Re: Trends in HIV-1 in young adults in south India

[Guest guest]

A letter on ‘MSM and HIV in India’ published in the Correspondence column of the Lancet - www.thelancet.com Vol 368 July 8, 2006. p115.

Although Rajesh Kumar and colleagues’1 analysis included no data that identified men who have sex with men, we applaud their recommendation that HIV prevention strategies in India include this population. However, the suggestion specifically in regard to men who have sex with men, that peer interventions using “condoms, education, and negotiation skills offer the best hope to attenuate overall growth of HIV-1 in India” overlooks crucial obstacles to HIV prevention.

Increased attention to men who have sex with men in Indian HIV surveillance is one important element of HIV prevention. Only 15 (2·3%) of 659 HIV surveillance sites operated in 2004 by the National AIDS Control Organization (NACO)2 included such populations in data collection. Nevertheless, in the two Indian states (out of 36) in which data were collected, HIV prevalences of 6·8% and 9·6% among men who have sex with men in Chennai and Mumbai,3 respectively, suggest a need to greatly expand monitoring of the epidemic among this group.

Equally important, however, and probably associated with the lack of HIV surveillance data among men who have sex with men, is an ongoing context of stigma, violence, and criminalisation. UNAIDS4 and Human Rights Watch5 report routine harassment, detention, and sometimes imprisonment of men who have sex with men and of HIV/ AIDS peer outreach workers merely for carrying condoms or proffering HIV prevention information, on the grounds of “promoting” immoral or illegal behaviour. Men can be jailed for up to 10 years for “homosexual sex” under Indian Penal Code 377.

Lessons learned from more than 20 years of combating HIV/AIDS suggest that, whether in south Asia or North America, criminalisation, violence, and stigma are antithetical to public health and often conspire to prevent HIV prevention.

We declare that we have no conflict of interest.

* A Newman, Venkatesan Chakrapani, Ashok Row Kavi, Abraham K Kurien

p.newman@...

University of Toronto, Faculty of Social Work/Centre for Applied Social Research, 246 Bloor St West, Toronto, Ontario M5S 1A1, Canada (PAN); Indian Network for People Living with HIV (INP+), Chennai, India (VC, AKK); and The Humsafar Trust, Mumbai, India (ARK)

1 Kumar R, Jha, P, Arora, P, et al, for the International Studies of HIV/AIDS (ISHA) Investigators. Trends in HIV-1 in young adults in south India from 2000 to 2004: a prevalence study. Lancet 2006; 367: 1164–72.

2 National AIDS Control Organization (NACO). HIV estimates—2004. http://www.nacoonline. org/contact.htm (accessed April 14, 2006).

3 National AIDS Control Organization (NACO). Observed HIV prevalence levels state wise: 1998 – 2004. http://www.nacoonline.org/facts_ statewise.htm (accessed April 14, 2006).

4 UNAIDS. UNAIDS concerned over arrests of men who have sex with men in India. http://www. unaids.org.in/displaymore.asp?subitemkey=371 & itemid=285 & subchnm= & subchkey=0 & chnam e=Press%20Releases (accessed April 14, 2006).

5 Human Rights Watch. Epidemic of abuse: police harassment of HIV/AIDS outreach workers in India. http://www.hrw.org/ reports/2002/india2/ (accessed April 14, 2006).