Missing Pieces: HIV Related Needs of Sexual Minorities in India

24 Oct 2008


The report highlights recommendations made during a two-day consultation on effective implementation of targeted interventions for sexual minorities. The recommendations were made to UNDP by representatives of sexual minorities, donors, government functionaries, NACO, State AIDS Control Societies and programme planners.

India has an estimated 2.3 million HIV infections, which translates into an overall HIV prevalence rate of 0.34 percent. The epidemic has many specific variations within India, as several states in southern and the north-eastern part of the country show higher HIV prevalence. They also demonstrate diversity in predominant patterns of HIV transmission as the epidemic in southern India is largely due to unprotected sexual intercourse, and that in the north -eastern part of the country due to unsafe needle usage. Even low HIV prevalence states are characterized by the presence of high risk pockets with potential for greater spread of epidemic in these states.

Thirty nine percent (39%) of HIV infections are in women, and many infections are in rural areas. There could be a significant burden on communities and the health services sector with numbers of infections on the rise in many districts. The epidemic in India is still concentrated in groups with particularly high risk behaviour including men who have sex with men (MSM), female sex workers (FSW) and injecting drug users (IDUs). At the national level, the overall HIV prevalence among different population groups in 2007 continues to portray a very high prevalence among these groups – IDU (7.2%), MSM (7.4%), FSW (5.1%) & STD clinic attendees (3.6%) and low prevalence among ANC clinic attendees (0.48%). Clearly, increased focus on MSM/TG interventions is the necessary way forward within the national HIV programme. UNDP has recently been identified as the UN agency to lead work on issues of sexual minorities , and therefore, is working to develop a strategy for its work.

UNDP India supports the National AIDS Control Organisation (NACO) of India to implement the current national programme, and helps to expand its reach. It also helps NACO to ensure that the programme is inclusive of those vulnerable to HIV. UNDP approaches its support to the NACP-III from the gender and rights perspective, with a significant emphasis on stigma reduction an d greater involvement of PLHIV and members of key populations such as sexual minorities.

The practice of male to male sexuality in India is very complex and in many ways, unique; MSM and Transgenders have emerged as a core high risk group in NACP-III. Decriminalization, although necessary, is not enough to combat homophobia and even in settings where some rights have been secured for MSM, they can easily be eroded. MSM interventions have thus to go hand in hand with fighting against stigma and discrimination and promoting human rights. At this two-day national consultation of MSM and TG, their representatives, donors, government functionaries, NACO, State AIDS Control Societies (SACS), programme planners and those involved in implementation came together to provide UNDP with strategic advice on the way forward.

Recommendations of the Consultation The participants urged UNDP to support processes that enable effective implementation of Targeted Interventions for Sexual Minorities, support rights based community action and develop leadership among their representatives, build capacities of State and District level functionaries (health and nonhealth) on issues of Sexual Minorities, generate new knowledge and evidence on issues of HIV and Sexual Minorities, and develop strategies to sharpen focus on the needs of the TG ( Transgender) community.

The report discusses these and other recommendations in detail. On the basis of this report, UNDP will work with NACO, UNAIDS and community representatives on an action framework for providing focused technical and financial support to NACP-III on issues around HIV and Sexual Minorities.

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