S. Menon Cheruparambil1, L. Kumaramangalam2, A.R.R. Kumar3 
1127 First Floor Sterling Road, Nungambakkam, Chennai - 600034, India, 2, Prakriti No 8, Jaganathan Road, India, 3Prakriti - Sahodaran, India

Issue: The spread of HIV in India has made hitherto covert male to male sex increasingly visible. However, the cultural and social contexts of this behavior are neither understood nor explored. Worldwide, successful HIV prevention programs have shown that behavior change to be efficacious and sustained has to occur within the context of individuals' lives and communities.

Description: In India, temple festivals are a very important part of people's lives. These annual celebrations draw large congregations from different parts of the country. In South India, two festivals have a specific significance to the MSM community; i.e. Koovakkam in Tamil Nadu state and Kottankulangara in Kerala state. Both these temple festivals sanction cross-dressing and this attracts hundreds of men who sexually access these cross-dressers. These sexual unions have religious sanction and this leads to indiscriminate and unsafe sexual acts. Traditionally Indians believe that our religion protects us from any infection and HIV prevention has primarily concentrated on heterosexual transmission. A staggering number of unsafe sexual acts take place at these religious festivals. In Kerala at Kottankulangara, on the last 2 days of a 10-day festival, men and boys have to dress as women to participate and light festive lamps in obeisance to Goddess Veerabattari Devi as part of a ritual vow or oath that needs to be fulfilled. The cross-dressed men and boys lead a procession of the Goddess into the village holding lamps and it is the prerogative of the onlookers to "eve tease" them in a sportive manner. In Tamil Nadu, in mid April Alis/Hijras (transgender) gather from all over India to participate in the annual Koovakkam festival; where they get married to the Lord Koothandavar and once the marriage is consummated, the following day the Lord is sacrificed and the Alis/Hijras become widows. What is most significant is that though interventions for HIV exist for both MSMs and Alis/Hijras in India, these programs have neglected to educate the need for safe sex during such festivals.

Conclusion: Any penetrative sexual act needs protection, irrespective of its religious sanction or otherwise, and MSM HIV intervention programs need to address and take the above issue into account, and educate the community-accordingly.

Presenting author: S. Menon Cheruparambil, 127 First Floor Sterling Road, Nungambakkam, Chennai - 600034, India, Tel.: +914 482 528 59, Fax: +914 482 528 69, E-mail:

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A. Bondyopadhyay 
7/10 Botawalla Bldg 2nd Floor Horniman Circle, Fort Mumbai 400023, India

Issue: There are laws in India which increase the vulnerability of MSM to HIV/AIDS by creating impediments to HIV prevention and care intervention and outreach work with the MSM community.

Description: Laws should enable the process of prevention of HIV/AIDS through intervention and outreach. However the legal framework in India contributes to exactly the opposite by marginalizing MSMs. For example laws relating to public nuisance and obscenity in the Indian Penal Code are often used to harass MSM outreach workers and other members of the MSM community. This results in increasing closeted high-risk behaviour. Harassment of the MSM community often takes place because homosexuality is criminalized under Indian law.

Conclusion: Therefore homosexuality must be decriminalized so that HIV prevention and care intervention and outreach work with the MSM community progresses unhindered.

Presenting author: A. Bondyopadhyay, 7/10 Botawalla Bldg 2nd Floor Horniman Circle, Fort Mumbai 400023, India, Tel.: +91 22 267 6213, Fax: +91 22 270 2563, E-mail: aidslaw@vs

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A. Jafar1, S. Khan2 
1Executive Director Bharosa, 21/6/5 Peerpur House 8, Tilak Marg, Lucknow 226 001, India, 2The NAZ Foundation International, London, United Kingdom

Issues: In Lucknow, like elsewhere in India, there are significant numbers of male youth 21 years old and under, unmarried but who are sexually active with other males. Often such behaviours arise because of a very restricted access to sexually active females because of socio-cultural reasons where unmarried females are socially policed by their extended families in a culture that is shaped by homosocial and homoaffectionalist frameworks. Many of these males are from low income groups working in tea shops, cheap restaurants, or begging. Others may well be still in government education schools and colleges, or homeless, vulnerable and stigmatised because of their class, caste, and age. They have no access to sexual health education, condoms, or STI treatment.

Description: Bharosa has implemented a youth sexual health programme that provides a social space to discuss personal issues of sexualities, sexual behaviours, sex education, safer sex promotion, and access to counselling, condoms and non-stigmatising STI treatment. Recruitment has been through word of mouth, personal friendships and sexual partners, where the age of participants in the programme are between 15-21. Skills building programmes have empowered the youth to manage and develop their services for their peers. These services include socialising meetings providing a variety of indoor and outdoor games, such as cricket, videogames, picnics, and so on. Regular sex education and sexual health classes are held, many now being presented by youth representatives themselves. The youth group members act as peer educators among their friends and peers in a variety of settings, sharing information about sexual practices, safer sex, STI/HIV/AIDS and condoms. They have access to psychosexual counselling both in a group or one-to-one, where questions about masturbation, male to male and male to female sex behaviours, identities, worries about desire, erections, ejaculations, wet dreams or shape/size of their penis are addressed in a sympathetic, non-stigmatising and supportive way.

Conclusions: Since November, 1998 when the programme was initiated; 1100 youth have participated, 360 counselled, 260 accessed STI treatment, 624 condoms have been used

Groups Developed: Cricket Team - Cricket Matches, Carom Board Team - Carom Board Matches, Singing Team - Antakshri Competitions
Knowledge of HIV/AIDS/STIs has increased from a zero base to 90%

Presenting author: A. Jafar, Executive Director Bharosa, 21/6/5 Peerpur House 8, Tilak Marg, Lucknow 226 001, India, Tel.: +91 522 208 689, Fax: +91 522 271 760, E-mail:

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S.R. M.N Jayaram Nagapp1, H.A.J. Amijikari Janarthanam2 
11369 18th Mn Road, 6th St, 'I' Blk, Vallalar Colony, Anna Nagar West, Chennai - 600 040 (Tamil Nadu), India, 2Indian Community Welfare Organisation, Chennai, India

Issue: Developing a close monitoring tool to assess the impact on MSM intervention.

Methodology: An exploratory ethnographic studies were implemented by I C W O 6 months before it started its intervention Research Team maped 72 crusing areas in chennai In the main crusing areas the Research Team had studied about their networks, timings pickup points, social meeting places, power structures, socio/economic profiles, risk behaviours, commercial network, type of male sex workers and their operation patterns

Results: Peer educators (contact person) 6885 persons were interacted and educated. 2755 were new persons and 2632 were followup 6481 IEC materials used in the education sessions, 11748 condom distribution 499 STD referral were given and 1848 condom demonstration were done

Baseline Survey Results: First baseline indicates 27% of condom useage and at the terminal of first year 40% of the condom use achieved

Conclusion: It is obvious from our experience the result clearly demonstrates a considerable change in the knowledge and in their sexual behaviour of among MSM in chennai. When we compare this site with other crusing areas in Tamil Nadu it is much clear that there is an impact of our intervention MSM from other cities and towns in Tamil Nadu consider MSM in Chennai as much more knowledgable and skilled in safer sexual behaviour MSM from other areas seek information from MSM in Chennai.

Presenting author: S.R.M. N Jayaram Nagapp, 1369 18th Mn Road, 6th St, 'I' Blk, Vallalar Colony, Anna Nagar West, Chennai - 600 040 (Tamil Nadu), India, Tel.: +91 44 626 01 92, Fax: +91 44 628 59 19,

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M. Setia1, M.R. Jerajani2, M.V. Gautam2 
18/49 Piramal Nagar, Goregaon - West, Mumbai 400062, India, 2Department of Dermatology, Sti & Leprosy, Mumbai, India

Issues: The need to address MSM related issues have not been adequately dealt with in the National HIV prevention strategies in India. The infections specific to this behavior have not been categorized in all the government statistics and the proportion of infections due to MSM activity has been labeled as 0.7% by National AIDS Control Organization (India). However we would like to present a different view of the population attending the STD clinic at LTMG Hospital, a tertiary care center in Mumbai (Bombay).

Description: Men who denied of having sex with a female or a male inspite of having a sexually transmitted infection were asked relevant questions in the lingua they could understand the reply was affirmative. By sensitizinng the physicians to this way of history taking about 30% of our patients reported some form of same sex behavior during their lifetime. We went to community at one of their meeting joints to invite them to attend the clinic but in the 3 months that followed only 3 patients attended the clinic, the reason being loss of anonymity and the illegality of the behavior and probability of the judgmental attitude of the treating physician. However most (75%) of our routine male STD patients who attended the clinic and reported same sex behavior did not associate any identity with it as it was not sex but only "masti" (mischief) with a very close friend or some discharge with a "gud" or "khajua". In the clinic, condom use by these men during such sexual activities was close to 1% (sometimes used) as "AIDS is spread by female sex workers and we are safe if we have sex with other men". Most (80%) of the men were in the age group of 20-30 years and the most common place of first sexual encounter was in a public toilet at one of the many railway stations in the metro. Some of them (40%) did receive some form of payment either in the form of money or `food and liquor'. For some young boys (4 cases) it was a form of easy and safe money. Many of them (60%) knew the exact places where they can be picked up and where they can pick up other boys for sexual activity. Inspite of this behavior at such a massive scale they were married or about to get married and were very comfortable with it. None of them associated transmission of HIV/AIDS with this kind of sexual activity.

Conclusions: Sexual networks of most MSMs are extended, difficult to ascertain and subject to denial. Those involved are at a high risk for the transmission of STIs and HIV but often do not frequently access the STD or health clinics owing to stigmatization and criminalization of the MSM behavior in India. A majority of these men are married; therefore their sexual activity has an impact on women's reproductive health. More scientific dialogues on the STIs present in this population and the behavioral correlates of the same are essential if we want our prevention efforts to be more successful.

Presenting author: M. Setia, 8/49 Piramal Nagar, Goregaon - West, Mumbai 400062, India, Tel.: +91 22 874 7048,

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M.H. Khan1, S.C. Menon2, L. Kumaramangalam3 
1127 First FL, Sterling Road, Nungambakkam, Chennai 600034, India, 2Sahodaran, Chennai, India, 3Prakriti - Sahodaran, Chennai, India

Issues: Most males who have sex with males, are either married or will get married in the future due to social and cultural pressures. The wives of those men are unwillingly exposed to various infections due to the indiscriminate sexual practices of these men.

Discription: SAHODARAN has an outreach team of 10 field officers who access the many hidden networks spread over the city of Chennai. with a population of 5 million and growing the male; female ratio 2:1 in Chennai City. The males above the age of 25 years are either married or will get married and those within the community of (males who have sex with males - MSM) are no exception. Hence sexual acts are manifold and not restricted to their female partners alone. The high incidence of HIV in the population of Chennai finds this an extremely suitable enviorment to be transmitted indiscriminately. As media and other HIV/AIDS awareness programs only target, the hetrosexual route of transmission, the majority of males are lulled into complaiancy, believing that male to male sexual behaviour is devoid of any risk of transmission of either HIV or any other Sexually transmitted infections (STIs)

Conclusion: The need of the hour is for the married MSM to realiase and assess their own risks and he/her ability and also accept responsibility for their indiscriminate sexual actions, vis-a-vis, risks unknowingly placed on their unsuspecting female partners.

Presenting author: M.H. Khan, 127 First FL, Sterling Road, Nungambakkam, Chennai 600034, India, Tel.: +91 44 825 2859, Fax: +91 44 528 69,

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L. Kumaramangalam1, C. Sunil Menon2 
1Prakriti, #6, Jaganathan Road, Nungambakkam, Chennai, India, 2Prakriti Sahodaran, Chennai, India

Issue: Multiple projects/Community Based Organizations (CBOs) exist amongst males having sex with males (msm) in India. However, internecine feuds have jeopardized the sustainability and efficacy of HIV prevention programs, as well as compromised the credibility of the community, especially with donors and the government.

Description: In the nascent stages of Sahodaran Chennai's inception, it became obvious that, despite much work being done by the msm community, due to lack of communication lots of misunderstandings had resulted in bitterness and an absence of trust. A sense of community was wanting even amongst people with similar lifestyles. Men with common needs and issues were unable to empower each other. A significant portion of Sahodaran's objectives is advocacy to create a socially and politically supportive environment, to enhance and sustain behavior change. The first step was to create a forum where msm programs & CBOs, from all over the country, could come together. To facilitate this, a national meeting, where 14msm led pro-grams participated, was organized by Sahodaran. This meeting enabled the msm communities from all over India to share their views and experiences, discuss common agendas and create a blueprint for a combined and constructive future protocol - MAANN.

Conclusion: The birth of MAANN has resulted in greatly improved communication between msm organizations, facilitated the sharing of information, especially technical expertise, increased the community's credibility with bilaterals and, more importantly government, at both National and State levels. Today MSM is on the National AIDS agenda in India.

Presenting author: L. Kumaramangalam, Prakriti, #6, Jaganathan Road, Nungambakkam, Chennai, India, Tel.: +91 44 827 622, Fax: +91 44 826 9625, E-mail:

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A. Hajra1, S. Chakravarty2, R. Sinha2 
1468A Block K New Alipore, Calcutta 700053, India, 2Pratyay, Calcutta, India

Over the last 3 years, Rakhi has emerged as a major event in the social and cultural calendar of MSM in Calcutta and its suburbs. The symbolism of Rakhi has been extensively appropriated to celebrate friendship and solidarity among feminised MSM in the form of a festival cutting across barriers of caste, class, creed, language and gender orientations.

The findinds of the Operations Research recently concluded by Praajak the NGO that supports Pratyay has corraborated the instincts of field workers that occasions and events where the participation of members of the MSM networks is spontaneous, can provide a platform and a space for dissemination of sexual health information in a cost-effective manner.

It was also understood that if such an event was directly organised by community support groups of MSM themselves, the mobilisation of people for such an event becomes easier. A successful experiment in event celebration had already been concluded in April. This was a cultural function organised by Pratyay, the only support group for MSM in Calcutta. It was called "Baisakhi Jalsa" and it was held to mark the successful completion by Pratyay of the first year of its existence. This programme showed that sexual health messages, especially with regard to condom usage and the issues that an HIV + MSM may have to face could be presented to the audience in the guise of entertainment.

This encouraged us to think of utilising the occasion of Rakhi Utsav to spread the message of sexual health. It was also decided that an indoor Rakhi Mela will be organised to celebrate Rakhi and Pratyay would actively participate, in its capacity of being a community based organisation, in campaigning, organising and looking for financial assistance. This would also help build capacity in Pratyay to handle events in a professional manner.

Presenting author: A. Hajra, 468A Block K New Alipore, Calcutta 700053, India, Tel.: +91 33 400 0455, Fax: +91 33 400 0592,

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K. V. Singh 
Development, Advocacy and Research Trust (DART), 143 A, 2nd Floor, Gujar Dairy, Gautam Nagar 110 049, India

Issue: HIV/STD risk reduction amongst resource poor MSM (males having sex with males) in Delhi, India.

Description of the Project: MSM are the most discriminated and harassed group without access to medical, health, and other support services. The project methodology is based on 3 important components and principles:

(1) Psycho-Social issues: Dealing with fear, shame, humiliation, low self esteem, no confidence, lack of social acceptance, tensions of joblessness, alcoholism in the family, marital discord, pressures to marry, have a child, etc. through training, personal counseling, group exercises and confidence building. Support meetings and 'buddy networks' are instrumental.

(2) Economic issues: The second most important component is an ability to earn a living. building linkages within and outside the group for economic support, employment opportunities and skills development.

(3) Access and availability of sexual health services: Appropriate and timely referrals for STD treatment, counseling referrals.

Looseness=1 Conclusions: Trends observed in 1 year: Training, skills building, networking, support (buddy groups/peer acceptance) has lead to an enhanced self-esteem and self-confidence level within the group. Many of them are now ready to take charge of their life and accept behavior change for HIV prevention as a lifelong continuous process. Many more are employed and regular on their jobs, HIV prevention issues are being discussed informally amongst peers. The network has for the first time talked about their feelings, hopes and aspirations, going beyond the limited discussion on sex and sexuality. There is a ongoing discussion on discarding all labels (we are using MSM here to explain the issue), preferring not to make their sexual preferences/behaviors as the central and core theme of their life. Wherever possible and necessary, female partners of the MSM were also accessed for counseling without disclosure and in a confidential manner.

Presenting author: K. V. Singh, Development, Advocacy and Research Trust (DART), 143 A, 2nd Floor, Gujar Dairy, Gautam Nagar 110 049, India, Tel.: +911 165 611 28, E-mail:

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A. Lahiri 
468A Block K New Alipore, Calcutta 700053, India

Issue: The practice of anal sex, is the basis of an identity for kotis (feminised MSM). They take on the persona of a woman and generally perceive themselves as penetrated males. Thus where the formation of an identity itself is based on the grounds of an unsafe sexual act, any Behaviour Change Communication (BCC) towards safer sex, thwarth their sense of a personal identity. This hinders community development. The author perceives that the present identity is gaining ground, as there is no alternative identity, and hence it is becoming increasingly difficult to check the practice of unsafe sex and HIV/AIDS transmission. However if the present identity (that of a feminised male) be reinterpreted not in terms of sexual acts but in terms of a gender construction, a new way of perceiving themselves is promoted. And this is where the role of culture and religion can play an important role, to foster the new sense of identity. Enabling the kotis towards behaviour change without endangering their sense of identity.

Description: This is the primary reason why Pratyay, the support group for feminised MSM have laid stress on the koti identity, not on the basis of any sexual behaviour (anal penetration) but in terms of gender construction. The findings of the Operations Research Survey showed that addressing the koti population from a gendered point of view yielded better results in terms of HIV/AIDS education and behaviour change, peer support and community building. As part of the operations research seminars, group discussions, reading sessions, etc were some of the ways through which the reinterpreted identity was advertised and developed. Examples were given from Hindu religion, cults and cultures and characters like Mohini and Ayappa towards a gendering of the male. Through the group discussions, kotis themselves formed a new identity based on gender developing on the Hindu mythlogical character of Gandharva. Socio-economic cultural groups were formed based on the new identity.

Conclusions: The advantages of promoting a new sense of identity are: (1) The scope of the old identity enlarging, more and more feminised MSM can become a part of the community, resulting in the emergence of a big social group with a new koti identity that helps bridge the gap between them and mainstream society, enabling socials support, (2) The new basis of the identity, promotes behaviour change, (3) The development of a culture of condom usage and a shift towards safer sex behaviour, (4) Socio-economic groups enable kotis to set up small scale cottage industries resulting in an improved economic condition. This develops self esteem.

Presenting author: A. Lahiri, 468A Block K New Alipore, Calcutta 700053, India, Tel.: +91 33 400 0455, Fax: +91 33 400 0592, 

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S. Rao1, S. Menon2 
1Sahodaran, 127 First Floor, Sterling Road, Nungambakkam, Chennai 600 034, India, 2Sahodaran, Chennai, India

Issues: With sex being taboo in India, more so for the homosexuals, the gay community finds it difficult to discuss issues related to their sexuality and lifestyle with family and friends. Given the existing conditions prevailing where the very concept of homosexuality is ignored, the gay community in Chennai needed a supportive environment where they could be comfortable with their choices and discuss issues.

Description: Sahodaran realized that gay men are uncomfortable with the kothis - men who identify with the opposite sex and behave so, with there being socio-cultural biases which precluded them interacting, and there was felt a need for the formation of an independent gay peer support group. So using the friendship network, 4-5 gay men accessed Sahodaran's technical capacity and venue to form a peer support group. The group from its initial small start has now grown to include about 20 regular members with frequent drop-ins from other parts of the country. The group meets regularly once a week for a couple of hours and provides a forum for discussion of issues vital to the gay community. It provides a meeting ground for like minded gay people to interact, come to terms with their sexual orientation, share their experiences, and to create awareness of health issues such safe sex practices and HIV/AIDS awareness. Speakers from the fields of law, human rights, media, health/medicine, and from other related fields address and counsel specific issues. Now Chennai Mitra provides counseling services, a secure environment for drop-ins, access to legal services, and advocacy.

Conclusion: It has been established that there exists two groups, the kothis and the gay community, whose needs vary and therefore require their own respective peer support groups. The emerging middle class in other towns also need similar peer support groups for the empowerment of individuals and the community.

Presenting author: S. Rao, Sahodaran, 127 First Floor, Sterling Road, Nungambakkam, Chennai 600 034, India, Tel.: +91 44 825 28 59, Fax: +91 44 825 28 69, E-mail:

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S. Balasubramaniam 
5 Natarajan Street, Chennai 600083, India

Issues: This paper examines the status of homosexual rights in India, gay sexual practices and health and special condom needs for the homosexual population and how they are addressed by a Gay community organisation in Chennai.

Description: Homosexuals in India are not allowed to exist; the general population believes that homosexual practices cannot be allowed and that homosexuals should be beaten, harassed, even put to death by the authorities. Gays are forced by family into heterosexual marriages. Community Based Organisations have been started all over India; the author's initial organisation in Tamil Nadu was the prototype. Currently a Gay HIV+ groups are being developed.

Homosexual prostitution clients come from all socio-economic classes; condom usage is low and is a special problem when alchohol is involved. The author is gay and has been living with an HIV+ diagnosis since 1993. He was the first Indian man to come out as Homosexual and has faced persecution for his stand from within and without his community.

Conclusion: Currently, the gay community is splintered and confused. Motivation is necessary from groups already formed and active. An India-wide movement is forming to fight for gay rights and medical services at the government level.

Presenting author: S. Balasubramaniam, 5 Natarajan Street, Chennai 600083, India, Tel.: +91 44 371 2324, Fax: +91 44 442 0651,

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D. Vaswani, A. Bamne, P. Nigudkar, A. Gogate 
Mumbai Districts AIDS Control Society, Mumbai, India

Issues: Eunuchs, the proportionate segment of society has remained its inert part with religious backing in early days & indifferent attitude in present era. This has caused the problems for tackling the issues of eunuchs. Over a period of time due to increased cost of living there is a change in their life style & are indulging in unsafe sexual practices. This has posed a threat to the community as the spread of HIV/AIDS is facilitated through them. Hence an urgent need to intervene was felt by City AIDS Control Society.

Description: Eunuch community existed in every nook & corner of city, the society has not accepted them as a part of culture & constituent element. With urbanisation, overcrowding & other impacts of adoption of modern style of living, the Eunuchs change their life style and are indulging in unsafe sexual practices (anal & oral sex). Prevalence & spread of HIV/AIDS amongst Eunuchs & general population is emerging out to be a critical problem. Eunuchs community is not properly organised & is like hard core to reach due to their system of hierarchy & powers adopted by them. The estimated number of Eunuchs in the city of Mumbai are >25000. 40% of which indulge in sex trade. The sero positivity amongst tested was 35%. Hence need of intervention is realised. Therefore the process of organising, involving, encouraging & supporting them was started. 15 Active Members of Eunuchs community were called upon & were oriented about the ensuing HIV/AIDS problem. This group was supported for formation & registering as NGO in August 1999. Eunuch mapping was done & till date 980 Eunuchs at rest & intervene. 760 eunuchs examined for STDs, 60% treated for STDs, 90% of the eunuch counselled for health seeking behaviour & 92% accepted condoms during sexual act.

Conclusion: Comprehensive intervention with Eunuchs, resulted in adopting safer sex practices, utilisation of condom & health seeking behaviour by 980 Eunuchs with snowball effect.

Presenting author: D. Vaswani, 10 Gokul Kunj, Plot 717 Ird Khar West, Mumbai 400052, India, Tel.: +91 22 646 24 83, Fax: +91 22 410 02 45,

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S.H. Appaduraihirudayanathan 
169 Nelson Manikam Road, Choolaimedu Chennai 94, Chennai 600094, India

Issues: Eunuchs as a group are discrminated against severely in South India, they are deprived of all basic needs. They are illiterate, jobless and alienated from family and community. Their only source of income is sex work. Thus they are at great risk of HIV/AIDS infections. Even if they recognize their vulnerability, they are forced to continue in this work for their survival.

Description: Eunuchs in Chennai formed an association in 1994. There are about 500 members, allowing for migration between cities. 40-50 are currently diagnosed as HIV+. The purpose of the association is to act as a support system and for the upliftment of their economic and social status.

The Eunuch lifestyle itself is a high risk one, the threat of HIV/AIDS is a source of constant anxiety. 6-8 clients are serviced in a day, generally both oral and anal sex. Out of 8 clients, only 2-3 will agree to condom use. Clients come because curiosity concerning eunuch's genitalia and because of low cost (1/2 that of female sex workers). This paper is based on counselling sessions, community organisation work, peer educations and HIV+ self help groups conducted by the authors.

Conclusion: Special attention needs to be given to this misunderstood group, including support, income generation alternatives, reduction of risk behaviour through education, improved medical treatment and nutritional programmes.

Presenting author: S.H. Appaduraihirudayanathan, 169 Nelson Manikam Road, Choolaimedu Chennai 94, Chennai 600094, India, Tel.: +91 44 374 4659, Fax: +91 44 442 0651, E-mail:

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V. N. Sabapathy1, L. Arulraj2, D. Shivakumar2 
1Prakriti, #6, Jaganathan Road, Nungambakkam, Chennai - 600 034, Tamil Nadu, India, 2Prakriti, Chennai, India

Issue: The VRIDDHI project with sex workers in Villupuram, in Tamil Nadu, also works with a unique population ALIs or transgendered people. They live in a closely-knit community of more than 700, and as elsewhere in India are highly stigmatized by others. They are all engaged in sex work, but their awareness about STD/HIV/AIDS was very low, as also condom usage.

Methods: Through initially unresponsive, through beneficiary friendly outreach work, rapport was estab-lished and their confidence and trust gained. Using one to one interaction and group meetings and through folk and live media awareness on STD/HIV/AIDS was imparted and the need for them to adopt preventive steps, especially for STDs. As neither male doctors nor female doctors were willing to treat them, a dedi-cated service-minded male health care provider was recruited as part time employee and trained to give im-mediate treatment for their STD problems. This doctor was also trained to examine and treat for anal STD, counsel patients and prescribe condoms. Free condoms were distributed to both Ali's and their clients. Clients were also targeted whenever possible with non-judgemental attitude. And behaviour change communi-cation counseled. Some clients were also referred to our doctor for treatment of STDs.

Results: The Ali community's response to our intervention was dramatic. Awareness and perception of self-risk increased considerably. Clients are not entertained without condoms. They even sold condoms to the clients, who did not bring condoms.

Conclusion: Successful sexual health programs worldwide, have shown that participatory, stakeholders friendly attitudes & strategies have succeeded in sustainable behaviour change. We should not be judge-mental or stigmatize any community because of their lifestyles. Therefore we should implement effica-cious, contextual programs that promote and sustain safe sexual & health seeking behaviour.

Presenting author: V. N. Sabapathy, Prakriti, #6, Jaganathan Road, Nungambakkam, Chennai - 600 034, Tamil Nadu, India, Tel.: +91 44 827 62 22, Fax: +91 44 826 96 25, E-mail:

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S. Moses1, T. Abraham2, J. Devadass2 
1No.8, I-Floor, Thiruvallurvar Nagar, Anna Nagar East, Chennai - 600 102., India, 2Chennai, India

Issue: Western Bio-Medical categories of homosexual and heterosexual do not adequately explain the Indian context. In fact, there is a third gender involving genetic males called Ali in South India dressing as women and being non-male and non-female. A majority of these Ali are castrated and work as sex workers performing the receptive role in anal and oral intercourse due to which they are at high risk of HIV/AIDS infection.

Project: An estimated 500 Ali reside in Madras and lead a communal-type existence under the guidance of their leaders or Gurus. Given their high dependence on prostitution and the low access to STD/health care, an integrated approach was evolved within the broader health and socio-economic context. The Gurus were oriented and appointed as community resources persons responsible for health education and to provide referral services for social and health needs. Condom promotion was also taken up through the Gurus. Additional income generation was started through vocational training programs like envelope and doll making. Literacy and social uplift programs were organised and integration of Ali with mainstream society initiated.

Result: The use of Gurus as change agents ensured that the community participated completely. The increase in social visibility of Ali as people 'who are not just strange beings but who are actually doing good work' improved their status in society. Increased additional income generation also minimised their dependence on sex trade and they could refuse clients refusing condom use. Reported consistent condom usage is as high as 62% (Jan'98). Increased access to health care has also increased Ali seeking adequate and early health care thereby increasing their health conditions.

Lesson Learned: AIDS prevention calls for an integrated community mobilisation approach that addresses the community priorities and basing HIV/AIDS within the socio economic context.

Presenting author: S. Moses, No.8, I-Floor, Thiruvallurvar Nagar, Anna Nagar East, Chennai - 600 102., India, Tel.: +91 446 461 641, Fax: +91 446 445 604, E-mail:

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V. Chakrapani1, S.D. Fernandes2, J. Mallika2, M. Ganapathy2 
1Madras Medical College - GGH Campus, Room No 9 New PG Quarters, Chennai 600 003, India, 2Madras Medical College, Chennai, India

Background: A study on the sexual behavior of men who have sex with men (MSM) and men who have sex with men and women (MSMW) in each locality is a must so as to tailor any intervention programs according to the local needs. Also, such a study can serve as a baseline, based on which intervention programs can be evaluated in the future. Sexual behavior of MSM and MSMW in Chennai, Tamilnadu, which put them as well as their partners at risk of Sexually Transmitted Infections (STIs)/HIV-infection is explored in this study.

Methods: In this ongoing study, four MSM/MSMW (including sex workers) are trained to ask about sexual behavior and fill up a structured questionnaire on the same. Men with homosexual and bisexual behavior are interviewed at the field level (i.e. mainly at the cruising areas, in Chennai) and by snow balling method. The information which are recorded include: socio-demographic characteristics; level of comfortability with their sexuality; type of sexual practices with their steady partners, casual partners, spouse and sex workers; consistency of condom use; attitude towards safer sex practices; alcohol and injecting drug use, etc.

Results: Though anal sex is not very commonly practiced, unprotected anal intercourse (homosexual and heterosexual) as well as unprotected oral sex is not uncommon among those who practice them. Other sexual practices include mutual masturbation, intercrural intercourse, fingering, introduction of some objects (as sex toys) into the anus, oro-anal contact, breast sucking, etc. MSMW do not consistently use condoms with their steady male or female partners/spouse. Many felt that it is very difficult to talk about using condoms with their partners. Also, many agreed that it is difficult to use condoms when they are very excited.

Conclusions: Safer sex messages should not only address vaginal sex but also anal and oral sex. Steady partners of MSM and MSMW are at risk of STI/HIV since condoms are not consistently used while having sex with them. Consistent use of condoms should be emphasized not only with casual partners but also with steady partners. Condom negotiation skills must be taught in addition to emphasizing the importance of using condoms even in excited situation.

Presenting author: V. Chakrapani, Madras Medical College - GGH Campus, Room No 9 New PG Quarters, Chennai 600 003, India, Tel.: +914 482 307 02, Fax: +914 482 569 00, E-mail:

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