In India, there remains a large gap in actual information on sexual behavior, especially among MSM and gay-identified men. This sector is most difficult to reach. Stigma and denial attached to these behaviors has pushed it underground. Whatever little material exists indicates strongly the need for intervention among MSM in India.
Kumar B and Ross WM state that 'Very little systematic research is published on homosexual behavior in the Indian subcontinent in terms of actual practices and associated HIV transmission risks" (Kumar and Ross, 1991). NACO too acknowledges, "…little is known about MSM behavior [in India]" (NACO, 2000).
McKenna says, "This absence of enquiry - this failure of research - is in one sense self-perpetuating: if no information exists on sex between men, then sex between men must either not exist or be so rare that it is statistically insignificant in any consideration of HIV and AIDS" (Neil McKenna, 1996).
In a review of HIV prevention interventions in developing countries, Merson et al note, "It is evident from our review that there are three high-risk populations for which there is a dearth of evaluated prevention interventions in developing countries - men who have sex with men, youth and IDUs [injecting drug users]. Notably absent from our review were scientific evaluations of programs that focused on men who have sex with men. These populations are often difficult to reach in many countries because of the stigma associated with homosexuality, but are urgently needed in view of the high-risk of HIV infection among gay men" (M H Merson et al, 2000).
Regarding the reasons for the lack of HIV prevention intervention research in developing countries, Merson et al say, "…One of the most important reasons for the small number of scientific evaluation of HIV prevention interventions in developing countries has been the limited number of researchers in these countries with appropriate training…A fundamental step in improving prevention research in low and middle-income countries must be to expand the training of social scientists and epidemiologists, so that more of them are able to conduct the much needed prevention intervention research" (M H Merson et al, 2000).
Whether the first decade of this new millennium will also be characterized by remarkable lack of attention devoted to the situation of MSM in India remains to be seen.
Kumar B and Ross MW. Sexual behaviour and HIV infection risks in Indian homosexual men: a cross-cultural comparison. Int J STD AIDS, 1991 Nov-Dec;2(6):442-4.
Michael H Merson, Julia M Dayton and Kevin O'Reilly. Effectiveness of HIV prevention interventions in developing countries. AIDS 2000, 14: (Suppl 2) S68-S84
NACO, 2000. India responds to HIV/AIDS. A strategic response to the HIV epidemic by the Government of India, the UN and its development partners in India.
Neil McKenna (1996). On the margins: Men who have sex with men and HIV in the developing world. London: Panos Institute.