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







In this section, the issues faced by gay men in their day-to-day life are briefly discussed. The scientific studies on their high-risk behavior and risk of HIV transmission are discussed in the second part of this paper.

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"Gay people, like non-gay people, vary enormously in shape, size, appearance, occupation, view point and self-perception. There cannot be said to be any single [defining characteristic of] homosexuality, as gay men and lesbians are not a coherent, easily definable group. Differences in region (including rural/urban ones), religion, and economic class make for widely divergent experiences and attitudes regarding marriage, same-sex eroticism and individual identity. There is, therefore, no such thing as a [single] "gay" certainly. Also, there are vast differences between gay men and lesbians in the way they experience and think about their sexuality"(AIDS Bhedbhav Virodhi Andolan,
ABVA, 1991)

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Beginning of attraction and reactions to it
Often the attraction towards the same sex persons is recognized in the adolescent period or even much earlier. While narrating his early childhood experiences a gay man says, "…I was getting more interested in boys. I must have been about 10 years old then. I would love to touch a boy and whenever a boy brushed himself against me, or touched me, my whole body would quiver for no reason. I don't know what was happening to me. Neither had I any knowledge of sex then…"(Sangha Mitra, Feb. 1999). At first, these persons are confused about their feelings and try to avoid them. They lack any kind of information on sexuality issues, since talking about sex is a taboo in India. Some may feel that they are passing through a phase and will soon get over it. For some it could be a 'passing' phase but for others it is not so. Some may try hard to project themselves as heterosexual - by eve-teasing, by developing a 'steady' relation with a girl, or even to the extent of visiting female sex workers along with their friends.

No one to support

While a few persons accept their sexuality, the majority think that the feelings they have and what they are doing are abnormal and immoral. They may develop guilty feelings, become isolated from others and may suffer from bouts of depression. They cannot share their feelings even with their close friends, let alone their parents. This is because they simply don't have the courage to discuss this matter for fear of rejection and disapproval. Those who do reveal their feelings to their non-gay friends may lose their friendship forever. Also, some may feel that by revealing their feelings they may make their family members suffer unnecessarily.

"Coming out" to parents

Some do inform their parents, especially their mothers, either in a preplanned way or in a sudden burst of emotions. Some parents may accept their son for what he is, but most times parents are stunned by their son's "coming out". For many parents, this is something they have never given thought to, or anticipated, or have come across only in media as happening to someone else. They cannot accept that it is happening right in their own house and may react by denying the significance of the disclosure. Often the first reaction is to assume that their son is just passing through a phase or he is just in a state of confusion. Some think he is psychologically upset and needs to be treated by a psychiatrist. Still others may feel guilty assuming that they have brought up their son in a wrong manner. They may develop concerns about how to face relatives, friends, acquaintances, how to develop marriage alliances for the other family members, etc. A mother of a gay man said this when her son came out to her, "My first reaction was -
'what will happen to my gold bangles'…"(ABVA, 1991). [Note: If a man "comes out" as gay in India it may mean - no marriage and therefore no dowry! - Dowry refers to the money/'gifts' given by the bride's family to the bridegroom to facilitate marriage in India]

Marriage [heterosexual] as a cultural norm
In India, marriage is considered a duty and obligation to one's family. Questioning the marriage arranged by the parents or expressing unwillingness in getting married makes parents think that their son is not obeying them and/or has no love for them. There is a very strong social pressure to marry and to father children to continue one's lineage. The desire of a person to get married [to a female] is often of little or no consequence and may not be considered at all. Probably, the highly interdependent nature of relationships in India as compared to the individualistic culture in western countries like United States is one of the root causes.

Since marriage is the social norm and everyone else around them is getting married, most of the gay men/MSM don't want to question the meaning of such marriage even when they are not interested sexually in the wife to be. If a man does not want to get married (to a woman), the society suspects his 'masculinity' and rumors may spread that he is 'impotent' or can't father a child. To avoid such stigmas, a gay man is compelled to marry. Some may willingly get married not because they desire sex with a woman but simply for a 'life-long companion and a friend'. But what about the woman who gets married to a gay man - will she be happy? Most of the time wives of the gay men don't know about the hidden sexual longings or same-sex sexual behavior of their husbands. Many may sense that something is not right, but cannot identify the cause and often blame themselves or their behavior for the lack of warmth. Some gay men, while not loving their wives, may still willingly perform their [sexual] 'duty'.

Even gays who are out to their parents are very often forced to get married to a woman since their parents, as well as they themselves, may see marriage as the only "solution" to 'getting rid of this unnatural habit'. A gay man said, 'When I came out to my parents they told me -"You can behave according to your own wishes but we need a grandson"…'

Another gay man said, "As I see things now most gay men in India get married off and fool themselves (besides their wives) then try to give the impression of living happily ever after. Then they advise their bachelor friends to marry. No wonder, more than half the gays who cruise in my area are married. I know of at least four who married less than a year ago and are back on the cruising scene, almost every night. Seriously, no laughing matter, at least for the wives… In the west you call them married, bisexual men who lead secret, double lives. Over here they are called Indian married men..." (ABVA, 1991).

A cross-cultural study (Kumar and Ross, 1990) conducted on 44 North Indian homosexual men found that most men had had bisexual experiences in the past 2 months and half were [heterosexually] married. The authors stressed the significance attached to marriage and lack of a distinct homosexual subculture in India (Kumar and Ross, 1991).

Monogamous relationship
In India, where arranged marriage is the cultural norm and where there is much opposition even to heterosexual love (note: arranged marriage is the rule in India), one can very well imagine the level of unacceptance towards 'gay marriage', let alone understanding homosexuality. Many Indian gay men find the concept of 'gay marriage' ridiculous and a western concept. While a few public lesbian 'marriages' have been reported (discussed elsewhere) and a few cases of friendship agreement ('Maitri Karar') between women have been documented, till date a public 'gay marriage' between two men in India is yet to be announced (though cohabitation of a few gay couples have been reported in newspapers). While some gay men may choose to be 'monogamous', many have sex with steady as well as casual partners. Many persons don't want to have a committed long-term relationship because it would be disastrous for them in term of their family and their social standing.

Those persons who are in a steady monogamous relationship are often possessive in nature. They may tolerate their partner mingling freely with opposite sex friends but not with the same-sex friends. If one of the partners come to know that what he considered as "mutually" monogamous relationship is in fact not so, that relationship often breaks up. Some persons may follow 'serial monogamy'. If one of the persons in a 'monogamous relationship' gets married to a woman, the relationship may end. A gay man narrates, "…I had a close physical friend. We loved each other at many levels. …he could not avoid an arranged marriage. The end result of it is that he has a life that is crushing him mentally. His wife, who is a great person, feels the strain and does not understand why. He never drank, until yesterday…I got over our break up and adjusted. About the only joy I see on his face is when he comes to visit me and sees that I am happy. Hard, cruel realities...What are we going to do to help others escape from the same trap?…"(in Trikone, Nov-Dec, 1989). Some times even after marriage some persons may continue their relationship in a secret way, living a typical closeted life.

Gay scene
In larger cities, especially in Metros, one can see a lot of 'gay scene'. There will be many cruising areas in these cities that can serve both as pick-up areas and also as areas where they can have sex. Cruising areas are frequented not only by gays but also by other men who have sex with men but who resist any 'gay label'. "…I find many cruisers insisting that they are "men" (giving the impression of being heterosexual) who would prefer to shove their hands behind their backs or in their pockets, and expects you to do the rest. But the fact that he prefers male sexual delights is something he will never admit..." - a gay man in a communication to ABVA, 1991.

Police harassment
In many cruising places, especially public toilets and beaches, gays encounter a lot of harassment from policemen. The main aim of the police is to extort money from these gays and in some cases also force these gays to have sex with them. It has been reported that policemen lure gay men by pretending to have interest in them. "…The policemen had taken my address from an identity card in my pocket. What if they came to my house and threatened me, asking for more money? What if my parents found out that I was a gay and looking for sex in public places? But where else could I look for it?…" asks a gay man (ABVA, 1991).

A gay man summed it up thus: "We won't make it criminal for you to have sex or build stable relationships, just refuse to acknowledge you exist, close down all the places where you can meet each other, threaten to throw you out of your job, your home, the country if we can catch you, watch you die and tell you deserve it, steal your books, your children, reject you as friends, drag you into court, into hospital, into prisons, into asylums…Then when you come whining to us that you are badly treated, we'll tell you there's something unstable, sick and abnormal about you, that we have other priorities and you're lucky to have any rights at all"(ABVA, 1991).

Only when there is a self-conscious gay identity, one can 'come out'. In India, where there is near lack of gay identity, one cannot talk about "coming out" at all. However, as mentioned earlier gay-identified youth do come out but that too in very small numbers. Even this small number attracts the attention of the media because of its rarity. Kyodo News Service (Feb 5, 2000) reported - "An increasing number of middle-class Indian gays are 'coming out of the closet,' much to the disapproval and consternation of their families" and it credited the growth of gay life, in part, to satellite television and the Internet (From International news #304 - Feb 21, 2000, (c) Rex Wockner).

The marriage of Lila and Urmila
"In December, 1987, police women Lila Namdeo and Urmila Srivastava of the 23rd battalion stationed in the outskirts of Bhopal, caped their year long friendship by marrying each other…"(Trikone, March 1988). Their act provoked a sensational stir as the nation struggled to grasp the implications of a public lesbian marriage. On police record, Lila and Urmila have been discharged from the police force for unauthorized absence from duty. However, it seems that the real reason for their removal from the police service is the fact that they were lesbians and announced that they married each other (ABVA, 1991).

Some role models
Ashok Row Kavi is an openly gay journalist and who is the editor of "Bombay Dost", a gay magazine from Mumbai. He, together with two other gay men, founded the Humsafar Trust in Mumbai, which was registered in March 1994. Ashok represents the Trust in government bodies and official organizations like the National AIDS Control Organization (NACO), India.

Sekar Balasubramaniam is the first person in India to come out as an HIV-positive gay man in 1994. He strongly felt that gay men should be educated to protect themselves from HIV infection. Hence he along with a group of gay men started Social Welfare Association for Men (SWAM), a community-based organization for MSM in Chennai. SWAM strives to create awareness and inculcate safer sex behaviors among MSM in Chennai.

Saleem Kidwai is a quiet and very vigorous research worker. He is a lecturer in history and has co-authored an excellent book on the history of homosexuality in India - "Same Sex Love in India - Readings from history and literature". He is a powerful builder of support systems for gay men in India and one of the trustees of 'Humrahi', a gay group in

There are many persons in the Indian sexuality minority communities who are doing excellent work in different fields - like Owais Khan, who made use of the internet to build queer activism and started the LGBT e-group (LGBT-India) for the first time and Pawan Dhall, Integration, who has run the first long lasting and sustained magazine on gay issues in eastern India (Naya Pravartak) and initiated Network East.

An Indian gay men's view on "coming out"
A 30 year-old Indian gay man in a communication to ABVA says, "Being a gay and being publicly gay in India are two different things. The latter entails social and professional retribution which I was not prepared to with stand…"(ABVA, 1991).

Except for a handful of persons, there are few positive images or role models in India which may encourage gay Indians to 'come out'. However it should be understood that "coming out" is a complex phenomenon and the need to come out and the possible consequences of coming out may mean different things to different people in different settings.

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The existence of lesbians has been vigorously denied in India let alone the denial of homosexuality in general. Many centuries ago, Vatsyayana, in KamaSutra, mentions about women who have sex with women (as "svairini"). It is only in recent years that Indians have come to know about lesbianism after the sensational lesbian marriage of Lila and Urmila (discussed previously) in 1987, occasional newspapers reports on "woman killed herself due to exposure of lesbian relationship" and the recent controversial film, "Fire" (which portrayed sexual relationship between two married Indian women).

View of Indian women's organizations on lesbianism
In spite of the 25-year-old women's movement, lesbianism is not even considered a legitimate issue to be commented upon by the women's organizations in India. Some women's groups are even hostile to lesbianism. Only a very few women's organizations in India have nonjudgemental attitude towards lesbianism. In a communication to AIDS Bhedbhav Virodhi Andolan (ABVA, 1991), "There is a basic difference between female and male homosexuality", says a lawyer and activist of Forum Against the Oppression of Women (FAOW), Bombay, "Lesbianism is an integral part of the women's movement for liberation. It constitutes an important area of their struggle against the exploitative principles and institutions of patriarchy. Lesbianism questions and threatens the existing male-dominated social order in a way that male homosexuality does not" (ABVA, 1991).

Among women's groups, lesbianism was first brought up at the Calicut conference in 1990, during the session on single women. The efforts of a few lesbian activists enabled a separate session on this issue in the 1994 Tirupati conference where the attempt to claim space was met with severe hostility from some participants. Recently it was also discussed at the 1996 Ranchi conference, where there was a workshop on lesbianism open to all women, attended by more than seventy women, and a closed evening gettogether only for "women who love women" (CALERI, 1999).

Support groups, magazines and helplines
Not much is known about the existence of lesbian support groups or activist groups in India prior to 1980s. Anamika, a South Asian lesbian magazine ran for a few years starting May 1985 but then become defunct. Shamakami, a newsletter for South Asian "feminist lesbian-identified women" made its debut from the US in June 1990. In July 1991, Sakhi was announced as a lesbian network coordinated from Delhi. Many other lesbian networks do exist in informal ways. Sangini is the first telephone help line and counseling service that is available for "women who are attracted to other women". This was launched in October 1997 with the help of Naz foundation, India. Sangini also organizes support group meetings for these women on a regular basis. Aanchal is another helpline for lesbian and bisexual women in Mumbai. Stree Sangam is a collective of lesbian and bisexual women in Mumbai. A group called Sapphoprovides support and counseling services for lesbian and bisexual women in Calcutta. Women's Network is a group of lesbian and bisexual women in New Delhi. CALERI (Campaign for Lesbian Rights) is a collective of individual lesbian activists and many groups which work in the area of human rights and democratic rights (CALERI, 1999).

Being a lesbian in India
"Lack of space for discussion of alternate sexuality (or sexuality period), and social denial of lesbian existence creates a situation wherein women are compelled to remain silent about their sexual orientation. Marriage is the norm and majority are married by the age of 29. Not only does these lead to problematic heterosexual bonds, it is a social imperative that imposes enormous constraints on the formation of the non-heterosexual identity. Thus many lesbian and bisexual women marry men due to family pressure, caste stricture, force, lack of alternative, or fear of facing the non-acceptance and also the loneliness that staying single might entail. Such homophobic social conditions contribute to psychological, emotional and sometimes physical distress" (Sangini, undated, ?2000). In India, once a woman recognizes attraction towards another woman, she may be confused about her feelings and starts thinking that she is abnormal. She can not share her feelings with her parents or even with her close friends. Many are caught in a sense of isolation and guilt. Since they lack even basic information on sexuality, they don't know how to deal with their feelings. In India, where arranged marriage is the norm and strict obedience to parents and conformity to social expectation are central to cultural identity, these women have little choice. Loyalty to the family or fear of making a stand block women from asserting their right to independent life styles. Sometimes these women may try hard to change, deny or erase their feelings in a variety of ways: some may get married thinking that their 'obsession with these feelings' will disappear after the marriage but only to discover later that it is not so; some may consider secret escape or even consider suicide as a release from these pressures; some educated urban women may also think of sex change operation for the sake of their partner or to escape social stigma. Not ironically, one may come across messages like "A 30 year-old gay man looking for a marriage of convenience with a lesbian" in the classifieds section of Indian gay magazines.

Lesbian women also find it difficult to meet female partners and to find a safe place to discuss intimate matters with them. Apart from the societal isolation, lesbian and bisexual women are also detached from eachother, as they are a fragmented and invisible community. Only in the Metropolitan cities, small informal communities of middle or upper class lesbian women exist, most invisible to the public eye.

Some women discover that they are lesbians or bisexual women only after marriage. They may be confused about "new" feelings of attraction to women, the possibilities of sex between women, concerns about the sexual transmission of HIV between women and other sexual health/hygiene concerns. But do these women consider divorce?. Very rarely, since they are economically (and possibly emotionally) dependent on their husbands. Also, their family may not accept them once divorce occurs. "The general opinion [i]s it [i]s important to maintain the 'social facade' of marriage and that being involved with a woman should not affect the functioning of marriage" (Sangini, undated, ?2000). While this view may not be widespread, the sad truth is lesbians in India don't have the economic independence and social support to resist marriage or to live with their female partner.

Absence of self-conscious lesbian identity in most women means their identity will remain 'invisible' in the society. Also, the social taboo is so strong that most of these women detest being called lesbians. This has hindered the formation of lesbian support groups and activist groups. Even lesbian-identified women may not be willing to come to support groups because they may find the idea of attending a support group as an alien or western concept. Also, there are some practical problems like time constraints due to domestic work, and attending a support group means they have to leave the house without informing their family.

Relevance of bisexual behavior of Indian women in the context of HIV transmission
"Disclosing one's orientation to counsel[ors], medic[al] and legal service providers is difficult with most assuming heterosexuality and having homophobic opinions. This results in the severe neglect of lesbian and bisexual women's mental and sexual health needs. That many women commit suicide, experience suicidal feelings and encounter frequent bouts of depression demonstrates this" (Sangini, undated, ?2000).

A woman who describes herself, as 'lesbian' should not be thought of as having low risk of HIV infection. Most of the Indian lesbians are behaviorally bisexual (since many get married) whether they like it or not. That means there is considerable risk of HIV transmission due to their bisexual behavior, and through certain sexual practices like cunnilingus with their female partners during menstrual period and sharing of sexual toys which can produce trauma. Also, once they get pregnant the risk of transmission to the unborn baby also exists. These issues need to be addressed in any comprehensive HIV prevention and care programs for women.

Research studies on Lesbians in India:
Few scientific studies are conducted on the sexual health of lesbians in India. And there is a very large gap in understanding about the prevalence of lesbian/bisexual behavior of Indian women and their relevance in the context of HIV spread.

The first author of this paper came across an abstract, "A comprehensive study on lesbianism and sexual behavior among women, BOSS & CIPCA Organization, India", in the abstract book of Fifth International congress on AIDS in Asia and the Pacific, Kuala Lumpur, 1999 (554/PSCD035, p42). The abstract reads, "A two year study has been conducted by BOSS & CIPCA Organization with a project coordinator (w) and 7 health counselors (w) in nearly 4 universities, and 22 degree college women's hostels, and eight working women's hostels in the southern province in India. A total of 20,902 women aged between 14 - 24 years were selected for personal talks regarding their sexual practices and awareness about HIV/AIDS. It is found that 33% of the women are accustomed to self-satisfying procedures, while only 9% have sex with male partners and 11% of them are lesbians. The others are controlling their sexual desires with the help of meditation and concentrating on their studies and other activities. We educated them through awareness campaigns in their hostels and provided them essential IEC". Surely this painstaking study needs appreciation until you see, " [We] Identified 211 women who are prone to lesbian sex and educated them about the HIV/AIDS and safer sexual practices and provided them behavior therapy to avoid lesbian sex. Most of the lesbians responded well to our awareness campaigns. 121 women have changed their behavior, the remaining who are addicted to lesbianism are unable to leave it, but are following safer sexual practices. We are still trying our best to bring about behavior change in them". The entire focus of this study was thus shifted from providing "sex education relating to HIV/AIDS and safer sexual practices" to hunting for lesbians and 'fixing' them. Also this study gives the term "behavior change" a new meaning. Is it not ironic that a women-only-team conducted this study?. Would they give "behavior therapy" to those women who have sex with men since the risk of man-to-woman transmission of HIV is much greater then woman-to-woman transmission?! This study reflects the Indian society's attitude in general to homosexuality as "a disease to be cured, an abnormality to set right, and a crime to be punished".

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The following description of 'identities'/'labels' are based on informal discussions and in-depth interviews with individual persons with different identities, and informal group discussions with persons with different identities (especially those in Chennai) by the first author. Thus, the following discussion represents the current views on some of the "Indian identities". If any person feels that a particular identity has been misrepresented or vital things of that identity are not expressed adequately, that is not intentional.

Language and terminology in the area of sexuality can be problematic. People's selfperceptions and self-identifications can vary widely from culture to culture, as well as within each culture.

Many women and men whose principal emotional-sexual attraction or conduct is towards people of the same sex will, for many reasons, not necessarily identify as ''lesbian'' or ''gay''. Some may identify with other analogous terms which are more meaningful in their particular cultural context. Others may not see their sexuality as a basis on which to construct an identity, or may find it difficult to apply a fixed label to their sexuality (Amnesty International, AI-index: ACT 79/003/1999).

Western typologies (in sexuality) are often not considered to be relevant in developing countries. Though no attempt has been made to 'box' an Indian identity into one of the 'western identities', occasionally however similarities and differences between certain 'Indian identities' and 'western identities' have been noted below.

(Note: The term 'Hijra' is used in North India, while the term 'Ali' is used in Tamil Nadu. Many NGOs/CBOs as well as health care providers commonly use the term 'Eunuch' to denote Hijras/Alis. Almost all Hijras/Alis call themselves only as Kothis.)

Hijras have been in India for centuries. In the ancient times, they occupied high political posts in the royal courts. They are believed to have special powers to bless or curse. They are organized into small visible communities (with their 'Guru' [spiritual leader or master] and other Chelas [disciples]) but they may live alone or with their male partners. Their traditional way of livelihood is by singing and dancing in festival occasions, marriages, birth of a male heir, etc. Also, sometimes they go for begging by clapping ("Thali") at market places and shops. Because of the gradual decline of income in these 'jobs' some are forced to enter into sex work.

Hijras are born as biological/anatomical males who reject their 'masculine' identity in due course of time to identify either as women, or not-men, or in-between man and woman, or neither man nor woman. There are no valid data to state how many intersexed persons ('hermaphrodites') are living in the Hijra community but they are likely to be extremely rare. According to Transpal Sentinel, a magazine for Indian crossdressers and transsexuals, intersexed persons may constitute a disproportionately small number, as small as one for 20 thousand or more. Hijras were regarded previously as cross-dressed homosexuals by some authors (cited by Serena Nanda, 1999) but Hijras are equivalent to the transgendered/transsexual persons.

Those persons who identify themselves with women often leave their birth families at a very young age and join the Hijra/Ali community. Lack of education, lack of other job opportunities and lack of economic/emotional support from their birth families compel many to enter into sex work for survival. Thus, Hijra/Ali community has mainly persons belonging to the lower socioeconomic status. There is no information about cross-gender identified males who belong to middle and upper class families. It is possible that such persons don't want to join the Hijra/Ali community because of various reasons (Transpal Sentinel, 1998).

Subgroups among Hijras:
The following classification is a slightly modified version from an article that appeared in a transgender magazine (Transpal Sentinel, 1998) in India.

1. Nirvan (Nirvan Kothi): Those who had undergone "Nirvana" (Salvation - as castration is known) i.e., removal of both testes and penis (voluntarily/willingly) and who are in woman's attire. These persons are usually known as "Nirvan Kothi(s)" or simply as "Nirvan(s)" with in the Hijra/Ali community. Traditionally, emasculation is done by a senior Hijra/Ali called 'Daima' (Hindi) or 'Thai Amma' (Tamil) which literally means 'mid-wife'. These days, many Hijras/Alis undergo emasculation operation by quack doctors (fake medical personnel).

2. Aquwa (Aquwa/Ackwa Kothi): Those who wear women's or men's attire, but who have not yet undergone castration but may or may not want to undergo castration in the future. Many live as women under a Guru, while training in singing, dancing and other rites of the community, as they wait to attain Nirvana. Some of them are under "Gurus" who teach them about female mannerisms such as how to speak, sit and make gestures like woman. [This is equivalent to the 'real-life' experience/test in the western countries, during which the person who wish to have sex reassignment surgery has to live as a woman for about one or two years]

3. Zenana: Here even though they think of themselves as woman, these persons don't want to undergo 'castration' because they don't want to meddle with nature (i.e., mutilate themselves). These persons may be in men's or women's attire. (Currently this term is not in common use with in the Hijra/Ali community. These days, these persons also come under Aquwa Kothis)

  • The term "castration" is used here to mean removal of the penis as well as the testicles, even though it usually means removal of testicles only. The term 'emasculation' can also be used to mean the same.
  • The above classification is a simplified one and the description given for the subgroups may not be accepted universally by the Hijra/Kothi community.)

Some Hijras who are yet to be castrated or don't want to get castrated may be in the men's dress. These persons are more likely to be confused with feminine homo/bisexual males (see later). Also this led to the prior misconception that "pure passive" homosexuals exist, since these transgendered persons practiced only or mainly receptive anal/oral intercourse. i.e., there was (and is) confusion in differentiating between uncastrated transgendered persons (uncastrated Hijras) and feminine homo/bisexual males.

(Thus, if we have to say in western terminology, Hijras/Alis are a heterogeneous group which include, but are not limited to, pre-operative transsexuals (in male or female dress), transsexuals in transition [under hormonal therapy], post-operative transsexuals and nonoperative transsexuals)

It must be understood that even the Hijra community often considers the terms "Hijra/Hizda/Hijde" (or the term 'Ali' in Tamil) as derogatory and demeaning. That term is used here only for discussion purposes and should not be attached any other connotation. Hijras/Alis usually refer to themselves as "Kothi" only(both in North and South India) and refer to their [Hijra] community as "Kothi lowg" (means 'Kothi community' in Hindi). The term 'Hijra/Ali' itself is considered to be derogatory by many Hijras/Alis (Kamal Dhalla and Ruth Lor Malloy, 1997).Thus the terms ""Hijra/Hizda/Hijdes" and "Ali" are gradually becoming more of labels than identities. However, within their community certain derogatory words like - 'Pottai (Tamil language)', 'Ombodhu (Tamil language)', and even masculine pronouns are freely used to refer to other 'Alis'. Recently, some Ali activists in Tamil Nadu has coined the term "Aravani" to replace the term "Ali" (though the term "Aravani" is not widely known or used).

Though Hijras can be asexual, many do have sex with men. Some Hijras engage in commercial sex work for lack of other options and are willing to leave this work if they are given alternative jobs (Timothy et al, 1999). Those earning their living as commercial sex workers do practice high-risk sexual behavior with their clients, casual and steady partners (since they practice receptive anal and oral intercourse) (Venkatesan C et al, 1999a). Some Hijras get "married" to a man and cohabit with him. Hijras call that man (or any man who only penetrates) as"Panthi", which (according to them) means 'real man'. A Hijra remarked, "We call those men as 'Panthi' who penetrate us. If we came to know that he is being penetrated by others, we don't like him and don't want to have sex with him…because one day or other he will also become like us". They don't seem to know the fact that a man can penetrate as well as get penetrated but still regard himself as no lesser than other men. This may be due to the conventional 'Indian way' of thinking, i.e. viewing the penetrator as "man" and those who get penetrated as either female or those who have feminine tendencies. This also reflects the tendency to view the penetrated person as 'inferior'. This follows the simple "heterosexist logic": woman is inferior _ woman gets penetrated by man _ any man who is penetrated by other man = feminine nature predominates in the penetrated man _ anything feminine is inferior = penetrated man is inferior.

Some Hijras get married to a female before joining the Hijra/Ali community and may also have children from that marriage.

The emphasis of the sexual role - 'penetrator and person who gets penetrated' - is more likely only to reaffirm their gender identity as woman. It is also very likely that for the same reason Hijras tend to have multiple male (man) sexual partners. Thus getting into sex work serves a double purpose - not only does it solve the problem of money but it also gives Hijras a psychological satisfaction since Hijras feel that men are coming to them since these men consider them [Hijras] as women.

If you think that since Hijras think of themselves as woman they don't penetrate, you could be wrong!. Ashok Row Kavi says, "We came to know that in some parts of Mumbai Hijras in sex work are getting more money from truck drivers than the female sex workers. On enquiry, much to our surprise, we found that these [uncastrated] Hijras penetrate [the anus of] the truck drivers and that is why they are given more money". If Hijras identify themselves with females and only consider those who penetrate as 'real man', then how come that they penetrate other 'man'!. Vatsyayana, in KamaSutra, while describing the virile behavior in women [purushayita], notes that certain women mount their male partner [upasripta] and sodomizes him [purushapasripta] (Alain Danielou, 1994). If women can penetrate and still regard themselves as woman, then there is no surprise if Hijras penetrate but still regard themselves as 'woman".

Bairupi or Bairupiya ('Fake Hijras')
In North India, some males mimic Hijras by wearing female dress and go for begging by clapping (so as to make easy money). Hijras claim that these fake Hijras (Bairupi), by their indecent behavior in public spaces and trains, spoil the name of Hijras.

Kothis are a heterogeneous group. It is unrealistic to expect that a single 'definition' of Kothi-identity will fit everyone with that identity. The meanings attached to Kothiidentity vary according to the region, language, age group, socioeconomic status, educational status, degree of involvement in Kothi community and even from one Kothiidentified person to another. Having said this, one can justify the diverse opinions held by different individuals and CBOs on Kothi-identity.

Traditionally, the 'definition' for 'Kothi' is - "males who show obvious feminine mannerisms and who involve mainly, if not only, in receptive anal/receptive oral intercourse with men". However, most of these feminine homo/bisexual males who identify themselves as 'Kothis' get penetrated as well as penetrate (Note: Sometimes the term 'Khada Kothi' is used in North India to denote some Kothi-identified feminine homo/bisexual persons who cross-dress and penetrate their male partners). Also, a significant proportion of them have bisexual behavior and many also eventually get married to a woman.

Most of the Kothi-identified males show varying degree of feminine mannerisms/behavior and also cross-dress occasionally. These persons are akin to "queens"/"drag queens" in western countries. If Kothis do have "feelings of a woman" and female mannerisms/behaviors, why don't they consider themselves as Hijras/Alis? This is a complex issue and may have more than one possible answer. This could be because the degree to which they identify themselves with woman may not be sufficient to warrant the 'Hijra'/'Ali' label.

As mentioned earlier, most (if not all) Hijras/Alis prefer to call themselves only as 'Kothi'. Thus there are two groups which share the Kothi-identity. One group is persons with Kothi-identity but those who don't think of themselves as Hijras/Alis. For the purpose of discussion, let us call these persons as 'simple' Kothis. Another group is the Hijra/Ali community, whose members identify themselves only as 'Kothis'.

The 'simple' Kothis don't cross-dress publicly except when soliciting sex work or in the Kootandavar festival in Tamil Nadu (But they are careful not to let their birth families know that they cross-dress). Many don't have an urge to undergo emasculation even though they cross-dress. But some do undergo emasculation and later may cross-dress part-time or full time. They are more likely to be living with their birth families or living with their wives. Some 'simple' Kothis don't socialize well with the Hijras/alis while some may mingle freely with them. Some of these 'simple' Kothis also consider themselves as 'Aquwa Kothi' since they are not emasculated (or don't want emasculation). Some do take female hormones for breast development though they don't want emasculation. In Tamil Nadu, 'simple' Kothis differentiate themselves from the Alis by saying -"Avanga romba patchaiya irupanga" (which means - "there are more patchai". Note: In Tamil language, the term "patchai" literally means 'green'). What they actually want to convey is - Alis are those persons who show obvious feminine mannerisms, puts on female make-up, are in women's dress most of the time, and who may or may not be castrated.

(Thus, in western terminology, 'simple' Kothis include, but are not limited to, 'drag queens', feminine gay/bisexual men [who might never cross-dress], male-to-female transgendered persons, pre-operative transsexuals, non-operative transsexuals and aleto- female transsexuals in transition, i.e., taking female hormones)

In contrast, Hijras/Alis are more likely to be in female dress almost all time, and more likely to have either undergone emasculation or have resolved to undergo in the near future. They are more likely to have left their birth families (or left their wives, if married prior to joining Hijra community) and living with other Hijras/Alis. Most Hijras/Alis consider 'simple' Kothis as "Aquwa Kothis in male dress and/or Kothis who don't want to undergo emasculation".

Some educated feminine homo/bisexual males who have "Kothi' identity alsoidentify themselves as "gay". They have learnt this English term through the organizations that work for Kothis and Hijras, or through their friends. Likewise, some self-identified gay men prefer mainly (if not only) getting penetrated. Some proportion of them, who socialize with Kothis, thus also identify themselves as "Kothis" because of their behavior. Thus one can see "dual identities" in India.

It must be understand that even though feminine homo/bisexual males may call themselves "Kothis" many persons are quick to point out that they are not "Hijras/Alis". Also, the very act of including "Kothis" under the transgender umbrella is resisted quickly by some educated feminine homo/bisexual males, as they don't consider themselves as 'transgender' (English term). On the other hand, many Hijras/Alis consider the term "Hijras/hizdas (or Alis)" as synonymous with "Kothis" even though they mostly prefer to call themselves "Kothis". These days, those Hijras who have access to NGOs/CBOs working with GLBT communities know the English term "transgender" and proudly call themselves "transgender" even though they might not have fully understood the meaning of that term.

NGOs/CBOs that work with MSM reach mainly "Kothis' and "Hijras" since they can be easily identified and approached in the community. Thus these organizations are 'missing' the majority of "men who have sex with men" who look "normal" ('straightlooking'), those who don't have a self-conscious identity, and those who don't cruise.Thus a major segment of MSM remains invisible and hard to reach.

Kothi/Kowdi bashai (Tamil) or Kothi/Kowdi basha (Hindi)
This refers to the code language that is used by the Kothis to refer to certain things (mainly sexual acts). Actually this is not a 'language' as such since only certain things are given code words. These code words have been developed so that exchange of information can occur freely in the public spaces without other persons understanding. Usually the code words that are used by 'simple' Kothis are essentially the same as that used by Hijras/Alis (who also call themselves Kothis). These code words vary from state to state in India.

The term 'Panthis' is used by Kothis/Hijras to refer to those persons who are 'real men' - in the sense those who only penetrate. Though it may also refer to rough and tough appearing men, a man who shows subtle feminine mannerisms may still be regarded as 'Panthi' if he only penetrates. These days, the term Panthi is used more loosely by Kothis/Hijras to denote heterosexual persons as well as any man who is masculine and who also has sex with women. This term is also used to denote the steady person (or 'special boy friend') of a Hijra/Kothi or the 'husband' of the Hijra. Some times the 'husband' or the steady partner is referred to simply as '(your) mard' [means man, in Hindi].

The sexual orientation of 'Panthis' is usually believed to be 'heterosexual' in orientation but fluid enough to have sex with Kothis/Hijras. There is a belief that 'Panthis' basically get attracted only to the feminine nature of Kothis/Alis and they don't have a homosexual orientation. But it is also possible that Panthis have homo/bisexual orientation but feel intimidated to have sex with other masculine males and thus prefer to have sex with Kothis/Alis who are feminine.

'Panthi' is more of a label than an identity since 'Panthis' came to know of that term only through Kothis/Hijras and they themselves don't take that term seriously. Some times calling oneself 'Panthi' is a matter of prestige since those who are penetrated are considered inferior. While it is possible that Panthi is only a penetrator because he is "lacking interest in experimenting in reciprocal sexual activities" as suggested by some authors (Asthana and Oostvogels, 2001), it is more likely due to the stigma attached to being a receptive partner. Some times a self-conscious homosexual (who might penetrate as well as receive) prefers the term 'Panthi' rather than the term 'Kothi'. Thus for sexual role playing some body has to take the Panthi role (penetrator) and somebody has to take the Kothi role (penetratee). Even a self-identified 'gay' man who socializes with Kothis has to say he is a 'Panthi' if he wants to have sex with a Kothi-identified person.

Panthis are either married to a female or eventually will get married to a female. Some of these 'Panthis' also have sex with other men (of any sexual identity) and may also penetrate as well as get penetrated (oral or anal). Though there is a general assumption that Kothis/Hijras may not accept their 'Panthis' if they know that their Panthis get penetrated as well, in reality as long as he behaves in a 'masculine' manner with Hijras/Kothis they are not rejected (however, this is not always the case).

Some Hijras/Kothis get 'married' to 'Panthi' even though that Panthi might have been already married to a female. Some may get 'married' to a Panthi and may also accept these Panthis wanting to get married to a female while other Hijras/Kothis may be possessive and may not easily be willing to 'share' their husbands).

Thus, in general, a combination of the following things can be used to find out whether a person is Panthi or not. Kothis/Alis generally believe that: A Panthi -

  • is masculine in appearance.
  • only inserts and never becomes a receptive partner to any one.
  • does not even touch the male genitalia (if not emasculated) of the Kothi/Ali.
  • only gets attracted to Kothis/Alis and not to other masculine males.
  • mainly gets attracted to females and thus has every right to have sex with females and to get married to a female (though some Kothis/Alis are very possessive).

[Note: Previously, the 'real man who only penetrates' used to be called 'Kowriya' or 'Giriya' in the 'simple' Kothi language and 'Panthi' in the Hijra language. These days, mainly the term 'Panthi' is used by Kothis/Hijras though the term "Kowriya" is still in usage in North India]

DANGA (this term is used mainly in Chennai, Tamil Nadu)
The term Danga is used mainly by the NGOs/CBOs to refer to Kothi. Even some researchers (Asthana and Oostvogels, 2001) have used the term 'Danga' rather then the term 'Kothi' while describing the different identities in Tamil Nadu. But 'Danga' is actually more of a label than an identity. Only a few Kothis (especially those who work in NGOs/CBOs) know that the term 'Danga' is used to mean 'Kothi'. Some mistakenly believe that 'Danga' is the English translation for 'Kothi' or officially Kothi is known as 'Danga'. A related term 'Saree Clad Danga' is also used by the NGOs/CBOs in Tamil Nadu to refer to Kothis who crossdress as well as to Aquwa Kothis (Alis) who crossdress. The term Danga is not widely used or known to the Kothi community.

"DOUBLE-DECKER" (the exact term used by Kothis/Hijras)
This refers to persons who get penetrated as well as penetrate, and those who may also have sex with women. It is because these persons get penetrated as well as penetrate other, Kothis classify these persons as a separate category - "Double-deckers". Since the term being a 'English' one, it means that this term has been only recently coined by the Kothi/Hijra community. The feminine mannerisms in Double-deckers are often overlooked, as they may be very subtle even though in some it would be obvious to any body. Some of these persons usually identify themselves only as 'Kothis' rather than 'Double-deckers' even though they 'accept' that they are 'Double-deckers' if questioned directly (Like - "Yes, that is how sometimes other Kothis call me"). Thus Kothi and Double-decker may not necessarily be mutually exclusive categories. It also may mean that sometimes 'Double-decker' is more of a label than an identity but it could be regarded as a subcategory of 'Kothis'. However, some may not call themselves as 'Kothis' but still accept the label 'Double-decker' (probably because they might think that calling themselves as 'Double-decker' is more prestigious than calling themselves as 'Kothi', since the latter means 'effeminate and being passive'). Almost all Doubledeckers eventually get married to a female.

The term 'gay' essentially has the same meanings as that in Western countries for the educated self-identified homosexual males belonging to the middle and upper class. But for some self-identified homosexual males the meaning attached to the word 'gay' may be sometimes quite different.

While some well-educated persons, regardless of their sexual orientation, may have never heard the term 'gay', other well-educated self-identified homosexual persons eventually do find a name to identify with - the English term 'gay'. They learn this term either while searching the library to find more information about their 'condition' or through other 'gay' friends. Thus the term 'gay' is not a familiar term even for well-educated persons, whereas the terms 'homosexuals', 'homosex' and 'homo' are usually very familiar. Even these terms may be sometimes confused with different things (The first author had personally heard a male patient saying - "I had homosex". Only after some time was it recognized that he was actually referring to masturbation as 'homosex').

The less-educated self-identified homosexual persons, who have access to NGOs/CBOs that serve MSM, eventually and inevitably come to know about the English terms - "Gay, Bisexual and Transgender". As these terms are not properly explained to them, these terms are used by these persons with their own personal definitions and they also experiment in equating the western identities with the Indian identities. For example: - the term 'gay' is used to mean all persons who are attracted to same-sex partners regardless of the gender identity of the persons. Thus eventually almost all the Indian identities like - Kothis, Hijra, Panthi, Double-decker, etc. comes under this term 'gay'. However the Hijras (especially those who are always in woman's dress irrespective of the castration status) are usually given the label 'transgender' (English term). Kothiidentified feminine homo/bisexual males are, however, quick to protest that they are not "Transgender". This is not because they fully understand this term but because it has become synonymous only with Hijras. The English term 'gay' has been 'translated' by some as "English Kothi"! (Some persons call English-speaking Kothi-identified persons as 'English Kothis'). Or alternatively some times 'translation' of Kothi results in 'Gay'. A Kothi-identified person said, "So what do you call 'Kothi' in English - Gay!".

(Note: In some CBOs, where gay-identified persons may socialize with Kothi-identified persons, gay-identified persons may say that they are 'Panthis' since these 'gays' don't want the Kothis to call them 'Kothis'.)


Unlike the western identities like 'Gay, Lesbian, Bisexual' that have some 'standard' definitions, there are no pre-existing definitions for the "Indian identities". Consequently, whatever a person thinks about his/her identity becomes the true essence of that identity to that person and whatever any other persons have to say about that identity becomes wrong. In other words, everybody (researchers as well as the community members) thinks that they are correct and others are wrong.

Many researchers/authors think in their own ways and their description of "Indian identities" is likely to be influenced by many factors like -

  • Through whom and by what methods have the information about various identities been collected (Eg: Whether the researcher really had discussions with persons with different identities or was the information collected through 'key informants'? Or whether the respondents were recruited through 'snowballing' method? - since that means persons are more likely to identify with others sharing similar views about that identity [not necessarily] and thus the sample is more likely to be 'homogeneous')
  • The conscious or sub-conscious influence of the knowledge the researcher has about western identities.
  • The censorship (by the researcher or the community members) of certain issues which may pose certain risks to both the community members with a particular identity as well as the researcher.
  • The meanings attached to the Indian identities, like any other field, changes over time. This means description of 'Indian identities' this year may be 'outdated' a few years later. Even if one thinks that identities are immutable, the meanings attached to those identities are not.

Sexual health outreach should attempt as far as possible, to respect the identities chosen by individuals and not attempt to force upon them western constructs such as gay or transgender. These days, the term "males who have sex with males" is used to indicate those biological males who have sex with other biological males. Then, in a strict sense, it includes Hijras (uncastrated and castrated), Kothis and other "men who have sex with men". Working definitions such as 'males who have sex with males' are appropriate for outreach as long as these are treated as behavioral categories which may include people with any of the above identities, males who don't identify as any of the above, as well as males who may subscribe to constructs such as gay and bisexual. However, due respect should be given to the sexual identity assumed by any male who has sex with other males.

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The sexual networks between persons with different 'Indian' identities and those with 'western' identities are illustrated in the diagram. One can see that there is a great potential of transmission of HIV/STDs among these different groups and also to their female partners and future children.

  • Persons with 'Kothi' identity mainly act as receptive partner, but many penetrate also (with different partners or on different occasions with the same partner). They have sex with Panthis, 'Double-deckers', 'Gays', 'Bisexuals' and persons with no selfconscious sexual identity. Kothi-identified persons usually don't have sex with other Kothi-identified persons, however many also have sex with females and a significant fraction of these eventually get married.
  • 'Panthi' is only a label. It is the Kothis who call their masculine male partners as Panthis. Thus, very few (if any) persons will call themselves 'Panthi'. Consequently most 'Panthis' also will come under the category of persons who don't have a selfconscious sexual identity. These persons, though believed to be only penetrators by the Kothis, also may act as a receptive partner with other 'Panthis' or 'gays'. Almost all Panthis have sex with females and eventually get married to a female. If the Panthis don't want to use condoms, then Kothis might have unprotected sex with them since if they insist on condom use they might loose these potential sex partners (Panthis).
  • 'Double-deckers' too, like 'Panthi', is only a label given by Kothis to those persons who insert as well as receive. Thus, some Kothis themselves are 'Double-deckers'. If a Kothi has sex with a person and that person penetrates as well as receives, then, according to the Kothi, that partner is a 'Double-decker'. But that person's identity may be 'gay', 'bisexual', 'Kothi' or may have no specific identity. Most 'Doubledeckers' have sex with females or eventually get married to a female.
  • 'Alis/Hijras' who have not undergone emasculation and wear male or female clothes (Aquwa Kothis) are usually attracted toward and want to have sex with masculinelooking males whom they call 'Panthi'. But, whether that person is 'Panthi' or not can be decided only after a sexual encounter with those masculine-looking males. A masculine-looking male is expected only to penetrate, and if he also wants to be a receptive partner then he is shunned. This emphasis of the receptive role being the very basis for the Kothi identity means Kothis are at high risk for HIV infection.
    (Note: 'Double-deckers' may have sex with 'Alis' who have not undergone emasculation, but they have to play only the 'insertor' role while having sex with 'Alis').
  • 'Alis/Hijras' who have undergone emasculation (Nirvan Kothis), needless to say, act only as receptive partners. They have sex with masculine-looking males whom they call 'Panthi'. 'Double-deckers' may also have sex with 'Nirvan Kothis'.
  • 'Gay' men have sex with other 'gay' men, Kothis, 'bisexual men' and persons who have no sexual identity. Some 'gay' men don't prefer to have sex with femininelooking/ acting males thus avoiding Kothis and 'Alis'.
  • Persons with 'bisexual' identity are very rare. They may have sex with other 'bisexual' men, 'gays', Kothis, 'Double-deckers', 'Alis' and persons with no selfconscious sexual identity. Almost all the 'bisexual' men have sex with females and eventually get married to a female.

Thus, it is important to note that there is considerable bisexual behavior among persons with any identity (except possibly 'Alis', even though some 'Alis' might already be married to a female before joining the Hijra/Ali community, or before emasculation). Also, many get married to women. They can not use condoms with their wives since the wife will then become suspicious of their husband's behavior. Also, it might be difficult to explain why they are using condoms if their wives have already undergone tubectomy (in India, many women undergo tubectomy after having two children).

Note: It is the Kothis/Hijras who have coined the terms 'Panthi' and 'Double-decker' to classify their male partners according to whether they only insert or also receive. Consequently, male partners of Kothis/Hijras will be labeled as 'Panthi' and 'Doubledecker' (by Kothis/Hijras) according to their sexual role. Thus these male partners of Kothis/Hijras don't have any "identity" like 'Panthi' or 'Double-decker'. Some times, Kothi-identified persons who receive as well as penetrate might say, "I'm Kothi. But sometimes I behave like Double-decker". Some Kothi-identified persons may have sex with other Kothi-identified persons by not exhibiting their feminine mannerisms. A Kothi-identified person says, "When I saw a Kothi to whom I get attracted very much, I act like a 'Panthi' [means - in a masculine manner] and have sex with that Kothi" [implying being the penetrator].

To summarize,

  • Identities may or may not have correlation with behavior/sexual practices, even though the basis of certain identities itself is having particular behavior/sexual practices. More research is required in this important area.
  • Complex sexual network among persons with different identities means rapid transmission/acquisition of HIV/STD from one group to another.
  • The complexity and magnitude of the sexual networks among persons with different identities makes it difficult to distinguish which group is actually the 'bridge' group.

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The presence of different identities (both indigenous and western) poses many challenges in bringing together the sexual minority community in India and uniting in the fight against HIV/AIDS for the following reasons.

  • In western countries persons with 'gay' or 'bisexual' identities have sex with one another (i.e., with persons having the same identity) and are organized on that common ground. In India, persons with identities like Kothis or Alis/Hijras do not have sex with one another but are organized on the common ground of their sexual role (being a receptive partner) and having feminine mannerisms. This means persons with these identities are relatively at high risk of HIV infection than those males who only penetrate (e.g., Panthis). Community outreach, peer education, and condom distribution should be useful strategies to educate Kothis about HIV/AIDS and safer sex, since Kothis mingle freely with each other and identify as a community.
  • In Ali/Hijra community, 'Chelas' [disciples] are under the control of 'Guru' [master]. Thus, there has been a suggestion that the 'Guru' can play a significant role in establishing and enforcing codes of safer sex behavior (Asthana and Oostvogels, 2001). While such a strategy sounds good, it is not without problems. For example, one Ali asked "How can an Amma (mother) give condoms to her own Ponnu (daughter)?" Note: In Tamil Nadu, 'Guru' is also called 'Amma' (mother) and Chela is also called 'Ponnu' (daughter). Community outreach, peer education and condom distribution can be useful strategies.
  • 'Panthis' and 'Double-deckers', as mentioned earlier, are only labels. Hence, it may not be possible to identity these persons and teach them about safer sex. They can be reached through mass media by broadcasting HIV prevention messages which talk about risk of unprotected sex between males. Also, the Kothis/Alis can be taught condom negotiation skills so that they have safer sex with their male partners.
  • 'Gay' (and 'bisexual') identity is present mainly in the middle and upper class educated men. Persons with 'gay' identity don't mingle with one another freely. Since 'coming out' is very rare and marriage is a cultural norm almost every one with 'gay' or 'bisexual' identity gets married. The stigma attached to homosexuality, not feeling the need to come out, the fear of being considered 'impotent' if not married to a female and the social pressure to get married all prevent a the gay-identified person from resisting marriage. Thus gay-identified persons don't find any valid reason why they should come out and fight for their 'rights'. Thus, while the 'individualistic culture' of the west helped in organizing the gays in western countries, the 'interdependent culture' of India prevents 'gays' from getting organized since they are unable to resist their family and social pressure. Gay-identified persons can be reached through CBOs as well as through appropriate mass media HIV prevention messages which the gay men can identify with.
  • Gay/bisexual-identified men may not want to mingle with persons with indigenous identities (like Kothis or Alis/Hijras) because of differences in socioeconomic status, educational status and presence of feminine mannerisms in Kothis/Alis. This means it will be difficult to bring together persons with different identities to jointly fight against HIV/AIDS.
  • Since many persons with any identity (except possibly Alis/Hijras) have bisexual behavior and also don't use condoms consistently with male or female partners, there is a high risk of transmission to their male and female partners (including wives) and future children
  • Since identities may or may not have correlation with behavior/sexual practices, no presumptions should be made about the sexual behavior/practices of persons with a particular identity. This is especially important in the preparation of HIV prevention education messages and in designing HIV prevention intervention programs for MSM with different identities.

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A research study was conducted in West Bengal, India in 1999, to study the sexual orientation and sexual identity of men who have sex with men. 52 MSM were asked to rate their preference on a 7-point (Kinsey type) scale on 6 variables, which distinctly describe the sexual orientation (Joseph Sherry, 1999). The composite score for sexual orientation showed that 55.8% are predominantly homosexual, 36.5% are predominantly bisexual and a small percent of 7% are predominantly heterosexual. When asked about how they wished to be known in their society, 44% did not have a name to be identified, 20% preferred to be known as bisexual, 18% as gay/homosexual and 9% as heterosexual. Moreover, 7.7% wished to be known as 'MSM' [a new 'identity'] and 2% as Dhurani [may come under transgender category]. This study shows the inconsistency between sexual orientation and sexual identity as shown by studies conducted in other countries.

Most often persons who have same-sex behavior used to say - "I like homosex" or "I have interest in homosex" (Or if some persons are questioned whether they ever have had sex with a man might say, "I'm not interested in homosex"). Some may say "I learnt this habit from my friend" or "This line [which means behavior or activity] was introduced to me by one of my relatives". For some persons 'homosex' is thus an activity, for some it is a 'habit', and for some it is a matter of whether one has interest in that or not.

The first author of this paper has come across hundreds of MSM in the STD clinic of Govt. General Hospital, Chennai, Tamil Nadu, where he got trained. Unlike in Western countries, here one cannot ask the patient whether he/she is a heterosexual, homosexual or bisexual. This is simply because there are no terms for them in Indian languages (though there are many derogatory terms to denote feminine males in almost all languages). In Tamil Nadu, a Tamil technical term has been coined to denote homosexual men, which is not widely used and unknown to many lay people; in Tamil newspapers the term 'lesbians' is used as such in Tamil language. Hence, here physicians used to ask
-"whether you have sex with woman, man or both"? In this setting, MSM (belonging to low socioeconomic status) were asked about how they see their same-sex behavior. The following responses were obtained.

- "I also have sex with women"
- "They [other men] only approach me [to have sex]"
- "I only penetrate"
- "It is only an outlet to release my tension"
- "Other men seduce me quite often"
- "We just help each other"
- "It is just for a fun"
- "That man told oral sex will relieve the itching sensation in his throat"
- "This will be over once I get married"
- "I'm married but only occasionally I have sex with men"
- "My wife doesn't allow me to do certain [sexual] acts. That is why I approach men"
- "My wife's vagina has become loose. Hence I have anal sex with men"
- "I'm happy with my wife but sometimes I just have to go out and find a man to have sex with".

All these excuses, denial of attraction towards men, blaming others for one's behavior, etc. are mainly due to the fear of social disapproval, rejection and discrimination. Not paradoxically, those men who are aware of the sexual attraction to other men feel very guilty about their behavior and even ask for converting them to "normal". 'Gay identity' is present mainly in urban, educated (middle and upper class) persons since they came to know of these English terminologies and have access to information.

To summarize, in general, the near lack of 'gay identity' in India is due to:

  • Homosexuality is never discussed openly.
  • Lack of specific terms in Indian languages for gays and lesbians.
  • Ignorance of the concept of sexual orientation and sexual identity.
  • Perceived homophobia in the community.
  • Internalized homophobia.

Bisexual identity is virtually absent in India mainly because (as discussed earlier) the concept of sexual orientation and identity is not known or understood by even people with alternative sexualities. Also, the English term 'bisexual' is not known or familiar even among well-educated persons. Often doctors themselves mistake this term to mean inter-sexed persons (formerly 'hermaphrodites').

If a person has bisexual behavior or attractions, he may simply ignore the same-sexual behavior /attractions as he is attracted to woman also. This is incontrast to a person with a predominant same-sex behavior/attractions since here this person may feel different because he may feel he is not having enough attraction to woman. Consequently he tries to find a 'label' for his condition and eventually finds one like - Gay, Kothi, etc. However in Indian men who are erotically attracted to both genders, the need to get a label or for that matter even to feel 'different' may not arise since they are also getting attracted to women.

Among these persons with bisexual behavior/attractions, some may be conscious about their attractions to either gender. These persons, who might think of themselves as 'bisexual' if they were in US, eventually get married. However it seems that no one uses the term "[heterosexually] married bisexual men" but only the term "[heterosexually] married gay men" (Note: Some MSM who don't have any self-conscious sexual identity and who may get married can be simply referred to as "[heterosexually] Married MSM"). Thus it is also likely that these persons are not actually 'forced' into heterosexual marriage but may willingly get into heterosexual marriage life.

Thus the term "married gay men" may or may not mean the following things: Some are actually "bisexual men" who don't regard themselves as 'gay' or 'bisexual'; some are actually not 'forced' into heterosexual marriage; some of these are actually 'gay' men who may or may not like having entered into a heterosexual marriage life.

As discussed earlier, the term 'Double-deckers' is used to specifically indicate those who penetrate as well as get penetrated. This criterion may be stressed by some as essential to this identity. Sometimes, persons those who have sex with both men and women are also called 'Double-deckers'. Thus using the first criterion, some authors (Asthana and Oostvogels, 2001) have suggested that 'Double-deckers' are coming closer to the western identity 'gay'. If the second criterion is used, then 'Double-deckers' may come close to the western identity 'bisexual (man)'.

Persons who have access to CBOs working with MSM also came to know the term 'bisexual' and sometimes prefer this term to gay or Kothi (One person says, "I would rather call myself a 'Panthi or bisexual' than as 'Kothi or gay'". Note: Here this person doesn't like the term Kothi because it implies 'being passive' and also he doesn't want the label 'gay' since he thinks it is synonymous with 'Kothi'. This also may indicate he is not quite serious about the bisexual identity).

Persons with true bisexual identity are yet to come out but surely the acknowledgement of such identity is on the rise which is indicated by the inclusion of 'bisexual' in the agenda of 'Gay' organizations as well as in the emergence of many GLBT organizations.

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Indian culture tolerated same sex eroticism for centuries. But the former British rulers found this repulsive, and declared it a crime in the Indian Penal Code (IPC), which was enacted in 1861. IPC section-377, originally drafted by Lord Maculy in the early 1830s, reads:

"Unnatural offences: Whoever voluntarily has carnal intercourse against the order of nature with either any man, women or animal shall be punished with imprisonment for life, or with imprisonment of either description for a term which may extend to 10 years, and shall also be liable to fine.

Explanation - Penetration is sufficient to constitute the carnal intercourse necessary to the offence described in this section" (ABVA, 1991, Lawyers collective, 2000).

The exact scope of this vague definition - "Carnal intercourse against the order of nature" -has generally been interpreted to include acts of anal sex as well as oral sex between males. The possibility of this definition being extended into heterosexual acts of anal or oral sex also exists but has not been tested. Consent of the other party is completely irrelevant for conviction but it may be a relevant consideration while fixing the quantum of punishment. It must be pointed out that homosexuality per se is not an offence, and an "act" of unnatural intercourse has to be proved. Though the law makes only anal (and possibly oral) intercourse between two males a crime, in practice and in effect it criminalizes homosexuality.

The legal status of homosexuality in the Indian Armed Forces follows the model set by section 377. Section 46 of Chapter VI Offences, of the Army Act, 1950 states: "Any person subject to this act who is guilty of any of the following offences, that is to say - a) is guilty of any disgraceful conduct of a crude, indecent or unnatural kind - shall on conviction by court-martial, be liable to suffer imprisonment for a term which may extend to seven years or such less punishment as is in this Act mentioned." Similar provisions exist in the Air Force Act, 1950 (ABVA, 1991).

Sec.377, which criminalizes homosexual behavior, is today responsible for the denial of various fundamental rights like life and liberty, health, privacy, speech, movement, etc., to the sexual minorities. The denial of these fundamental rights to sexual minorities lead to their enhanced vulnerability to HIV/AIDS by making them highly invisible and unreachable for HIV prevention education and for providing sexual health related services. It has also resulted in low self-esteem (which indirectly decreases condom use and increases risky sexual behavior), discrimination in employment, vilification, threats of physical violence, extortion of money from police, etc.

It is now an accepted postulate that the only way of protecting vulnerable populations from HIV/AIDS is by protection and promoting their rights, so that they are in an empowered position to protect themselves. However, due to S.377 IPC, effective interventions are rendered impossible because dissemination of information on anal and oral sex, distribution of condoms, etc. could be construed as abetment of a criminal act.

Many countries including the United Kingdom have decriminalized adult consensual homosexual acts. In India, however the same old British law is being followed blindly with out any inclination to reexamine it. Recently, the Law commission of India (LCI) has examined this issue while reviewing 'rape laws' and recommended changes to the existing laws. The LCI 172nd report has included in its recommendation the repeal of section 377 and has expanded the term 'rape' i.e., penetration of the vagina, anus or mouth with the penis, to any other part of the body. This report is a mere beginning and has not comprehensively dealt with this issue. Many human rights groups, GLBT groups, Child rights groups, and Women's groups are debating upon the LCI deliberations. They are trying to find out inadequacies in the LCI recommendations and to propose necessary changes.

Elimination of sodomy laws and legalization of marriage among gay men and lesbians are considered as one of the environmental structural interventions in HIV prevention (Kim M Blankenship et al, 2000). Hence it is high time that all discriminatory legislations on homosexual behavior be repealed in India in line with many European countries.

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Near lack of self-conscious sexual identity in India has prevented the MSM community from organizing themselves for a long time. Many attempts have been made since the late 1970s to start support groups for gays and lesbians and to communicate with gays through newsletters discussing issues relevant to gays in India, but only a few have stood the test of time.

As early as 1978, a gay newsletter called "Gay scene" was started from Calcutta. It ran monthly until it folded in 1980. In May 1985, Anamika, a newsletter for South Asian lesbian and bisexual women came out. The publication in 1986 of Trikone, a newsletter for South Asian gay men and lesbians brought out by two Indian graduates from California, USA, was considered as a major event for gay people in India who can read English. (Now it also addresses the rights of bisexual men/women and transgendered persons). Sympathetic coverage in Indian magazines like - Society and India Today brought its address to hundreds of people in the cities and small towns across the country.

In June 1988, Shakthi, a South Asian lesbian and gay network, was formed in London. Shakthi kabar, the newsletter of a South Asian lesbian and gay network, a few years later from London and like Trikone, was circulated free of charge in India. In June 1990, Shamakami, the newsletter for South Asian Lesbian and bisexual women, came out. Freedom, an "Indian Gay Newsletter" was launched from Gulbarga, Karnataka in August 1990 and was published monthly. The Golden club city of Bangalore was formed in March 1991 "to provide a nonjudgemental forum of like-minded people to meet and also to work for an amendment to the Indian constitution which is at present hostile to us".
There were also other transient groups (e.g. Gentlemen's club of Calcutta, 1989), which vanished as soon as they formed (ABVA, 1991).

In July 1991, Sakhi, a lesbian group, was formed in New Delhi. In November 1991, the groundbreaking report (on Indian homosexuality) by AIDS Bhedbhav Virodhi Andolan (ABVA), Less than gay, came out from New Delhi. In December 1991, Pravartak, a gay magazine from Calcutta, came out. In August 1993, Counsel club, was formed in Calcutta. Sangini, a telephone help line and counseling service that is available for "women who are attracted to other women" was launched in October 1997 with the help of Naz foundation, India.

Perhaps the most momentous gay event of 1990 was the appearance of Bombay Dost, a gay magazine edited by Ashok Row Kavi, an openly gay journalist. Dost received widespread sympathetic coverage in Indian media. It is brought out simultaneously in English and Hindi. Ashok Row Kavi together with two other gay men founded the Humsafar trust, which was subsequently registered as a public charity in Mumbai metro in 1994. The Humsafar Trust has four components: community work, street outreach, advocacy and research. The Trust educates men on STD and HIV/AIDS through its outreach programs as well as through its sister publication Bombay Dost. The Humsafar Trust has many credits to it in the area of sexual health of sexual minorities in India. It conducted the first HIV awareness survey among self-identified gay men and results were published in 1991. A rapid needs assessment with a participatory approach was conducted which led to the beginning of a skeletal street outreach and condom distribution network in 1992. The trust is responsible for organizing the first gay men's conference in the subcontinent after consulting all the gay groups in India, the objective of which was to network with peer leaders from the emerging gay groups in South Asia. The trust networks not only with other gay groups in India's larger metros but has taken upon itself the task of helping set up gay groups in smaller towns of India. In May 2000, the Humsafar trust organized the three-day conference called "Looking into the Next Millennium." (supported by : India Fund, UNAIDS, DFID & SIDA). One hundred ten gay and lesbian activists from around India attended this conference (international news #316 - May 15, 2000 (c) Rex Wockner). The conference was an effort to build a NGO network of sexual minorities and initiate sexual health interventions among them. As a result of this, 'Network India", which is the network of almost all the existing sexual minority community groups in India has been formed.

Many support groups of sexual minorities are being formed throughout various parts of India. The Kyodo News Service reported Feb. 5. that "[Indian] Authorities are registering one new gay activist group about every six months…" (From international news #304 - Feb 21, 2000, (c) Rex Wockner). Some of these support groups also have their own newsletters, which also provide information on HIV/AIDS and safer-sex practices. Also, access to the Internet has lead to 'Internet activism', and many informal Internet based gay groups like - Gay Bombay, Gay Calcutta, Gay Delhi, BiIndia, etc are being formed.

One can now see the emergence of 'GLBT' groups in India which fight together for their rights. These include organizations like- Sangama in Bangalore,Sambhavna in Mumbai and groups supported by Naz (India) Foundation Trust (HumNawaz, HumRahi, HumJoli) in Delhi. Other CBOs and NGOs which work with/for sexual minorities include Dai Welfare society in Mumbai, AIDS Bhedbhav Virodhi Andolan (ABVA) and Siddhartha Gautam Trust in New Delhi, Mitrudu, Expressions and Saathi in Hyderabad, Prajak, Sapphire creation, Pratyay, Integration and Counsel Club in Calcutta, Udaan in Mumbai, Good as You (GAY), Jagruti Gelaya, Swabhav, Snehashraya andSabrang in Bangalore, Mansa in Orissa, Social Welfare Association for Men (SWAM), Sahodaran, Sahodaran Prakriti, Chennai Mitra and South Indian AIDS Action Program (SIAAP)Trichi innovative AIDS action program in Tamil Nadu, Aravani in Kerala, Bharosa and Friends India in Lucknow, Aasrain Patna, Samantar in Pune, and Lakshya in Gujarat.

The reasons for the formation of support groups are many. Though the need to organize themselves has been mainly due to social and political reasons, some gay organizations are started mainly to create HIV/AIDS awareness among the gay community and to educate them about the safer sex practices. But it has been commented that Selfidentified groups [a]re being manipulated into wholly HIV based work and marginalized through some clever calculation" (Humsafar Trust, 2000b). While the formation of many groups may be welcome news for the gay activists, it has also has introduced new problems. "Strange tensions [a]re now evident in the emerging gay networks. Whereas just a decade ago, there was little politics within the networks, a new war ha[s] now erupted between 'Kothis' and gay-identified gay men. Suffice to say something strange [i]s happening" (Humsafar Trust, 2000b). It must be noted that this 'politics' in the sexual minority communities is seen only among the various self-organized groups and it is not applicable to the sexual minority communities who don't belong to or don't have access to these support groups/organizations. Understandably, the need for these various groups to work together is the top priority at this crucial time. Only when there is solidarity among these groups will the common goal of fighting against discrimination and stigmatization on the basis of sexual orientation and gender identity become successful.

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