Women in India as in most of the South Asian countries stand marginalized pertaining to various policies, programs, services, particularly if the issues are revolving around sexuality and HIV/AIDS. Reaching out to the female partners of MSM through a comprehensive STI, HIV/AIDS service package poses a challenge. Women are the first among the vulnerable populations in the context of HIV/AIDS awareness programs globally especially so in India. The institution of marriage is “sacred” with many unwritten rules marginalizing the fairer sex where patriarchy rules. Every child born and brought up in this culture is strongly expected to marry heterosexually. Women married to MSM stand vulnerable in the context of accessibility of STI, HIV services due to the various issues revolving around confidentiality, masculinity, patriarchy and power dynamics which needs to be skillfully addressed.
HIV preventive counseling is a difficult task since very few context specific resources on sexuality issues of sexual minority are available to counselors in India. An improved understanding of the sexuality experiences of Men who have Sex with Men (MSM), and an appropriate therapeutic approach is crucial for creating a scientific reference base for effective counseling in targeted HIV prevention interventions. This paper discusses developmental and sexuality issues of Men who have Sex with Men (MSM) and highlights the need for a shift from stereotyped counseling practices to strength based counselling within targeted HIV prevention interventions to make therapeutic alliance more holistic. Counseling in targeted HIV prevention interventions, specifically designed for MSM population, needs to be redefined and thus should not be just restricted to HIV/AIDS and STIs.
Sexually transmitted infections (STIs) remain a public health problem of major significance in most parts of the world and are responsible for high morbidity, complications and sequelae. The exact magnitude of the global burden of STIs is not known. WHO estimates that about one million new cases of STIs occur daily in the world out of which about 400,000 new cases of STIs are estimated to occur daily in South and South-East Asia.
The appearance of HIV and AIDS has focused greater attention on the control of STIs. STI rates not only indicate the extent of unprotected sex, but also an individual with an STI is more vulnerable to contracting HIV than an individual who has no other STIs. Some STIs, when present, facilitate the transmission of HIV. A number of studies have implicated both ulcerative and non-ulcerative STIs to varying degrees, with relative risks ranging from 1.5 to 8.5. . Although the cofactor effect seems to be higher for ulcerative diseases, non-ulcerative infections could be more important in some populations because of their frequency and prevalence.
The phrase “Men who have Sex with Men” (MSM) refers to those men who engage in sex relationship exclusively with other men (Homosexuality) or who engage in sex relations with either men or women (Bisexuality). In the global program on AIDS conference in Geneva (1992-93) governments accepted the behavioral phrase “men who have sex with men” as a depoliticized euphemism. The phrase “men who have sex with men” is a collective social identity for all men who have sex with men irrespective of how they might identify themselves.
Men who have sex with other men in India are diverse in their sexual identities. Some identify with modern “gay” or “bisexual” identity while others with indigenous sexual identities like “Koti” – feminized male, usually a sexually passive partner; or “Ghadiya” – masculine male and usually a sexually active partner. “Double – Decker” refers to those who penetrate their partners and are penetrated by their partners. “Ghadiya” and “DD” are labels and usually not “identity”.
In our society having sexual relationship with same sex is considered to be abnormal. These behaviors are seen in society as immoral, dirty and unnatural. As a result they tend to be more vulnerable to sexually transmitted infections including HIV/AIDS and a host of psychosexual problems. Counselling therefore becomes an important aspect of any sexual health intervention programme specifically if it is designed for vulnerable groups.
Often health care providers rarely had the opportunity to understand the sexual diversities and to be educated about the health issues of sexual minorities. Keeping that in mind, this handbook has been compiled to provide basic but essential information on men who have sex with men (MSM) in Gujarat. This handbook is expected to increase the knowledge and enhance the skills of doctors/counselors, psychologists and social workers on the Counselling issues of MSM that will ultimately lead to improvement in the quality of services available to MSM in the clinical and counseling settings.