They are told their orientation is unnatural, their profession criminal and their existence precarious yet outreach programmes for them are minimal. Although male sex workers (MSWs) come under the high-risk category under HIV intervention programmes, their names rarely make it to the list. The result is more than 25 years after the initiation of the country's AIDS control programme, most of them continue to engage in unsafe sex.
A study by a group of researchers from institutes across the world, including the National Institute for Research in Tuberculosis (NIRT), Chennai, has found that 74.2% of the MSWs they surveyed accepted more money from their clients to not use a condom. The study, recently published in AIDS Care, took into account experiences of 100 male sex workers around the age of 25 years in the city. Beena Thomas, an NIRT scientist, who was part of the research, said at least three-fourth of the subjects surveyed expressed difficulty in convincing their clients to use condoms. “They find it hard to negotiate. And if sex work is their only source of income, it is likely that they agree to go forward without protection as the clients pay more,“ she said. The subjects said they earned between `2,000 and `8,000 a month.
Although male sex workers are at a higher risk of contracting HIV and sexually transmitted infections (STI), they remain understudied compared to their female peers. Experts attribute this to the stigma attached not just to sex work, but their sexual orientation as well.
The study also noted that only 64% of them reported ever testing for HIV. Dr Sundar Sundararaman, a physician who has worked with HIV patients for the past 30 years, isn't surprised by these figures. He said while HIV intervention programmes have listed transgender, women sex workers and homosexual men under the high-risk category, they are yet to recognize male sex workers as an exclusive group. “Male sex workers are not identified and so they aren't in the ambit of service delivery ,“ he said, advocating changes at the policy level. He said financial incentives for riskier sexual behaviour, coupled with lack of access to prevention services, increased prevalence of HIV and STIs among MSWs compared to broader population of men having sex with men. The study also noted that more than half of the subjects did not know the HIV status of their most recent client.
As believed, it is not just women sex workers who face abuse. Researchers found 60% of the MSWs faced verbal abuse and 40% were physically assaulted. Those who financially depended only on sex work were far more vulnerable and likely to report abuse.
Dr Vijaya Raman of Tamil Nadu AIDS Initiative said the numbers were alarming and urgent steps needed to be taken for intervention programmes to reach this group. “Our outreach programmes need to be revamped. This is an evolving sector. Previously , they operated in groups, now many of them work individually through the internet, which gives them anonymity,“ he said.
The study threw another surprise highlighting the need to identify this group -nearly 72% said they wanted to continue sex work. “This being the case, HIV prevention interventions shouldn't try to draw MSWs away but focus on facilitating skills that will support their ability to negotiate sexual safety,“ said Thomas.