World AIDS Day

Update: The Supreme Court of India passed a judgement on December 11 2013 saying that gay sex is illegal overturning the Delhi High Court verdict decriminalising homosexuality. It observed that the matter was not for the courts to decide but should be discussed in parliament. ‘It is for the legislature to look into the desirability of deleting section 377 of IPC,’ the Court said.

The theme for World AIDS Days from 2011-2015 is ‘Getting to Zero’ – zero new infections, zero discrimination and zero AIDS-related deaths. To achieve that we have to provide the proper facilities, treatment and services to the high risk HIV groups – intravenous drug users, sex workers and perhaps the most taboo of them all , men who have sex with men. A task like that is even more troublesome in a sexually conservative country like India because of the stigma attached to sex in general and homosexuality in particular.

Author’s Note: This is a completely neutral article with no value judgements attached. The term MSM was created by epidemiologists in the 90s to describe men who have sex with other men. This allowed them to study the spread of diseases among this particular subgroup without any sexual identities thrust upon them. MSMs can be gay, bi or straight and we are not bothered about sexual orientation. Please refrain from making any homophobic comments.

MSMs and HIV/AIDS

Due to the stigma attached to homosexuality, it has been hard to study the spread of diseases by intercourse between men. It’s even hard to pin down the number of MSMs – it could be anything between 2-16% of the world’s male population.. Recently the health ministry estimated that there could be four lakh MSMs in India and they are a high risk group and about 31000-41000 could be HIV positive. This makes MSMs (7%) the second highest HIV risk group after intravenous drug users (9.5%) and more at risk than female sex workers (4.5%).

Read more about causes, symptoms, diagnosis and treatment of hiv/aids.

Why MSMs are at a higher risk of contracting AIDS

When AIDS was discovered in the 80s, there were rumours that it was a disease that only affected MSMs and drug addicts. Though the rumours subsided, the fact remains that MSMs are high-risk groups compared to heterosexuals. This is because AIDS primarily spreads through the exchange of body fluids, which can occur during sexual intercourse, intravenous drug sharing, etc. Now the most common sexual practice among MSMs is anal sex.

1. Anal Sex

It is far more potent mode of transmitting HIV than vaginal or oral sex because…

  • The anus presents an environment that is host to more micro-organisms than any other part of the body which leads to an increased chance of infection.
  • Anal sex gives the body an increased potential for exchange of STDs because it can allow micro-organisms to enter either through the urethra or through small cuts, abrasions, etc. on the penis.
  • Also due to added friction during penetration, the possibility of a condom breaking during anal sex is considerably higher than vaginal sex.  

According to Wikipedia, these are the chances of contracting the HIV virus from an HIV positive person assuming protection is not used.  

Receptive anal intercourse

0.50%

Insertive anal intercourse

0.065%

Receptive penile vaginal intercourse

0.10%

Insertive penile vaginal intercourse

0.05%

We can clearly see, anal sex is 5 times more dangerous for the receptive partner than vaginal sex and 13 times more dangerous for the insertive partner.

2. Lack of use of condoms

Before AIDS became prevalent in the United States in the 80s, the condom was always seen as a contraceptive and not as a protection device against AIDS and other STDs. For this very reason, the condom has never been popular with MSMs and explains the high HIV risk.

3. Stigma and lack of HIV/AIDS education

In most societies, AIDS education is aimed at heterosexuals. None of the HIV/AIDS educational teaching aids specifically looks to educate MSMs. These have a tendency to skirt over the ‘unnatural forms’ of intercourse like oral or anal sex.

Another reason is our Victorian English attitude towards sex. Sex education is inconspicuous by its absence in most educational institutions and courses. The stigma attached to HIV positive MSMs isn’t just exclusive to India. When AIDS was first discovered in the 80s in the US it was believed to be a disease that affected homosexuals and drug addicts, people who ‘deserved’ it. It wasn’t until Magic Johnson, Freddie Mercury, Ryan White, Robert Reed and other high profile heterosexual people revealed that they had AIDS did the public’s perception change about the disease. Myths still persist about the disease and MSMs. This has made it very hard to reach out to that particular demographic whether it be to provide sex education or to provide services vital for HIV positive people.

Prevention and precautionary measures for MSMs

 1. Always use a condom for anal sex:  Even though a condom provides less protection than say vaginal sex it decreases the transmission risk. In addition, lubricants should be used to reduce friction, which will decrease the chance of the condom breaking. However one is advised to use water-based lubricants with latex condoms as oil-based ones may dissolve the latex and make them porous. An oil-based condom can be used with polyurethane condoms.

2. Avoid high-risk behaviour (casual sex or sex with strangers): It’s always a good idea to avoid sexual intercourse with people you don’t know. However, there may be circumstances when you do decide to have sex so it’s a good idea to always have condoms.

3. Ask for help: If you’re an MSM, there’s no need to hide. Seek help from an HIV/AIDS counsellor or if you don’t want to do it face to face you can always ask call in anonymously. Most HIV/AIDS counselling centres and helplines are managed by individuals who are sensitised to the needs of MSMs and some centres even have separate cells for LGBTs.

We need to reach out to all sections of society to promote safer sex. The right to healthcare services and sex education are our most indisputable rights irrespective of sexual orientation. Only then can we reach the zero mark by 2015. 

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