Page 1 – YOUNG RESEARCHER OF THE YEAR AWARD WINNER 2014 Copyright © ESOMAR 2014 BRINGING THE INVISIBLE TO LIGHT Researching the homosexual community in India and cutting through the social stigma Pallavi Dhall ESOMAR ESOMAR Office: Atlas Arena, Azië Gebouw Hoogoorddreef 5 1101 BA Amsterdam Phone: +31 20 664 21 41 Fax: +31 20 664 29 22 Email: [email protected] Website: www.esomar.org Publication Date: October 2014 ESOMAR Publication Page 2 – YOUNG RESEARCHER OF THE YEAR AWARD WINNER 2014 Copyright © ESOMAR 2014 COPYRIGHT All rights reserved. No part of this publication may be reproduced, stored in a retrieval system of any nature, or transmitted or made available in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of ESOMAR. ESOMAR will pursue copyright infringements. In spite of careful preparation and editing, this publication may contain errors and imperfections. 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The police tells me that if I intend to indulge in such ‘wrong things’, then I am bound to be treated this way’’- said a 19-year-old boy during a focus group discussion in New Delhi, the capital of my country, India. I was not surprised, disheartened but not surprised. The ‘wrong’ that the police was referring to was that the boy is a homosexual; he has sex with other men. Just when we as individuals, communities and a nation begin to believe that we have moved past such blatant bigotry, instances and narratives like these burst our bubble. Although the existence of homosexuality is evident in the Indian culture since pre-historic times, as seen in different forms of art like paintings and carvings in temples, homosexuals are in reality depicted more as an anomaly. Therefore, the MSM (Men who have Sex with other Men) are highly stigmatized and those who are engaged in this type of sexual behaviour are usually treated with social contempt. Furthermore, the inequality arising from our normative constructions of masculinity, social attitudes towards feminized males and their ‘unusual or unnatural’ sexual practices, instances of sexual abuse, assault and rape, poverty and disempowerment, alongside legal prejudice impacts their identity in particular and life in general. The MSM are one of the ‘hard-to-reach’ population groups among various others, such as female sex workers, transgender, drug users, etc. The fear of prejudice, mockery, stigma and discrimination has isolated this group from the rest of the society and consequently made them inaccessible. The endeavor was to reach this section of hard-to-reach population through this research project. The target group was sexually active men who have sex with men and who were not taking services from any Targeted Intervention (TI) projects being implemented in the country by NGOs with support from the Department of AIDS control. In a country where even the existence of the MSM population is not acknowledged, the attitude with which they are faced with is among the least of our concerns. The vulnerabilities among men who have sex with other men are well established across the public health arena, especially with reference to HIV/AIDS and other sexually transmitted infections. Low rates of condom usage, multiple sex partners and inconsistent lubricant use make them more susceptible. Although the efforts of prevention and support in care have been going on for a while now, the Government records point out that the reach of such interventions has not been quite successful. The seclusion and society’s aversion to their acceptance has become one of the most significant impediments against the HIV/AIDS programmes in India. A major cause being that till late men-with-men sex was seen as immoral and unnatural, not just by the general public but also by the legal system, which has resulted in keeping these communities at bay from all the government initiatives and programs aimed towards HIV prevention and care as most of the MSM population remains hidden and ‘hard-to-reach’. In India, there is a cultural categorization of MSM population; Kothis (men who tend to be the ‘receptive’ male partner in anal and oral sex and typically have effeminate mannerisms), Panthis (men who tend to be the ‘insertive’ male partner in anal and oral sex) and double-deckers (men who are both ‘receptive’ and ‘insertive’ partners). The Panthis are usually ‘masculine’, which makes it easier for them to blend and align with the societal norms, consequently making them ‘harder-to-reach’. The proposal to carry out this research study to understand the HIV-related risk behaviours among the MSM community, apart from operational difficulties, also presented a fundamental complexity: how do we reach them? MSM groups generally do not disclose their identity to others due to the fear of social seclusion that they might face if their identity is revealed and make it difficult even for the NGOs/CBOs to contact them. So, the Page 5 – YOUNG RESEARCHER OF THE YEAR AWARD WINNER 2014 Copyright © ESOMAR 2014 challenge of the study was to identify and test a methodology to approach this inaccessible, dark and hidden section of the society. METHODOLOGY Probability sampling methods do not work with hard-to-reach groups since there is no sampling frame to choose from, there are no defined boundaries and most importantly there are strong privacy concerns. The MSM population is hard-to-reach and harder-to-sample. The plausible way to tap the hard-to-reach MSM seemed to be through the peers or their close networks and thus the use of Respondent Driven Sampling (RDS) was arrived at. RDS, in the past, has been studied and carried out to reach hard-to-reach groups, however, this study was the first of this scale to use it: across three states and with a sample size of 1650. RDS is a chain-referral system where current respondents recruit their friends/peers for the study to be future respondents. It employs a dual system of structured compensation: a reward for being interviewed and a reward for recruiting peers to be interviewed. Broadly, it combines snowballing sampling with the mathematical model that weighs the sample to compensate for the fact that the sample was collected in a non-random way. However, the selection of the initial respondents referred to as our ‘seeds’ provides an opportunity for making it representative across age, education and geographical area. Each of the selected seed is given three unique, non-replicable coupons which they further distribute among their peers for participation in the study.