HIV PREVENTION AMONG MEN WHO HAVE SEX WITH MEN (MSM) IN INDIA: REVIEW OF CURRENT SCENARIO AND RECOMMENDATIONS Venkatesan Chakrapani, Ashok Row Kavi, L Ramki Ramakrishnan, Rajan Gupta, Claire Rappoport, Sai Subhasree Raghavan (April 2002) INDIA Venkatesan Chakrapani et al, 2002 HIV prevention among MSM in India, 2002 1 Authors’ Affiliations and Addresses: Venkatesan Chakrapani, MD, Consultant physician, Social Welfare Association for Men (SWAM), Chennai, India. E-mail: [email protected] Ashok Row Kavi, B.Sc (Hon) majoring in Chemistry, post graduate in Journalism from the IIJ (Berlin), post-graduate diploma in comparative religion, Ramkrishna Math. Chairperson, The Humsafar Trust, Mumbai, India. E-mail: [email protected] L. Ramki Ramakrishnan, Ph D, Postdoctoral researcher, School of Life Sciences, University of Texas at Austin, Austin, Texas 78712-1064 E-mail: [email protected] Rajan Gupta, Ph D, Theoretical Physicist and HIV Researcher & Education Volunteer, Los Alamos National Laboratory, New Mexico, USA E-mail: [email protected] Claire Rappoport, E-mail: [email protected] Sai Subhasree Raghavan, Ph D, Assistant Clinical Professor in Clinical Nutrition Medicine, Harlem Hospital Center/Columbia university, USA, and Over all Co-ordinator, Solidarity and Action Against the HIV Infection in India (SAATHII) E-mail: [email protected] [Opinions expressed herein are those of the authors and do not necessarily reflect the official positions or policies of the listed organizations.] Funding: None Suggested Citation: Venkatesan Chakrapani, Ashok Row Kavi, L Ramki Ramakrishnan, Rajan Gupta, Claire Rappoport, Sai Subhasree Raghavan. HIV Prevention among Men who have Sex with Men (MSM) in India: Review of Current Scenario and Recommendations. April 2002. Retrieved [date month year] from http://www.indianglbthealth.info/Authors/Downloads/MSM_HIV_IndiaFin.pdf Venkatesan Chakrapani et al, 2002 HIV prevention among MSM in India, 2002 2 For further information and to send suggestions/comments contact: Dr. Venkatesan Chakrapani, M.D., Consultant Physician, Social Welfare Association for Men (SWAM), 12/5, Natarajan street, Balakrishna Nagar, Jafferkhanpet, West Saidapet, Chennai - 600 083 E-mail: [email protected] Web: www.indianGLBThealth.info Acknowledgments We are grateful to many persons in the hivglbtindia subgroup of SAATHII e-group for their helpful and constructive comments. Venkatesan Chakrapani et al, 2002 HIV prevention among MSM in India, 2002 3 CONTENTS • Abbreviations and acronyms used • Definitions of the terms used in this paper • Introduction Part - 1: GLBT/Sexuality minority communities in India 1. Gay men in India. • Being a gay in India • “Coming out” in India 2. Lesbians and bisexual women in India 3. The ‘Indian’ identities, Labels and Sexual behavior 4. Sexual networks between persons with different identities: Implications for HIV transmission and acquisition in India 5. ‘Indian’ and western identities: Implications for HIV prevention 6. Near lack of gay and bisexual (male) identity in India 7. Legal status of Homosexuality in India: Implications for HIV prevention 8. Group action of GLBT/Sexual minority communities in India Part - 2: Epidemiology and Demography 1. Epidemiology of HIV/AIDS in India (in relation to MSM) 2. Estimation of MSM in India Part - 3: High-risk sexual behaviors among MSM in India: Potential for HIV transmission and acquisition 1. Concepts of risk groups and risk behavior 2. HIV risk behaviors among MSM in India - a brief review 3. Males who have Sex with Males (MSM): Different scenarios, Different needs, Different solutions 4. Limitations of research data on MSM in India Part - 4: Reasons for the lack of attention towards MSM community in India in the area of HIV prevention • By the Government of India • By NGOs • By the Health care providers/Researchers Part - 5: Recommendations to the Govt. of India and NGOs/CBOs for prevention of HIV/STDs among MSM community a. Recommendations to the Govt. of India b. Recommendations to NGOs/CBOs (which are working or intend to work with sexual minorities) • References Venkatesan Chakrapani et al, 2002 HIV prevention among MSM in India, 2002 4 ABBREVIATIONS AND ACRONYMS USED ABVA - AIDS Bhedbhav Virodhi Andolan AIDS - Acquired Immune Deficiency Syndrome CBOs - Community-Based Organizations CSWs - Commercial Sex Workers GLBT - Gays, Lesbians, Bisexuals and Transgendered/Transsexual persons HIV - Human Immunodeficiency Virus KABP - Knowledge, Attitude, Behavior and Practices MSM - ‘Men who have Sex with Men’ or ‘Males who have Sex with Males’ MSMW - Men who have Sex with Men and Women NACO - National AIDS Control Organization [India] NGOs - NonGovernmental Organizations STDs - Sexually Transmitted Diseases TSM - Transgender(ed) persons who have sex with men UNAIDS - Joint United Nations program on HIV/AIDS Venkatesan Chakrapani et al, 2002 HIV prevention among MSM in India, 2002 5 DEFINITIONS OF THE TERMS USED IN THIS PAPER “How we use language shapes how we think” The definitions of the words given below are not standardized and are used differently by different individuals and in different parts of the world. The meanings of words also change over time. Concepts and attitudes toward gender identity and sexual identity are changing in the society as a whole, as well as within the sexual minority communities. Therefore, the meanings of these words will continue to change as well. (Most of the ‘definitions’ are modified/adapted from the websites - www.siecus.org, www.biresource.org and www.gendertalk.com) Male: An individual’s biological status as male or female. A label used to signify a “human sex,” the biological designation based on genitalia. Can also be a socio-political term, used by an individual to label their gender identity. (Note: In this paper, the term ‘male’ used to denote individuals who are born with male genitalia, irrespective of the gender identity) Man: A term referring to someone who identifies as such, who may often exhibit masculine or male characteristics (see masculine and male). Popularly understood within a binary gender system to refer to someone who is male-bodied. (Note: In this paper, the term ‘man’ is used to denote the gender and ‘male’ to denote individual’s biological status) Masculine: An often ambiguous term that refers to self-expression, performance, actions, behaviors, dress, grooming, adornment, and speech popularly associated with someone who is male-bodied within a binary gender system. People of all genders can self-identify as masculine or as having masculine characteristics. Feminine: An often ambiguous term that refers to self-expression, performance, actions, behaviors, dress, grooming, adornment and speech popularly associated with someone who is female-bodied within a binary gender system. People of all genders can self- identify as feminine or as having feminine characteristics. Men who have Sex with Men (MSM): This term is used to denote all those men who have sex with other men regardless of their sexual identity. This is because a man may have sex with other men but still consider himself to be a heterosexual or may not have any specific sexual identity at all. This means one has to concentrate on behavior, in addition to the sexual categories, in the area of HIV/STD prevention. Males who have sex with Males (MSM): This is used as an umbrella term under which all biological males who have sex with other males are included, regardless of their sexual/gender identity. Thus literally it also includes transgender/transsexual (male to Venkatesan Chakrapani et al, 2002 HIV prevention among MSM in India, 2002 6 female) persons since they are actually biological males. [Note: Some transgendered/transsexual persons (male to female) don’t want themselves to be included under this term, even though this term mainly serves as a working definition. To denote such persons, recently, the term “Transgender persons who have Sex with Men” (TSM) has been introduced.] Men who have sex with Men and Women (MSMW): This denotes those men who have sex with men as well as women regardless of their sexual identity. This too, denotes just their behavior. Gay: One who has significant (to oneself) sexual or romantic attractions primarily to members of the same gender or sex, or who identifies as a member of the gay community. One may identify as gay without identifying as a member of the gay community and vice versa. Though ‘gay’ is a common term for male and female homosexual persons, these days it is mainly used to denote homosexual man. Self- identified gay men do not necessarily have sex only with men, but occasionally may engage in sex with women. (Note: In this paper, ‘gay’ refers to “any person (man) who is conscious of his erotic attractions/sexual behavior towards persons of same gender/sex (i.e., other men)”. Thus, the term ‘gay’ need not necessarily indicates ‘gay identity’ in this paper). Lesbian/Lesbian woman: A girl or woman who has significant (to oneself) sexual or romantic attractions primarily to members of the same gender or sex, or who identifies as a member of the lesbian community. In India, this term is used to indicate bisexual women also. Heterosexual (n., adj.): 1. Sexual or romantic behavior between a member of one sex and a member of another gender or sex. 2. One whose significant (to oneself) sexual or romantic attractions are primarily to members of another gender or sex. (Note: Heterosexual persons are sometimes referred to as “straight”. In this paper, most often the term ‘heterosexual’ is used as an adjective rather than as a noun). Homosexual (n., adj.): Individual with a primary sexual and affectional orientation or emotional attraction toward persons of the same sex. Male homosexuals are often referred to as ‘gay’, where as female homosexuals are referred to as ‘lesbians’. A term often viewed as negative, overly clinical, or disempowering by members of GLBT/Sexual minority community. (Note: The word ‘homosexual’ is most often used as a label and it may not be an identity. Also, this term is sometimes considered derogatory and not preferred by persons with same-sex behavior.