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.

Women in India as in most of the South Asian countries stand marginalized. Objective of this study was to explore sexual health and mental health vulnerabilities of female partners of Men who have sex with men (MSM) with 15 In depth interviews of female partners of self identified homosexual and bisexual men and 1 Focus Group Interview (FGI) Heterosexual marriages result into increased vulnerability of MSM and their female partners to STIs including HIV and mental health. Such unions lead to increased Mental Health and sexual health vulnerabilities such as incidences of Depression (4), feelings of emotional dissatisfaction (6), frustration (3) and increased irritability due to the partner’s sexuality(7), Feelings of being cheated upon and betrayal (5). Some of them (4) are forced for anal sex. Other 2 female partners reported that their husband asked for oral sex and performed even they disliked. 7 participants reported non-treated STIs in last 6 months. 3 participants had STI in the past went to traditional healer “Bhuva”. Six participants had STIs symptoms during interview but not considered as significant for treatment. 8 of the participants including five participants having STI symptoms did not know about STIs and its treatment. Sexual and mental health vulnerabilities of female partners of MSM need to be recognized and addressed strategically in Sexual Health Interventions.