Oral Abstract Number: THAD0105LB Sexuality and HIV Risk Amongst Gay Men: Options and Choices 24 July 2014  16:  Plenary 1 Association of Human Rights, Community Collectivisation and Vulnerability Reduction among Men who have Sex with Men in India: Myth or Reality? Authors: P. Prabhakar 1, Sangram-Kishor Patel 2, V.P. Rao 2, Vijay Nair 1, & James Robertson 3 1 India HIV/AIDS Alliance, Hyderabad, Andhra Pradesh; 2 Population Council, New Delhi; 3 India HIV/AIDS Alliance, New Delhi

Background “The full realization of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV epidemic, including in the areas of Prevention, Treatment, Care and Support.” Political declaration on HIV AIDS: Intensifying our efforts to eliminate HIV AIDS Adopted by the UN General Assembly on 10 th June 2011

What is Section 377 of the Indian Penal Code? Unnatural offences: Whoever voluntarily has carnal intercourse against the order of nature with any man, woman or animal, shall be punished with imprisonment for life, or with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine. Increased vulnerability Stigma & discrimination Impedes effective HIV response Background

The protection and promotion of human rights are integral to reduction of vulnerabilities and risk for HIV infection among MSM, transgender and hijra communities (MTH) communities Relationship between human rights, community mobilization and vulnerabilities among MSM are less explored. Rationale for the Study

Community Mobilization Processes Collective efficacy Collective agency Collective action Knowledge and Awareness of Human Rights and IPC Section 377 Outcomes Access to social protection schemes Access to social entitlements Violence reduction Objective

Study Design and Setting: Cross-sectional Behavioural Survey (2014) among MSM in selected districts of Andhra Pradesh state in southern India Sampling and Sample Size: Data from 1,200 MSM were collected from the program line listing using simple random sampling (SRS) Statistical Analysis: Descriptive statistics, frequency, bivariate analysis, multiple logistic regression analysis Data and Methods

Background Characteristics Age: Mean = 28.7 years (SD = 5.8 years) Formal education: 86 percent Marital Status 60% never married 33% currently married 7% widowed/divorced/separated/deserted Sexual Identity Anal Receptive (Kothi) (47%) Anal Penetrative (Panthi)(19%) AC/DC ( Anal Penetrative and Receptive) (27%) TG/Hijra/Others (7%)

Indicators (N=1,200)Percent Knowledge about at least one human rights issue92.5 Knowledge about all human of rights 4.0 Knowledge of right to dignity and equality, and right to be free from stigma and discrimination 8.1 Ever attempted to exercise any of the rights76.8 Heard about IPC section Knowledge about human rights and IPC section Level of Confidence that MSM can collectively fight against IPC section 377 Low62.6 High37.4 Result 1 Knowledge of Human Rights & IPC Section 377

Result 2 Nearly three-fifths of MSM reported high collective efficacy and collective agency; and one-fifth reported high collective action

Is there an association between community mobilization, knowledge about human rights, enabling environment and access to social protection?

Human Rights Access to two or more social protection schemes Access to all three social entitlements Enabling Environment (faced any violence) AOR (95% CI) Knowledge of human rights and awareness of section 377 No ® Yes 1.6 ( )*** 1.8 ( )***. 0.7 ( ) Knowledge about all human rights No ® Yes 2.3 ( )*** 3.4 ( )** - Knowledge of Right to Education No ® Yes 2.8 ( )*** 2.0 ( )*** 0.4 ( )*** Ever attempted to exercise any of the rights No ® Yes 1.7 ( )*** 2.1 ( )*** 0.5 ( )** Note: AOR: Adjusted Odds Ratio, CI: Confidence Intervals; Ratios are adjusted for age, education, marital status, typology of MSM Result 3 Association between Human Rights with Outcome Indicators

Collective agency Knowledge of human rights & section 377 Ever attempted to exercise any human rights Confident of organise and fight against section 377 AOR: 1.4 ( ) Collective action AOR: 1.2 ( ) AOR: 1.8 ( ) AOR: 2.8 ( ) AOR: 1.2 ( ) AOR: 1.0 ( ) Note: Odds Ratios are adjusted for age, education, marital status, typology of MSM Result 4 Association between Community Collectivization and Human Rights

Collective efficacy Access to any social protection schemes Access to two or more social protection schemes AOR: 1.2 ( ) AOR: 1.5 ( ) Collective agency AOR: 1.4 ( ) AOR: 1.6 ( ) Note: Odds Ratios are adjusted for age, education, marital status, typology of MSM Result 5 Association between Community Collectivization and Outcome Indicators

Summary  The comprehensive knowledge about human rights and section 377 is considerably low  Knowledge about human rights and IPC 377 significantly associated with access to social protection schemes and entitlements.  MSM who have knowledge of right to education and those who ever attempted exercise human rights have reported higher access to social protection schemes and entitlements and face lessor violence.  Community mobilisation is significantly associated with increased knowledge about human rights as well as in enhancing the accessibility of social protection schemes

Our study reinforces the need for a rights based framework to complement stronger community mobilisation efforts for reduction of vulnerability and to improve social inclusion of MSM in India and elsewhere Conclusions

Thank you! Dr. P. Prabhakar Director, Regional Office India HIV/AIDS Alliance allianceindia.org