Telling our secrets

Venkatesh Routh lives with his wife and two-year-old son in Mancherial, a small city in the Indian state of Andhra Pradesh. Three nights a week he says goodbye to his wife, who is nine months pregnant, and goes to the railway station. But instead of getting on a train he walks to the end of the brightly lit platform, past the chai-wallah selling hot sweet tea, to the point where the floodlights go no further. Here he steps into a maze of dirt paths and thorny bushes. There are no women, and the men have all come for the same reason: to have sex with other men.

"I come here in secret," says Venkatesh, standing in the dark. A train clatters past, horn blaring. "I am a kothi [effeminate homosexual]. I didn’t want to get married, but my family members pressured me. Every day for three years they kept asking, ‘Why don’t you marry?’"

"When I started coming here for sex I’d heard the word ‘Aids’, but I didn’t know how you get it. I didn’t know how to use a condom," he says. "Now I show other people how to use them properly."

As 29-year-old Venkatesh fills up the condom box bolted to a crumbling wall among the bushes, he is taking part in what looks to be one of the most promising HIV prevention efforts in the developing world in recent years. All over Andhra Pradesh, men who have sex with other men – who may or may not think of themselves as gay or bisexual and who are often married with families – are forming community groups and helping each other to solve their own problems. Venkatesh is one of them.

One in seven men who have sex with men in Andhra Pradesh is HIV positive according to the state government. They are almost 20 times more likely to be infected with HIV than the average Indian adult (the national adult prevalence rate is 0.36%). This is because unprotected anal sex with multiple partners carries a high risk of HIV, and because discrimination drives men who have sex with men underground.

Sylvia Rowley, for

Homosexuality is illegal in India under the notorious section 377 of the Indian penal code and is a social taboo. There is incredible pressure for men who are attracted to men to hide their sexuality. Sex between men is often limited to brief liaisons at so-called "hotspots" behind a train station or by the side of a highway. "We wear a mask, the masculine mask," says Krishna, founder of a network for men who have sex with men in Andhra Pradesh. "We drop our voices, change our walk. That is drama, you have to act."

Because men who have sex with men are so well hidden, it is almost impossible for government Aids agencies or HIV/Aids charities to reach them. "The Government people can’t walk around looking for hotspots," Krishna says, laughing at the thought. "They can’t find them!"

Men such as Krishna, however, do know where to look. In Andhra Pradesh, community-based organisations (CBOs) made up of men who have sex with men can now be found in every district. Outreach workers at the CBOs map all of the sex hotspots in their area and visit them daily, armed with an HIV education flipbook, a stash of condoms, lubricant, and a plastic model of a penis. Each CBO is supported by a local non-governmental organisation (NGO) which provides a drop-in centre and sexual health clinic, and a state level NGO, the Alliance for AIDS Action, a partner of the International HIV/Aids Alliance, which coordinates the programmes and provides training to the community groups.

CBO members also work with police, doctors and parents to tackle the wider discrimination that puts men like them at risk of HIV. "I tried to go to the government hospital because of an anal infection, but the doctor called me a kojja [derogatory word for transsexual] and refused to see me," says Venkatesh. "I felt so bad I wanted to commit suicide," he says, "but now we do workshops with the doctors to make them understand us better." This work is crucial as untreated sexually transmitted infections increase men’s vulnerability to HIV. If the sessions fail then Venkatesh will try other means – one doctor who constantly refused to treat men who have sex with men was sacked recently after CBO members talked to the hospital authorities.

Most groups also try to improve relations with the police because, as one man says, they "harrass us like hell". I was told about police at hotspots demanding bribes ("they will pocket whatever we have"), and arresting, beating and raping men. In response to this and violence by local thugs, CBOs have formed Rapid Action Teams – if a man is in trouble he can ring for help and a group of his peers will quickly come to the scene and challenge the attacker. CBOs also do "sex and sexuality" training to build a rapport and understanding with the police.

The results for these projects are staggering. An evaluation in 2007 showed that 96% of men who have sex with men reported using a condom with their last male partner, up from 55% in 2003. The prevalence of syphilis, which is used as an indicator for HIV, more than halved in the same period. This is a cause for celebration not just for men who have sex with men, but also for their wives. Roughly eight out of 10 men who have sex with men in Andhra Pradesh are married and if they become HIV positive it is very likely that their wives will too. The state Aids prevention body estimates that 96% of men who have sex with men in Andhra Pradesh (that they know of) are now being reached by this type of programme.

The Alliance for Aids Action hopes that by empowering men who have sex with men to solve their own problems, these changes can be made to last. "How long can a third party run a programme?" asks Narendra Nath, a senior programme officer at the alliance. "When this project finishes [in about five years] we hope that the CBOs will be able to keep doing the HIV prevention work."

Back in the maze of bushes by Mancherial train station a group of three kothis who have come here in search of "someone beautiful" crowd around. The mood is jovial and they joke that one man in our group is "looking very smart!"

"I don’t tell my wife I come here because she’ll feel bad," one says. But I use a condom – I don’t want to make her suffer."

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