The World Health Organization for the first time recommended that gay men, who along with sex workers, people who inject drugs and transgender people are most at risk of contracting HIV, should use the Tenofovir antiretroviral medicine as a preventive drug.
“Rates of HIV infection among men who have sex with men remain high almost everywhere and new prevention options are urgently needed,” WHO said in its guidelines on HIV prevention on July 11.
It strongly recommended that gay men consider taking antiretroviral medicines as an additional method of preventing HIV infection, alongside the use of condoms.
However in the Indian context, doctors are constrained to promote the preventive drug to gay men because of laws that criminalize same-sex relations, experts say.
“There are many barriers — social and legal — that make it difficult to market preventive treatment in India,” Dr Sanjay Pujari, Director of the Institute of Infectious Diseases in Pune told economictimes.indiatimes.com. “You cannot publicly start promoting this among gay men in India, when you have a law that criminalizes homosexuality.”
Pujari says that even when he has prescribed the preventive drug he still finds a reluctance to use it.
“It’s a double-edged sword. People sometimes feel guilty that they are being promiscuous by popping the pill,” Pujari said.
A man who tested HIV positive eight years ago, said it is high time that India at least opens a dialogue on this issue.
“There are a lot of people who are having unsafe sex. So we are at a stage where the least that we can do is give people the information that such preventive treatment exists, and the liberty to choose,” he said.
Pujari said that in the high-risk gay population, the sustained use of ARVs was only 30% and even during clinical trials, it was inconsistent.
Askok Row Kavi, activist and founder of the Humsafar Trust, an organization that fights for the rights of the LGBT community in India said Indians are still not ready to promote preventive HIV medicines because of the patriarchal set-up.
Same-sex relations, besides the legal censure that describes it as an unnatural act punishable by up to life imprisonment, is also seen as a social taboo.
Doctors including Pujari are clear that India needs a comprehensive debate in both the academic and public spaces on the introduction of the preventive medicine.
Though globally the number of people dying of HIV/AIDS has fallen, renewed intervention is still needed for those at risk, they say.
Tenofovir has been hailed by some as the next big medical revolution after the morning-after pill.