Stigma, Place, and HIV: The Legacy of the 1984 Bhopal Gas Disaster Among Indian Men Who Have Sex with Men

Background The 1984 Bhopal Gas Leak is widely considered the worst industrial disaster in history, and "big events" can have durable impacts on infectious disease transmission. Among men who have sex with men, we examined whether meeting sexual partners near the original gas leak site was associated with HIV, HIV-associated risk behaviors, and sexual stigma. Methods We used respondent-driven sampling to enroll MSM in Bhopal during 2023-24 (n=750). Participants reported the four locations where they most often went to meet sexual partners in the past year. Sexual stigma was defined by mechanism (enacted, anticipated, internalized) and source (healthcare, family, society). We calculated weighted (RDS-II) prevalences of HIV, population-level HIV viremia (≥200 copies/ml), and associated risk behaviors by meeting location type and distance to the original gas leak site. We used weighted logistic regression to examine associations between sexual stigma and partner meeting locations. Results HIV prevalence was elevated among participants meeting near the leak site: 21.7% within 1 km, 14.4% between 1-2 km, and 9.7% over 2 km. Population-level HIV viremia and the proportion of MSM engaging in sex work were also elevated within 2 km. Sexual stigma measures were significantly associated with meeting a partner within 2 km of the leak site. Transportation-related spaces were associated with higher prevalences of HIV and viremia. Conclusions Industrial disasters may create marginal spaces which concentrate individuals facing greater stigma and elevated HIV transmission risk. Venue-based interventions near the gas leak site and at transportation centers may be warranted in Bhopal.