Paul Arora and colleagues,1 in their overview of the HIV epidemic in India, appropriately identify known risk groups and possible contributors to the problem, focusing on heterosexual sex, specifically involving commercial sex workers. However, there may also be a need to revisit the relative contributions of other major groups.
One factor, the population of men who have sex with men (MSM), is rarely discussed because homosexual acts are illegal in India. Recent work presented at the International AIDS Conference in Thailand indicates that MSM may contribute substantially to the epidemic in both the homosexual and heterosexual communities. A recent survey of more than 3000 men in Andhra Pradesh found that over half of all anal sex acts between MSM were unprotected; in addition, almost half of the MSM were married, and more than half had had sex with a woman within the previous 3 months (and most of these encounters were unprotected).2,3 MSM in India represent a hard-to- service group, as the stigma of homosexuality and the responsibilities of marriage make disclosure difficult.
The effective interventions proposed by Arora and colleagues1 are essential to slow the rate of infections. Accomplishing this goal will require countrywide recognition of the HIV epidemic, sex education (both within and outside the classroom) and access to free voluntary counselling and testing, all of which must reach commercial sex workers as well as MSM. We hope that Sonia Gandhi's presence at the AIDS conference in Thailand is a step toward official recognition of the issues inherent to the epidemic.
References
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