1. MSM Estimates in India Ashok Row Khavi Ginia Loo Gina Dallabetta

2. Definition From point of view of HIV prevention Men who have anal sex with other men (receptive or insertive) AND Who have multiple partners including MSW Includes transgenders and hijra populations

3. Data – very limited Andrah Pradesh (HLFPPT) x/100,000 men of male population who are MSM East Godavari – 47/100,000 Vizag – 13/100,000 Guntur – 74/100,000 % of MSM who are anal receptive East Godavari – 47% of MSM anal receptive Vizag – 24% Guntur – 26%

4. Mumbai Estimated 150,000 transgenders (source ???) Of MSM surveyed (Humsafar Trust) – receptive anal sex between 53% and 62% reported between 2000 and 2005 (high reported condom use rates 72%) % of MSM at public sex recruitment sites – 20 – 25% Other data Pop Council Survey International HIV/AIDS Alliance (AP) Additional Chennai data

5. Methodology for estimates Need clear definitions Mapping exercises by research agencies with or without involvement of NGOs Extrapolation from population based survey data to determine the proportion of sexually active MSM and proportion who engage in high risk behavior NFHS III does NOT include this question. Applying internationally/regionally developed formulas for calculating proportion of high risk/more vulnerable MSM Thailand – 3 – 4 % of males reported recent sex with males Philippines – 3% of over 1,2000 males at blood banks reported anal sex in preceding months Chennai, India household based surveys 6 percent of males reported anal sex with other males (Go, JAIDS 2004).

6. Implementation issues Enumeration and mapping is better the more experience one has with community What is the intervention strategy for MSM community in India (personal observations) MSM communities are highly stratified and mutually exclusive Need to carefully choose NGOs for MSM work No definition of risk subtypes (chosen anal sex and multiple partners) General perception that anal sex is not sex – need better condom promotion messages Focus on obviously first – high risk venues, “risk space interventions”, “hot spots” Allow for learnings, adjustment as interventions move forward Research