APPENDIX 17
Memorandum submitted by Shivananda Khan,
Executive Director, Naz Foundation International
In all the prevention activities that are being
developed regarding the spread of HIV/AIDS and STIs in South Asia,
very little effort is being made in regard to male to male sexual
behaviours. While DFID has supported Naz Foundation International
in a range of activities that reflect concerns in this area, MSM
issues and needs have not been an integral part of strategy development.
Recently a series of situational assessments
have been conducted in India by NFI, in the cities of Hyderabad,
Bangalore, Pondicherry (all in India) and in Sylhet, Bangladesh.
These assessments (as well as those previously conducted in Lucknow,
Delhi, Madras and Calcutta) indicate a significant proportion
of male to male sexual behaviours, high rates of anal sex, gendered
patterns of sex encounters, low condom use, significant rates
of STIs, low levels of treatment, high rates of partner exchange,
no access to appropriate condoms of water-based lubricant, high
degree of stigmatisation and social exclusion . . . DFID have
received several reports regarding these issues over the past
few years from NFI, but as yet, there seems little in terms of
the broader dissemination amongst DFID programmes and initiatives.
It is very clear that MSM activities are not
an inclusive activity of a small number of middle class "gay"—identified
men, but spread across the social spectrum, including amongst
those from low income and marginalised groups of men. Further,
because of the social dynamics of South Asia, most MSM will be
married or become married, and because of the social construction
of MSM behaviours, many MSM will also have sex with female sex
workers . . . please refer to the numbers reports that NFI has
forwarded to DFID, as well as our quarterly newsletter Pukaar.
It is essential that any strategy developed
to prevent the spread of STI/HIV/AIDS in South Asia must include
issues relating to (a) anal sex as a behaviour that has a significant
presence in the sexual repertoire of many South Asian males, as
well as those amongst MSM with a significant risk, such as male
sex workers, and feminised males (called kothis indigenously)
who are regularly anally penetrated through multiple partners.
The risk of this network of males acting as a "core group"
which enables the spread of HIV both within and without is significant
enough to demand attention.
While very little high quality research has
been done on this issue, NFI has developed an extensive knowledge,
as well as a range of situational assessments that verify this
conclusion.
I would suggest that DFID would conduct a literature
review both internally and externally on this issue . . . since
it has received extensive documentation from Naz foundation International,
and that the evidence garnered should be included in any strategic
development for South Asia in terms of preventing the spread of
HIV/AIDS and STIs.
Shivananda Khan,
Executive Director, Naz Foundation International
September 2000
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