In Manipur, men having sex with men (MSM) have been exclusively affected by the HIV epidemic. In countries where such information is gathered, HIV infection rate amongst MSM are often higher than the general population due to multiple sexual partners, unprotected sex and the hidden nature of their relation in many communities contribute to the prevalence of HIV amongst MSM.

In most States people deny the existence of MSM, resulting in an alarming lack of prevention and care service directed at men behaviour.

Unlike other States the existence of feminine are accepted due to existing in the role of artist those who taking female role and taking a big role in giving social information direct to the people in the 'Shumang Lila' that is a kind of play that shows in the open area.

Some are coming up as Maibies who have been working and dressing up like a female to worship local deities so called as 'Lai Haraoba' from the immemorial time. This denial and discrimination against them feed the secrecy in which many MSM live increasing then risk taking and making it difficult to reach them with HIV prevention and intervention.

Developing and implementing intervention for this population is also difficult because of varying definition and perception of gender, sexual roles, homophobia and internalized homophobia.

Due to social pressure, there is inability of identifying themselves as MSMs. The concept of MSM is both receiver and giver during the sex but people think homos are only the feminine who commonly visible in the State.

There are many male partners of such feminine groups in the community. They do not think themselves as MSM and they hate to make friendship openly with those feminine male in the society but they make partner at the time of sex. So common people think homos are those male who act as feminine.

They have their own code language among themselves such as 'B' those who are feminine same as koti 'A' for those who are their male sexual partner same as panthi. 'AB' are those who behaves as both as B and A role during the sex same do-paratha. No record of transgender in the state.

Findings from the existing SASO-MSM project:

SASO implement MSM project in 1998 as an intervention program with the project name 'Prevention, Intervention of HIV/AIDS/STIs among MSM in Manipur following are the specific objective of the project.

Target - 700
Project Area - Imphal East and West
Project Goal- To reduce the sexual risk behaviour among the infected and affected 700 MSMs in Imphal.

Project Objectives: To increase the levels of knowledge on issues around sexuality, sexual health, MSM and their sexual partner.

Using condom is very rare due to lack of knowledge, unavailability of anal condom etc. Besides these, once they built up their partners, they never practice safer sex. They have their own meeting places (night joints) in the Imphal area i.e Paona Bazar, Polo ground, Porompat market, Moirangkhom Kabui Khul, Muzi etc.

They are afraid of going for treatment to the Govt hospital or private due to fear of social stigma. Law enforcement groups, middle aged married men, youths and ex-IBU are also one of their sexual partners.

It shows that there are still chances of getting and spreading infection like Hep B, C/HIV/STI, besides more than 46% of them have the habits of injecting 'Depo-Provera' a contraception injection as a hormone for increasing breast size manufactured by MAX (USA) and sometimes they have share the needle and syringes.

On the other hand, MSM is vulnerable group often facing problem like sexual abuse, physical harassment by the law enforcement, pressure groups and general youths. Despite 65% of them have been discriminated by the families i.e. not taking care, treating as useless person in the society though they have a very creative skills and talents in handicrafts designing, music, dances and drama as well as beautician.

Therefore, MSM is one of the most vulnerable groups of people who have the high potentially of spreading the infection, they need to be given more emphasis to find out immediate need so that appropriate intervention, prevention and care program could be implemented in order to prevent further infection and spread of blood borne diseases within the society.

Note:

* 'A' MSMs are not enrolled much because they do not think themselves as a MSM
* 22 are Muslim client
* 20 are tribal client
* We have conducted PSA (Participatory Site Assessment) found 1009 MSMs in the project area.
* Problem to sensitize among common women about our sexuality.
* 2003, MSM Sentinel Surveillance report (73 person were found to be HIV out of 250 target)
* 2004, MSM Sentinel Surveillance report (35 person were found to be HIV out of 250 target)
* 2005, MSM Sentinel Surveillance report (37 person were found to be HIV out of 250 target).
* Formed a SHG of MSM named AASHA (Awaken Artisan Shelter Assn)
* Formed a SHG infected MSM named 'New Hope'
* To built up capacity among the MSMs through training on issues of sexuality and sexual health.
* To organised workshops, seminars, and provision of drop-in-centre and telephone support tines etc.

Project Activities: - Field visit/ New client contact/ follow up
- FGD
- Group session/ Group discussion.
- Counselling individual and family
- IEC
- Health care
- Outreach service
- Community sensitization program
- Peer education training
- Community leaders training
- Free condom promotion/ condom outlet
- Net working with CBOs, GOs and NGOs
- Formation of SHG

Now we are providing the service under supervision of Project Orchid, the following is the findings from April 2005 to June 2006

- Total number of client - 510 (72.8%)
- No. of MSM (A) - 64 (9.14%)
- No. of MSM (B) - 339 (48.4%)
- No. of MSW- 107 (15.28%)
- No. of Muslim - 22
- No. of Tribal - 20
- No. of client who indulge anal sex - 400 (57.14%)
- No. of client who have multiple sexual partners - 368 (52.57%)
- No. of condom distribution - 100201
- No. of client who use condom - 270 (38.57%)
- No. of STI treatment -109 (15.57%)
- No. of multiple STI- 23 (3.28%)
- No. of referral for VCCTC- 82 (11.7%)
- No. of HIV + - 22 (3.14%)
- No. of client under the ART- 6
- No. of client the DOT- 3
- No. of client death due to ARC- 4
- No. of client death due to suicide for being as MSM-2