Although attitudes towards gay relationships have softened in the past two decades, a 2016 survey found that even among young people more than 60 per cent of respondents believed homosexuality was wrong.
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The Alliance has identified MSM as a key at-risk group being left behind in the country’s response to HIV, threatening India’s goal of meeting the UN’s “90-90-90” pledge by 2020. HIV prevalence rates are around 16 times higher in this group compared to the general public.
Intense societal pressure to get married at a young age makes the matter worse, Ms Aher says. Alliance estimates that 60 per cent of their MSM clients also have wives, making it very difficult to get them to open up about unsafe sex practices.
For many young men in India, anal sex is seen as harmless experimentation: the most common Hindi word for it is masti, literally meaning “fun”, or “mischief”. A complete lack of sex education means most people don’t realise it carries the same risk of infection as other forms of sex.
“We get people who will say they f***ed a man but won’t admit that they liked it because it undermines their masculinity,” says Ms Aher.
“If you don’t want to acknowledge you are having sex with a man, you won’t have conversations about sexually transmitted infections (STIs), you won’t be careful about correct condom use. You don’t want to talk about it – you just want to get it done!”
Groups like the Alliance are having to come up with innovative ways to reach men having sex with men, to let them know that they are at risk of HIV and need to get tested.
One option is to take advantage of the explosion of smartphone use in urban India. It is now thought that more than 50 per cent of all men in large cities like Delhi are online, and popular apps like Facebook, Grindr, WhatsApp and Instagram offer access to untapped communities that have never been subject to HIV outreach before.
Online trials have had very promising results. After a one-month test run with a social media consultant, the Alliance found the rate of clients getting tested at its Delhi clinic who heard about the service online rose from 6 per cent to 45 per cent.
Another agency using funding from EJAF has launched the website Safe Masti, which includes India’s first anonymous online chat service for MSM seeking more information about safe sex.
Programme manager Harsh Agarwal says the site has reached two million people in just 15 months. He believes government programmes, which exclusively rely on traditional methods of encouraging people to find out their HIV status, are increasingly out of touch.
“There has to be a shift to online, 100 per cent,” he says. “When you can meet anyone in the world from the comfort of your own home, no one in their right mind would want to keep cruising for sex [on the street].”
Safe Masti’s online chat service is manned by Vishwa Srivastava, a charismatic young doctor who says that, as a gay man who is also HIV+ himself, he can relate to shy and worried clients in a way counsellors at a public hospital never could.
Mr Srivastava described one case of a 21-year-old student from a poor family who was awaiting his initial HIV test results when he first reached out to the Safe Masti chatline.
“He hadn’t ever told anyone else about his sexuality, let alone about his HIV status. We talked, and when the test came out positive, he called me crying. He was feeling guilty and trapped. He felt like he was being punished by God because he is a sinner, for having gay sex.
“He didn’t know how he was going to inform his family. I helped him, I even sent him a little money to pay for travel to an NGO where he could start treatment. More than that, I could offer hope, and give him guidance for how he could go forward with his life.”
Despite the shift online, Delhi remains well-known in the LGBT+ community for its network of massage parlours, which are still among the most popular places gay men go to pay for sex.
Speaking at the Alliance’s Samarth clinic, former masseur Avinash says it will still be “some time” before attitudes shift in the wake of the September ruling of the Supreme Court striking down Section 377, a clause of the British-era Indian Penal Code that was interpreted as outlawing gay sex.
“Many don’t understand what the 377 [ruling] is,” he says. “They think it means two kuthi (Hindi slang for an effeminate man) can get married, and that’s something they don’t think should be done.”
Avinash says he regularly experiences firsthand the stigma against gay men in Indian society. “You get used to being called names. But there have been times when it was physical abuse too.”
He was one of the first clients to be tested positive when the Samarth clinic opened in 2016, at a time when he was cruising for sex with multiple partners more or less every night.
His contacts within the massage parlour network have been invaluable to the Alliance, and he still believes there is a place for the traditional outreach worker in the battle against India’s HIV epidemic.
“The chunk of the population may stop using cruising spots to hook up, but social media has its limitations,” he says. “People may be using a smartphone, but a lot are less educated and they won’t understand what you are trying to say.
“If I’m trying to bring a person for a health check, that message will still require some explanation, and some kind of support [afterwards]. You need that one-to-one personal touch to get people to understand.”
Money raised from public donations through the AIDSfree appeal will be used to support the Elton John AIDS Foundation projects in six key cities around the world (London, Nairobi, Atlanta, Kiev, Delhi and Maputo). Through UK Aid Match the UK government will double public donations up to £2m to be spent across projects in Maputo and Nairobi.