HIV Prevention among Men who have Sex with Men (MSM) in India: Review of Current Scenario and Recommendations







India has the second largest number of persons living with HIV/AIDS in the world after South Africa. India has an estimated number of 3.7 million (2.1 to 4.3 million) HIVinfected people at the end of 1999 (UNAIDS, 2000), and 3.86 million at the end of 2000 (NACO: accessed on 23rd September 2001). In India, national statistics shows that HIV spread is mainly through heterosexual transmission (NACO, 1999). As a result, awareness campaigns and prevention programs of Govt. of India have been focused on the general heterosexual population. Since HIV education for the public emphasizes only heterosexual transmission, men may be largely ignorant of the risks of man-to-man sex, or consider that the risks don’t apply to them; therefore they may not protect themselves and their male and female partners from HIV infection. Since national statistics show a very low percentage of man-to-man transmission of HIV (NACO, 1999), men who have sex with men (MSM) have been almost completely neglected from the HIV prevention programs of the Govt. of India. Since male-to-male sex is a criminal offence in India, and MSM are a marginalized and largely invisible population, MSM may be at high risk for HIV infection.

It has been estimated that a substantial number of men in India have same-sex/bisexual behavior (Ashok Row Kavi, 1999). Despite the relative invisibility of MSM in India, limited research suggests that a substantial number of MSM may engage in high-risk behaviors with both men and women (The Humsafar Trust, 2000a, Venkatesan C et al, 2000a, 2000b, 2001). Since almost all MSM eventually get married, this means the spread of HIV infection is not only to other men but also to their female partners and their unborn children. This larger transmission mandates the need to immediately initiate HIV prevention programs for MSM.

If same-sex/bisexual behavior is not addressed in the safer sex messages and if HIV prevention programs for MSM are not initiated immediately, then the nation would miss this timely window of opportunity to control the spread of HIV and to avoid so many preventable deaths.