster sample of 1239 men aged 18-29. Results show that almost one third of respondent reported their age at sexual debut below 18 years. There is also a wide variability in nature and pattern of sexual partners which is mostly influenced by education, occupation, marital status, type of partner, media exposure, leisure time activity, alcohol use and level of drinking. Study highlights that there is a wide gap between relational and sexual satisfaction (overall 20%) among married and unmarried youth in low income communities. Leisure time activities, high level of drinking and high exposure to mass media have a direct influence on coercion in first sex, especially when girlfriend is a sexual partner. Those respondents who had their first sexual intercourse with relatives/strangers/co-workers & others and who used alcohol during their first sex are less likely (p<0.01) to use condom in their first sex. Findings facilitate understanding of changing sexual culture and behaviour, growing liberalised sexual attitude and increased vulnerability among the youth. Programmes to equip and aware youth fully to make safe choices are required for elimination of sexual risk behaviour including transmission of HIV.

Keywords: Youth; Combination of partners; Relational satisfaction; Sexual satisfaction; HIV risk; STI


HIV: Human Immunodeficiency Virus; STD: Sexually Transmitted Diseases; STI: Sexually Transmitted Infections; BBFSW: Brothel Based Female Sex Workers; UNAIDS: United Nations Programme on HIV and AIDS


Thirty years into the HIV pandemic, a tremendous need remains to understand the factors shaping HIV transmission among youth, especially in higher HIV prevalence settings. Though the number of HIV infections declined by more than 50% in 26 countries between 2001 and 2012 [2], the shifting pandemic has been particularly burdensome to young adults. Multiple factors contribute to the rapid and expansive amplification of HIV, prevalence time of HIV, conditions of poverty that foster the spread of HIV, poor health care, co-occurring epidemics of other Sexually Transmitted Infections (STIs), limited access to condoms, and sexual networking patterns, including concurrent sex partners [3]. Sexual satisfaction is an important component in a good relationship as well as in good life. Though sexual satisfaction is relevant for both men and women as they have the capacity, desire and right to experience a satisfying sexual life [4], yet the study of sex in general is relatively new and is still a taboo in country like India. Sexual behaviour is mainly constructed in relation with social norms and influenced by individuals’ experiences. Hence, all individuals do not have the same social representations or the same norms when it comes to sexuality and are not expected to put the same set of values to it [5]. Generally in all societies, sexual permissiveness is often reinforced in men while women are rewarded for being sexually restrictive. Many societies exploit and degrade a man for any emotional weakness or outbursts while allowing women to become more emotionally invested in the relationship [6].

Sexuality in Indian society is seen as a cultural construct, which differs with age, social class and gender, division of labour, freedom of social life, moments and kinship arrangements [7]. There is exposure of liberal sexual culture through mediums like mass media, sexual stimuli and other sexual avenues, where youth have easier access to erotic materials which enhances opportunities for sexual liaison and substance abuse [8]. But the low income communities are overcrowded affecting the privacy of each and every individual in the community.

The concept of relationship which consisted of love, commitment, trust, support, intimacy and mutual exchange of emotions, has changed among youth and nature of relationship has become casual. This deteriorating meaning of relationship has led to multiple partner sexual relationship and heterosexual intercourse which is the most common mode of HIV transmission. Moreover substance like alcohol and drugs play a dominant role in sexual activity among youth since it reduces self-control and increases risky behaviors, such as unsafe sex. It is a primary cause of injuries, violence and premature deaths. It also can lead to health problems in later life and affect life expectancy [9]. This including the type of above mentioned sexual activity is frequently risky. There are signs of an increase in risky sexual behaviours in several countries. The examples of high sexual risk behaviour include: early sexual activity, especially before age 18; unprotected intercourse without male or female condom use; having multiple sex partners; having a high-risk partner (one who has multiple sex partners or other risk factors); having sex with a partner who injects or has ever injected drugs; unprotected mouth-to-genital contact; exchange of sex (sex work) for drugs or money [10]. These sexual behaviours results in the form of sexually transmitted diseases which affects the working population of the country. When young people have unprotected sex with multiple partners, they are putting themselves and others at increased risk of contracting various sexual transmitted infections and diseases especially HIV. Having multiple sexual partners in adolescence has also been identified as an indicator of risk-taking behaviours such as early sexual debut and unsafe sexual behaviours, smoking, and substance use [11,12]. Hence, there exists a persistent challenge to effective HIV prevention efforts for adolescents and young people that includes adequate access to highquality, youth friendly HIV and sexual and reproductive education and health services, as well as sexual violence against young women and girls. The purpose of this study is to understand sexual relation status and partner variation among youth. Further, this study aims to examine the relational and sexual satisfaction among both married and unmarried youth and to understand the risky sexual behaviour that leads to HIV transmission among youth.

Methods and Materials

The study has used data of a project entitled “Alcohol Use, Sexual Health Risks and HIV Prevention among Young Men in Low Income Communities in Mumbai, India” under the guidance of International Institute of Population Sciences (IIPS), Mumbai with Institute for Community Research and University of Connecticut Health Center (UCHC), Connecticut, USA as partners, sponsored by National Institute on Alcohol Abuse and Alcoholism. The survey was done over a span of 4 years from September 2005 to August 2009. The study consists of a sample of 1239 youth from 18 to 29 years of age selected from low income communities of Mumbai. The study has used some of the basic descriptive statistical tool to assess the age at first sexual intercourse, combination of partners, marital satisfaction, girlfriend relationship satisfaction, sexual satisfaction etc. In addition, bi-variate technique has been used to understand the relationship between predictors and response variables. The study has used Chi-square test to find the statistical association and significance of different variables. Binary logistic regression is also used under multivariate analysis.

Indices and scales used in the study

The following indices and scales have been used in the present study. A detailed description of each of them is given below.

Relationship satisfaction with wife

It is computed by recoding a continuous Guttaman’s scale, created by merging three statements concerning relationship with wife (You feel happy about your marital relationship, you feel discouraged about your marital relationship, you are very satisfied with your marital relationship). The continuous scale has been converted in two categories: satisfied and not satisfied.

Relationship satisfaction with girlfriend

It is computed by recoding a continuous Guttman’s scale by merging seven statements concerning relationship with girlfriend. These statements are; ‘you are better at your relationship with your girlfriend than most other people are with their relationships, you feel happy about your relationship, your needs are not satisfied in your relationship, you feel discouraged about your relationship, you are very satisfied with your relationship, you feel sad when you think about your relationship and your relationship with your girlfriend/ lover is very bad compared to most’. The continuous scale has also been converted into two categories: satisfied and not satisfied.

Self- assessment as a sexual partner

It is computed by recoding a continuous scale created by merging seven statements (you are a good sexual partner, your sex life meets your expectations, your sex life is very bad compared to most, you feel happy when you think about your sexual experiences, you are disappointed about the quality of your sexual relationships, you are worried about your sex life and you feel happy about your sexual relationship). The continuous scale has been converted in three categories: not satisfactory, somewhat satisfactory and satisfactory in the study.

Exposure to mass media

It is computed by adding five different forms of media exposures (Newspaper, Magazine, Movies (Hall/video parlour) T.V., Radio, and Internet) which is measured on five point scale. The index has been classified into three categories namely, low, medium and high.

Exposure to sexual stimuli

It is computed by recoding a Guttman’s scale, which is created by merging six statements concerning exposure to different forms of sexual stimuli (Romantic movies, Blue films, Other pornographic materials, Watching women, Watching women dance, Drinking alcohol). The continuous scale has been converted into three categories low, medium and high.

Leisure time activity

The leisure time activity was taken as a measure of the involvement in the more risk related activities among the youth with their peer group including roaming, drinking, playing cards, gambling, seeing women etc. This index has been classified into three categories no leisure time activity, one or two leisure time activity and three or four leisure time activity.

Level of drinking

The pattern of drinking is a composite scale indicator of the amount and the frequency of drinking of the respondent. The amount of drinking was first divided in low (1 to 2 pegs) and high (three or more pegs) and the frequency of drinking was categorized as the low (those who drank once or less than once in a month), moderate (drinking three to four times in a month), and high (drinking two or more times in a week).


Socio-demographic profile

The study consists of youth from 18 to 29 years age group. Among them half of the respondents belong to 25-29 age group, almost onethird of them are in the age group 21-24 and less than one fifth belong in 18-20 age group. Regarding marital status, it was found 60% of them are married and 40% are unmarried respondents. The level of overall education is very low in these communities where one third of them are educated to just primary and middle level. Majority of the respondents are Hindu followed by Muslim, Buddhist and others. Almost 51% of respondents live in rented house and their standard of living is also very low. In total, almost one-third of the respondents included in the study are factory workers and almost one-fifth of the youth are drivers.

Sexual relation and sexual satisfaction

The first goal of this study is to see the sexual behaviour of the respondents according to their age at first intercourse and combination of lifetime sexual partners. The analysis further proceeds by giving details about the marital relational satisfaction as well as sexual satisfaction for married men, and girlfriend relational satisfaction together with sexual satisfaction for unmarried youth.

Profiling of respondents according to their age at first sex

The study has brought out an important fact that premarital sexual intercourse among youth in low income communities in Mumbai is not uncommon. Around 12% of unmarried men had sex with their girlfriend and nearly 4 % and 2% had sex with ‘others’ and BBFSW respectively. The age at first sexual intercourse is also found to be below 18 years of age. Early sex i.e. before age 18 is inversely associated with increasing educational attainment, which shows that education plays an important role in generating awareness regarding sexual behaviour. Among different occupations, the drivers (44%) are more prone to have an early sexual debut. Exposure to sexual stimuli is positively associated with early sex. Around 58% respondents having high exposure to sexual stimuli had early sexual debut. A little less than half respondents involved in three or more leisure time activities have experienced first sex at very early age, whereas only23% respondents who are not involved in any leisure time activity are found to be involved in early sex.

Combination of lifetime sexual partners

The combination of lifetime partners affects sexual health of every individual. In this study the combination of partners includes ‘wife only’ ‘girlfriend only’ ‘brothel based female sex workers only’’ wife and girlfriend’ ‘girlfriend and female sex workers’ and ‘others’. The last category ‘others’ includes partners as MSM, strangers, bar girls etc.

The variation of partners are mostly found between 21 to 24 years age group where 6% have only girlfriend as a partner, 3% have both wife and girlfriend as partners and 3% reported there were other sexual partners. It is surprising to know that primary and secondary educated respondents have only female sex workers as partners.

Among unmarried males 4% have ‘others’ as partners. More than half of the respondents who are drivers by occupation have only wife as partners, 6% have only girlfriend as partners and 5% have others as partners. Among the respondents who are involved in three or more leisure time activities, around 7% have only girlfriend as their partner and 5% have others as their partner. The combination of partners is found increasing with the increase in standard of living i.e. low to high SLI. All the above taken background variables viz: age, education, occupation, marital status, type of partner, media exposure, leisure time activity, alcohol use in first sex and level of drinking are showing significant relationship with combination of partners when chisquare was applied (Table 1).