This is demonstrated not only by the latest figures of the National AIDS Control Organisation which show the prevalence in Tamil Nadu dropping from 0.5% in 2003 to 0.25% in 2007 in the case of general population and rising from 4% to 7% in the case of MSM but also by the findings of a survey conducted by Y R Gaitonde Centre for AIDS Research and Education (YRGCARE). The survey, comprising a sample of 721 MSM from 18 different cities in the state, found 9% of MSM to be HIV-infected.
"The sustained campaign by the government about the use of condoms and its various awareness programmes for sex workers (the prevalence of HIV among them decreased from 9% in 2003 to 4.7% in 2007) and truck drivers have clearly shown results. But things remain unchanged as far as MSM and drug users are concerned," says Dr Sunil Suhas Solomon, senior medical officer and epidemiologist at YRGCARE, who presented the data at the 16th Conference on Retroviruses and Opportunistic Infections in Montreal last year.
"MSM remain a hidden population in India primarily due to Section 377 of the IPC, which has historically criminalised sex between men, and also the societal and family pressures to marry. Hence, there is very little community-level data of HIV among MSM. So we used a technique called peer-driven recruitment, which uses MSM to recruit other MSM to arrive at the study sample," says Dr Solomon.
The study also documented the existence of HIV epidemics among MSM in many smaller cities such as Tirunelveli, Ramanathapuram and Tuticorin, which are usually not included in the planning of interventions targeted at MSM.
"About 35% of our sample of MSM were married. The higher prevalence of HIV infection among MSM who were married could partially be explained by their nature to keep their same sex practices even more hidden. Consequently, they ended up having more male partners, which has been shown by many studies to be a strong risk factor for HIV infection," explains Dr Solomon.
Sahodaran, an organisation that works with MSM, conducted a similary survey recently in association with the Tuberculosis Research Centre in Chetpet and found that 8% of MSM in Chennai were HIV infected. But Sunil Menon, who runs Sahodaran, says there is no tangible evidence to back such figures because the gay community still remains hidden. "Maybe the figure is shown rising just because more people are testing now than they did before. So there is no way of saying whether the prevalence is increasing, decreasing or remains the same," says Menon.
Says Dr Solomon, "The current phase of the National AIDS Control Programme has initiatives targeting MSM. Only time will tell the effectiveness of these programmes but the government needs to be applauded for the fact that it recognizes HIV among MSM as an issue and is taking steps to address it. However, it is equally important to address issues related to the families (wives and children) of these marginalised populations who are also being placed at risk via their spouses' behaviors."