Telling our secrets

[Guest guest]

Telling our secrets

Sex between men is illegal in India, putting them at high risk of contracting

HIV

Sylvia Rowley. The Guardian

Venkatesh Routh lives with his wife and two-year-old son in Mancherial, a small

city in the Indian state of Andhra Pradesh. Three nights a week he says goodbye

to his wife, who is nine months pregnant, and goes to the railway station. But

instead of getting on a train he walks to the end of the brightly lit platform,

past the chai-wallah selling hot sweet tea, to the point where the floodlights

go no further. Here he steps into a maze of dirt paths and thorny bushes. There

are no women, and the men have all come for the same reason: to have sex with

other men.

" I come here in secret, " says Venkatesh, standing in the dark. A train clatters

past, horn blaring. " I am a kothi [effeminate homosexual]. I didn't want to get

married, but my family members pressured me. Every day for three years they kept

asking, 'Why don't you marry?' "

" When I started coming here for sex I'd heard the word 'Aids', but I didn't know

how you get it. I didn't know how to use a condom, " he says. " Now I show other

people how to use them properly. "

As 29-year-old Venkatesh fills up the condom box bolted to a crumbling wall

among the bushes, he is taking part in what looks to be one of the most

promising HIV prevention efforts in the developing world in recent years. All

over Andhra Pradesh, men who have sex with other men - who may or may not think

of themselves as gay or bisexual and who are often married with families - are

forming community groups and helping each other to solve their own problems.

Venkatesh is one of them.

One in seven men who have sex with men in Andhra Pradesh is HIV positive

according to the state government. They are almost 20 times more likely to be

infected with HIV than the average Indian adult (the national adult prevalence

rate is 0.36%). This is because unprotected anal sex with multiple partners

carries a high risk of HIV, and because discrimination drives men who have sex

with men underground.

Homosexuality is illegal in India under the notorious section 377 of the Indian

penal code and is a social taboo. There is incredible pressure for men who are

attracted to men to hide their sexuality.

Sex between men is often limited to brief liaisons at so-called " hotspots "

behind a train station or by the side of a highway. " We wear a mask, the

masculine mask, " says Krishna, founder of a network for men who have sex with

men in Andhra Pradesh. " We drop our voices, change our walk. That is drama, you

have to act. "

Because men who have sex with men are so well hidden, it is almost impossible

for government Aids agencies or HIV/Aids charities to reach them. " The

Government people can't walk around looking for hotspots, " Krishna says,

laughing at the thought. " They can't find them! "

Men such as Krishna, however, do know where to look. In Andhra Pradesh,

community-based organisations (CBOs) made up of men who have sex with men can

now be found in every district. Outreach workers at the CBOs map all of the sex

hotspots in their area and visit them daily, armed with an HIV education

flipbook, a stash of condoms, lubricant, and a plastic model of a penis. Each

CBO is supported by a local non-governmental organisation (NGO) which provides a

drop-in centre and sexual health clinic, and a state level NGO, the Alliance for

AIDS Action, a partner of the International HIV/Aids Alliance, which coordinates

the programmes and provides training to the community groups.

CBO members also work with police, doctors and parents to tackle the wider

discrimination that puts men like them at risk of HIV. " I tried to go to the

government hospital because of an anal infection, but the doctor called me a

kojja [derogatory word for transsexual] and refused to see me, " says Venkatesh.

" I felt so bad I wanted to commit suicide, " he says, " but now we do workshops

with the doctors to make them understand us better. " This work is crucial as

untreated sexually transmitted infections increase men's vulnerability to HIV.

If the sessions fail then Venkatesh will try other means - one doctor who

constantly refused to treat men who have sex with men was sacked recently after

CBO members talked to the hospital authorities.

Most groups also try to improve relations with the police because, as one man

says, they " harrass us like hell " . I was told about police at hotspots demanding

bribes ( " they will pocket whatever we have " ), and arresting, beating and raping

men. In response to this and violence by local thugs, CBOs have formed Rapid

Action Teams - if a man is in trouble he can ring for help and a group of his

peers will quickly come to the scene and challenge the attacker. CBOs also do

" sex and sexuality " training to build a rapport and understanding with the

police.

The results for these projects are staggering. An evaluation in 2007 showed that

96% of men who have sex with men reported using a condom with their last male

partner, up from 55% in 2003. The prevalence of syphilis, which is used as an

indicator for HIV, more than halved in the same period. This is a cause for

celebration not just for men who have sex with men, but also for their wives.

Roughly eight out of 10 men who have sex with men in Andhra Pradesh are married

and if they become HIV positive it is very likely that their wives will too. The

state Aids prevention body estimates that 96% of men who have sex with men in

Andhra Pradesh (that they know of) are now being reached by this type of

programme.

The Alliance for Aids Action hopes that by empowering men who have sex with men

to solve their own problems, these changes can be made to last. " How long can a

third party run a programme? " asks Narendra Nath, a senior programme officer at

the alliance. " When this project finishes [in about five years] we hope that the

CBOs will be able to keep doing the HIV prevention work. "

Back in the maze of bushes by Mancherial train station a group of three kothis

who have come here in search of " someone beautiful " crowd around. The mood is

jovial and they joke that one man in our group is " looking very smart! "

" I don't tell my wife I come here because she'll feel bad, " one says. But I use

a condom - I don't want to make her suffer. "

http://www.guardian.co.uk/journalismcompetition/amateur-finalists-hiv-infection