MSM? What does MSM mean?

• Men who have sex with men.
• Some but not all MSM would identify as ‘Gay’.
• A way of describing a group based on behaviour rather than identity.

• But often these terms are used interchangeably.

Why talk about MSM & HIV?
Historical context of the Gay Rights Movement
Collides with…
The Emergence of the HIV virus
To Stimulate…
Both grassroots mobilization and further stigmatisation of MSM.

In the early years of the global HIV epidemic…
HIV was seen as a ‘gay disease’ resulting from perceived sexual promiscuity in the gay community.

The U.S. Centers for Disease Control announced that HIV posed no threat to women or heterosexual men.

Many religious conservatives believed that HIV was a punishment sent by God to punish MSM for their ‘immoral’ behaviour.

HIV was Called…
Even by Medical Authorities and Scientists!!

• Gay Plague
• Gay Cancer
• Gay-Related Immune Deficiency (Grid)
• Gay Compromise Syndrome

As the 1980s progressed…
Scientific knowledge grows and changes
Medical researchers discover that a virus causes HIV.

HIV infection emerges in other ‘High risk’ groups like IV drug users and female sex workers, but also in perceived ‘low risk’ groups across society

But Stigma, Fear, and Discrimination towards MSM remains!

The Historical Context into which HIV emerged in the 1980s

• The 20th century saw the world wake up and begin to recognize the rights of gay men and women globally.
• Same sex behaviour had once been criminalized in most countries.
• But as the 20th century progressed, homosexuality has been steadily decriminalized across the world – from Greece, UK, Israel, Chad, etc.

Stonewall Riots
In 1969, the police illegally raided the Stonewall Inn, a well-known gay establishment in New York City… Sparking protests that marked the beginning of the fight for Gay Rights in America.

Community Mobilization: Fighting Stigma and Providing Support
The modern gay rights movement sparked in the 1960s and 1970s provided fertile ground for mobilization around HIV in the 1980s
Organizations were founded in order to fight the stigma around HIV and provide support and care to HIV+ people

• Gay Men’s Health Crisis in New York City.
• San Francisco AIDS Foundation.
• ACT UP! Which began as a small local group grew into a global HIV/AIDS activist network.

But there is still work to be done…
Same sex behaviour still remains illegal in many countries and regions with accelerating rates of HIV infections

• Much of North and East Africa.
• The Middle East
• And India!

In Africa and the Middle East, penalties range from imprisonment to death.

Criminalization of MSM in India
Section 377 of the Indian Penal Code prohibits, “Carnal intercourse against the course of nature with any man, woman, or animal”.

Which can be interpreted freely to make even oral and anal sex between heterosexual couples illegal. But has primarily been used to legitimize the harassment of gay men and women.







The Impact of the Criminalization of Same Sex Behavior on the lives of MSM in India
It is commonly believed that Section 377 is no longer enforced and that de facto decriminalization has already occurred.

However, there are reports that this law has been used to legitimize both police harassment of MSM and the harassment of HIV prevention workers and others doing outreach work in gay communities

(Source: International Gay and Lesbian Human Rights Coalition)

Lucknow 4 – Will they be our stonewall?
In 2001, police raided the offices of two NGOs doing HIV work with MSM in Lucknow in Uttar Pradesh and arrested 4 workers.

The 4 workers were charged with a number of criminal offenses including those under Section 377 and were reportedly beaten, denied food, and forced to drink sewage water while in police custody, according to their lawyer.

Senior Superintendent of Police, a Mr. B. B. Bakshi, publicly stated that he would like to “Eradicate homosexuality which is against Indian culture.”
Impact of Lucknow 4 Case
3 of those arrested are eventually released from prison after 45 days, but the 4th was held without bail for 7 months.

This incident drew further national and international attention to the issues of gay men and women in India, particularly to Section 377 and to the extent to which this law has been used to unconstitutionally harass those working in the HIV and health fields to do outreach among MSM.

Human Rights Community Reacts
“In your capacity as chairperson of India’s National AIDS Council, these events should bring to mind previous incidents in which Section 377 has been used to harass HIV/AIDS outreach workers and non-governmental organizations (NGOs) engaged in vital efforts to halt the spread of the epidemic. Section 377 not only violates the basic human right to privacy; used as it clearly is to restrict freedoms of expression and association for marginalized groups–including groups at risk of HIV/AIDS–it is also a continuing threat to public health. This unfortunate incident shows vividly and urgently why it is incumbent on your government to ensure its immediate repeal.”

Statement of Human Rights Watch in a Letter to Prime Minister Manmohan Singh regarding the Lucknow 4 case.

(Source: Human Rights Watch)

So again…why MSM & HIV?
The fight against HIV/AIDS in the MSM community both globally and in India must be understood in this social and historical context…

And NOT hidden under layers of stigma, discrimination, and marginalization!

The Big Picture – MSM and HIV/AIDS Globally

• The majority of HIV infections around the world are acquired through heterosexual (male-female) sexual contact.
• However, in some regions, MSM account for a majority of new HIV infections, such as in the U.S., Canada, UK, Australia and New Zealand.
• 25% of new HIV infections are estimated to be among MSM in Latin America.
• 28% of HIV-positive persons in Bangkok, Thailand are believed to be MSM, compared to 22% HIV prevalence in Senegal (West Africa).
• Global estimates of HIV infections among MSM are difficult to measure because same sex behaviour is highly stigmatised and often pushed underground in many cultures.

(Source: AVERT www.avert.org/msm)

MSM and HIV/AIDS in India
The Statistics

• 6.4% HIV prevalence among MSM in Delhi (2006). (2008 UNAIDS Report on Global AIDS Epidemic)
• 25.0% HIV prevalence among MSM in major urban areas as measured through WHO sentinel surveillance (2004)
• 5.7% prevalence among MSM outside of major urban areas (2004)

(World Health Organization Epidemiological Fact Sheet on HIV and AIDS, 2008)

The Realities of MSM and HIV Risk
MSM are NOT at risk for HIV infection because

• Homosexuality is immoral
• All gay men are promiscuous
• HIV is a curse from God

But MSM are at risk because

• Anal sex carries the greatest statistical transmission risk
• Condom use has historically not been normative (no risk of pregnancy)
• Increased use of drugs/alcohol among MSM
• Pre-existing stigma and discrimination drives behaviour underground

Is india beginnning to wake up to the needs of msm?
Yes! But Slowly…

India held its first ever nationwide gay pride event with celebrations in Delhi, Bangalore and Kolkata.

The Fight against Section 377
Naz Foundation, Lawyer’s Collective and Voices Against 377 continue to advocate against this discriminatory legislation.

At the International AIDS Conference held in Mexico City, Mexico in August 2008, Indian Minister for Health Mr. Anbumani Ramadoss publicly stated his support for the repeal of Section 377.

The Section 377 case will go before the court again on 18 September 2008.

NGOs and Groups working on MSM issues in India

• Humsafar Trust (Mumbai) – www.humsafar.org
• Naz Foundation (Dehli) – www.nazindia.org
• Samapathik Trust (Pune) – www.geocities.com/samapathik_pune/
• Udaan Trust (Pune & Maharashstra) – www.udaantrust.org
• Swabhava Trust (Bangalore) http://members.tripod.com/swabhava_trust/
• India Network for Sexual Minorities www.infosem.org

Websites/Resources

1. International Gay and Lesbian Human Rights Coalition – www.iglhrc.org
2. Human Rights Watch – www.hrw.org
3. AVERT – www.avert.org/msm
4. 2008 UNAIDS Report on Global AIDS Epidemic - www.unaids.org
5. World Health Organization Epidemiological Fact Sheet on HIV and AIDS, 2008 - www.who.int/hiv/countries

For more information on HIV in India and Pune, and getting tested visit: www.wakeuppune.org