• By the Government of India
  
  
• By NGOs
  
  
• By the Health care providers/Researchers
  

By the Government of India:

1. The assumption that homosexuality does not exist in India. Those who agree with the presence of homosexuality in India think that MSM population in India is insignificant (in numbers) to pay it sufficient attention.
2. Lack of understanding of the multiple forms of male-to-male sexual behaviors that take place in Indian society.
3. Lack of research data on the sexual behavior in general, and same-sex behavior in particular, of the Indian people.
4. The official data presented on the modes of transmission of HIV in India indicate that the mode of HIV transmission is 'predominantly heterosexual' in India. The small percentage quoted as due to homosexual transmission do not alert the policymakers to formulate HIV prevention programs for MSM population.
5. The assumption that HIV prevention programs for MSM are the responsibility of NGOs/CBOs and Govt. can only 'assist' them in their work (that too with limited funding).
6. In India, anal intercourse between two consenting adult men even in privacy is a criminal offense. Thus for the Govt. of India it may be a dilemma - to condemn homosexual acts on the one hand and on the other hand to actively encourage MSM to utilize HIV prevention services.
7. Inattention towards the call for repeal of section 377 of Indian penal code, which criminalizes homosexual acts since it might be believed that giving importance to this issue may only bring trouble to the ruling party. Consequently, gay/bisexual men will be suspicious and unwilling to utilize the services of Govt. of India.
8. Another potential problem the Govt. of India may have to face, because of homophobia, is opposition to HIV prevention programs for MSM both from within the ruling party and from the opposition parties.
9. Lack of political will to address the health of gay, lesbian, bisexual and transgendered persons in the Indian society, as they are not visible in the first place and also they are not a strong, united, influential, political force (and hence the assumption that their votes may not make any difference).

1. Denial of homo/bisexual behavior in the locality where the NGO works.
2. The perception that the necessary work needs to be done by gay and bisexual men within their organizations, or by some other NGOs, or it can be done only by gay voluntary organizations.
3. The perception that 'it is too difficult to work with the gay, bisexual and MSM communities'.
4. Lack of skills and infrastructure to work with the MSM community.
5. Lack of interest in dealing with MSM issues may very well be due to covert or overt homophobia. This homophobia can result in all manner of direct or indirect resistance to work effectively with gay, bisexual and MSM communities.
6. Funding for HIV prevention programs for MSM is often very limited and with minimal or no explicit government endorsement. This makes it difficult for the NGOs to start or sustain programs for MSM.
7. Lack of interest among the donor agencies in supporting and sustaining prevention programs for MSM, which makes NGOs concentrate on some other projects on HIV/AIDS.

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1. Lack of sexuality education among health care providers has led to prejudices and misconceptions about certain issues on sexuality. This may very well affect the way physicians or counselors ask sexual history or the way they take care of persons belonging to different sexual orientation or gender identity.
2. Only few persons carry out research on behavioral sciences, especially sexual behavior. Though this may be due to lack of interest on this subject, or due to lack of skills in conducting a sexual behavioral research study, it may very well also be due to discomfort in entering this area. In addition, researchers may think behavioral research does not warrant much attention, or it has no relation with the clinical area, and hence it is not worthwhile to enter this field. It may also be because of fear of being stigmatized if one works in the area of sexual behavior, especially with MSM.
3. Failure to understand that homosexuality is not a psychiatric disorder but a normal variation of human sexuality. Many Indian doctors still think of homosexuality as a 'sexual perversion' and believe that gay men need 'treatment'. If this is the attitude of the Health care providers, then one can very well imagine the attitude of the general public.

[Note: This is in spite of the fact that homosexuality is no longer considered a mental disorder and was removed from the list of psychiatric disorders by American Psychiatric Association (APA) in 1973 and from the International Classification of Diseases (ICD-10) by World Health Organization (WHO) in 1993. But the WHO's ICD-10 still retains a diagnosis of "ego-dystonic homosexuality", a condition in which the patient suffers from anxiety or discomfort about his or her sexuality.)

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