prep: How India can ‘PrEP’ better for fight against HIV

When I came out in 1984, they used to laugh at me, saying why are you people asking for rights? There has always been a hierarchy of rights, and gay rights is always at the end. It was then that I knew I had to create a safe space where homosexuality was taken seriously. It started in 1990 with Bombay Dost, India‘s first LGBT+ magazine, and continued with the Humsafar Trust. There is, however, far more to be done in our community.

The sexual minority status of individuals often puts them into a unique state of vulnerability, especially when it comes to public health awareness. For one, even in this age of Covid-19, HIV (human immunodeficiency virus) continues to be a major public health crisis in India and around the world. There remains no vaccine or cure, and many continue to contract HIV every year. Insufficient awareness of preventive measures and societal barriers like stigma and discrimination have made it especially difficult for us to turn the tide against the HIV epidemic.

India experienced a surge of HIV cases in the 1990s and early 2000s. According to the National Social Marketing Centre (NSMC), during 2001-05, India was home to the third-largest number of HIV-infected people in the world, with 3.5-4 million HIV-positive people living in India in 2002.

Through various campaigns in the 1990s-early 2000s, citizens were reminded of the importance of preventing the spread of HIV by using condoms. The ‘Balbir Pasha ko AIDS hoga kya?’campaign was developed to be bold, controversial and eye-catching, and deliberately positioned to become a ‘talking point’, even gossip, among the target audience.

Today, while we lack similar campaigns that promote these resources, we have access to new-age medications like PrEP (pre-exposure prophylaxis), which can ensure HIV keeps away from those it hasn’t caught up with already. PrEP is a drug regime that involves use of oral anti-retroviral pills on an everyday basis to safeguard oneself from contracting HIV. When taken as prescribed along with condoms, it is highly effective against HIV.

As of 2017, in India, there were 2.1 million people living with HIV, 88,000 new HIV infections, and 69,000 AIDS-related deaths. The marginalised are often at high risk of contracting the disease due to their repressed gender identity, economic status, lack of education or general stigma surrounding the disease. While condoms were suggested as the main form of prevention of HIV, today, they should be encouraged to use medications like PrEP along with condoms.

PrEP is able to provide control to individuals where condom use can’t be ensured at all times. This is especially true for women and men (kothis) who engage in receptive sex. Additionally, when the HIV status of the partner is not known, or in case of a new partner/stranger where the status cannot be trusted, PrEP provides people absolute control over their health and are not dependent on others for protection against HIV. There are also newer methods like HIV vaccines and long-acting PrEP regimens that are presently under trial.

Approved by the US Centers for Disease Control and Prevention (CDC) and the World Health Organisation (WHO), PrEP is extensively used in North America and Europe. It reduces the risk of getting HIV from sex by about 99% when taken as prescribed. The oral form is available in India, and individuals must be informed and encouraged to use it. This can be an effective drug regimen not only among high-risk groups, especially MSMs (men who have sex with men), but also among sero-discordant couples and the community of people who have multiple partners and high rate of sexual encounters.

Having easy and safe access to medication like PrEP can prevent people from marginalised communities from contracting the disease and, in turn, bring their community closer together. How people behave and engage in risky behaviour is linked to their class, gender, religion, sexual partner, etc. We must tailor our public health programmes to reach our entire population – educated, uneducated, young, old, rural and urban.

Mumbai Seenagers, for instance, is a social support group for older gay men to help tackle the issue of loneliness among the older community members. As I write this, I may have found our next topic for ‘Seenagers chai pe charcha’: what if we had PrEP in our times?

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