Letter to the Editor
To the Editor:
Matthew and colleagues have provided excellent evidence regarding low awareness and misgivings about providers among men who have sex with men (MSM) in Boston.1 To those who are committed to root out the problem among MSM, unique challenges exist in diverse cultures as exemplified in this particularly interesting account from India.
Observational studies2,3 reported in the late 1990s have provided alarming figures on unsafe sex practices and HIV (and other STD) prevalence among Indian jail inmates and under-trial prisoners. In a survey2 of 249 inmates of Northern Indian prisons by a medical team from All India Institute of Medical Sciences, New Delhi, 3 males (1.3%) were found to be Western blot confirmed HIV-1 positive, whereas 28 (11.1%) men and 2 (22.2%) women were positive for HBsAg. Scabies, syphilitic ulcer, HCV, and poor knowledge of AIDS was significantly prevalent among the inmates. Seventy-six percent of men were MSM. In another cross-sectional seroprevalence survey, 3 of 1007 prisoners awaiting trial and 107 convicted inmates in a Central Prison in Southern India, 20 (1.98%) waiting for trials, all males, were HIV-positive. Low literacy, poor income, sexual promiscuity, and low condom usage were observed among the seropositives. These reports, as a consequence, have turned up more dust than imagined. In an unexpected turn of events, the medical recommendations to distribute condoms among the inmates, in view of high-risk sexual behavior, have been thwarted. Surprisingly, the reason for such noncompliance has been the Indian Law itself (Section 377 of Indian Penal Code), which holds sodomy as a punishable crime. Condom rationing to men in prisons is a pro-sodomy act and thus violates the law. The law has met with widespread criticism for being a hindrance to anti-AIDS efforts, and various public interest litigations filed by human right activist groups have questioned the constitutional validity of such a law.4,5 Some of the litigations follow sodomy criminal charges on homosexual rights activists.
What have been brought up by such incidents are the unique challenges they portray, in any given sociocultural milieu, to the anti-HIV efforts. The responsibilities of the providers and the government in such cases can not be overemphasized, and such studies1 are vital for the formulation of a concerted control measure.
1. Mimiaga MJ, Goldhammer H, Belanoff C, Tetu AM, Mayer KH. Men who have sex with men: Perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sex Transm Dis 2007; 34:113–119.
2. Singh S, Prasad R, Mohanty A. High prevalence of sexually transmitted and blood-borne infections amongst the inmates of a district jail in Northern India. Int J STD AIDS 1999; 10:475–478.
3. Sundar M, Ravikumar KK, Sudarshan MK. A cross-sectional seroprevalence survey for HIV-1 and high risk sexual behaviour of seropositives in a prison in India. Indian J Public Health 1995; 39: 116–118.
4. Mysko B. India: Challenge to constitutionality of criminal law banning homosexual acts dismissed. HIV AIDS Policy Law Rev 2004; 9:60–61.
5. Agoramoorthy G, Hsu MJ. Can India abolish the anachronistic homosexuality law to battle HIV/AIDS? AIDS 2006; 20:1469–1470.