Feature story

HIV programmes for MSM and transgendered people gradually being scaled up in India

17 May 2012

In India, the HIV epidemic is seriously affecting men who have sex with men (MSM) and transgendered people.
Credit: UNAIDS

Rupali always felt she was different. Born as a boy in India, she liked wearing girls’ clothes and finally at the age of 20, decided to disclose to her family her gender orientation. She declared she wanted to live as a woman.

“When I first decided to tell people about my sexual orientation and gender identity, I was scared,” said the 22-year-old. “But eventually I told everyone—my family, relatives, neighbours and friends.”

Rupali did several jobs, but found it too difficult to live openly as a man who has sex with men and work in a mainstream office. So, for the past two years she has been a sex worker in New Delhi. With the money she earns from her clients she supports her mother and younger brother. Her mother has had a heart problem for several years and Rupali needs to pay for her costly medicines every month.

But her job threatens her health as Rupali has a high risk of HIV infection.

In India, the HIV epidemic is seriously affecting men who have sex with men (MSM) and transgendered people. Among this population, 427 000 (in 2010) are considered at higher risk because they have multiple sex partners and many receive money in exchange for sex.

“When a customer is drunk, it is often difficult to convince him to use condoms,” said Rupali.

While sex work pays her bills, Rupali has been attacked several times. Like many transgendered people, Rupali finds it challenging to be fully accepted by her family and community. “The local thugs keep us in a constant state of terror. We fear them striking our faces with blades or brutally beating us up. But we fear the police even more,” said Rupali.

In India, the prevalence of HIV among MSM reached 7.3%, which is 20 times higher than among the general population. Recent data shows that HIV prevalence among transgender people in major cities like Mumbai and Delhi has soared even higher to nearly 25%. HIV programmes for MSM and transgendered people are gradually being scaled up.

The Pahal Foundation in Faridabad gets funding from the Haryana state government to provide HIV testing, treatment for sexually transmitted diseases, counselling and condoms to 750 MSM and transgender people, but hundreds more use their facilities every month.

Many of us MSM try our best to appear straight, but eventually we get ‘outed’. I know several people who lost their jobs because they were severely discriminated against by their co-workers

Manoj Kumar Verma, Outreach Worker at Pahal Foundation

“Everyone needs a support system. Without the support of their families and society, men who have sex with men and transgendered people often take their own lives or run away from home,” said Maksoom Ali, Project Manager at Pahal.

The Foundation has found that only a handful of the people they support are open about their HIV status with their families.

“Employment is a real problem for MSMs and transgender people,” said Manoj Kumar Verma, Outreach Worker at Pahal. “Many of us MSM try our best to appear straight, but eventually we get ‘outed’. I know several people who lost their jobs because they were severely discriminated against by their co-workers.”

There has been some progress in India for men who have sex with men and transgendered people. In the next phase of India’s National AIDS Control Programme (NACP4), there are plans to develop and implement programmes focused on the specific needs of transgender people. Three years ago, the Delhi High court decriminalized sex between adult men in a historic judgement.

Rupali is involved with an organization for MSM in West Delhi and she said she wants to contribute to her community. “Everyone has dreams but not all of them come true,” said Rupali. “That’s true for me too but I want to do something for my community and I want to be a better person.”