Received Date: December 18, 2016; Accepted Date: April 11, 2017; Published Date: April 18, 2017
Citation: Jaiswal A, Kirubakaran A (2017) Attitudes of Kothi (Men Sex with Men) on HIV/AIDS in Puducherry. J Socialomics 6:202. doi: 10.1472/2167.0358.1000202
Copyright: © 2017 Jaiswal A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Men who have sex with men (MSM) community are a highly complex, diverse and multi gendered population. Normally there are two clear distinctions to this population, one that is clearly visible and the other which is invisible as they exist as a part of the normative male population. MSM in India have faced hostility and social discrimination. The socio-political environment of the country is not favoured for MSM. MSM are the target due to their perceived abnormal identities and sexualities. Stigma and discrimination often results in lack of access to health care and other social resources, increasing the susceptibility of MSM to health risks such a HIV and STI’s. It is inferred from the research study, the poor knowledge and attitude towards HIV/AIDS has been found in Kothi’s group. In Puducherry region HIV prevalence among MSM is (2.0%). This MSM activity is grooming in Puducherry, so an attempt has been made to know the attitude and the awareness regarding the killer disease, and how to prevent it. In this study 200 Kothi were interviewed and collected the information. This qualitative investigation explored the attitude of Kothi (MSM) on HIV/AIDS in Puducherry region.
HIV/AIDS; Attitude; Men sex with men; Kothi
Who is Men Sex with Men (MSM)?
The term ‘‘Men who have Sex with Men,’’ or MSM, came into being in the 1980s in the context of public health efforts to understand men’s sexual behaviour as it relates to HIV transmission and prevention. The term is used to refer to a wide range of distinct groups of men: those who self-identify as gay, bisexual, or transgender; incarcerated selfidentified heterosexual men who, due to their circumstances, engage in voluntary sex with other men; self-identified heterosexual men who engage in sex with other men as a means of survival during incarceration, periods of homelessness, or for economic gain; men who have sex with females and/or with male-to-female transgender persons but also have sex with males; men who self-identify as ‘‘same-gender loving’’ or ‘‘sexual freaks;’’ and men who self-identify as ‘‘questioning’’.
The estimates for the prevalence of HIV in Men sex with Men (MSM) in India vary. Pockets of high HIV prevalence among MSM are identified in high prevalence States as well as in Delhi, Gujarat and West Bengal. Twenty-eight districts have 5 per cent or more HIV prevalence among MSM according to the BSS . The States that have the highest mean HIV prevalence amongst MSM in 2008 are Karnataka, Andhra Pradesh, Manipur, Maharashtra, Delhi, Gujarat Goa, Orissa, Tamil Nadu and West Bengal . The Government of India’s National AIDS Control Organization (NACO) estimates an overall HIV prevalence of 6.41 per cent among MSM, although this may be a lower-limit estimate. For example, in Mumbai, 12 per cent of MSM seeking voluntary counselling and testing services were HIVinfected, and 18 per cent of the MSM screened in 10 clinics in Andhra Pradesh were found to be infected 16-18. It was found 8 per cent HIV prevalence in a sample of 210 MSM in Chennai recruited by peer outreach workers . In the context of this disproportionally prominent level of HIV risk, it becomes extremely important to understand the socio-cultural factors that may exacerbate sexual risk among this group. HIV/AIDS prevalence among the MSM population in Puducherry is at 2.0 per cent of total population of Puducherry .
Statement of problem
Men sex with men is engaging in unprotected anal and vaginal sex with male and female sexual partners. MSM in India may play a “bridging” role in the spread of HIV into the public. Significant proportions of MSM in India, including Kothi’s, are married and engage in sex with both men and women. Thus, Kothi’s may be at elevated risk for HIV infection and may pose risks to both their male and female partners.
Need of the study
In the wake of HIV epidemic MSM behaviors have been categorized as elevated risk behaviors. The persistent stigma, heterosexism, prejudices, stereotypes and taboo about the same sex relationships are the major barriers for research and interventions among MSM subpopulation. MSM is a diverse group and importance should be given to their socio- psychological factors involved in perpetuating their risk behavior. The sexual behaviors and societal pressures enhance their chance to get infected with HIV/AIDS. In the Indian context, very little is known about such people, their socio-sexual networking, context, sexual behavior, problems and future strategies. Therefore, there is need to understand attitude towards HIV/AIDS among the MSM in Puducherry. This MSM activity is grooming in Puducherry, so an attempt has been made to know the attitude and the awareness regarding the killer disease, and how to prevent it.
Objectives of the study
• To study the attitude of Kothi (MSM) on HIV/AIDS.
• To suggest the preventive measure and future HIV/AIDS intervention among Kothi (MSM) in Puducherry.
Descriptive research method has been adopted for this research.
To achieve the goals of this study, the first-hand data collection with the help of purposive sampling for case study and pre-tested structured Interview schedule was used to full fill the objective and snow ball sampling technique was adopted to select the respondent. The primary data was collected through help of interview schedule by direct participant observation research technique. The data have been collected from the selected samples from different cruising points in Puducherry region where the Kothi’s indulge in sexual activity.
There is no exact enumerated population size of the MSM in the study area. These people are considered as invisible populations for the correct estimation. The researcher tried to identify the people with MSM (Men who are indulged in Sex with Men) activities, with the help of Sahodaran NGO working on these communities and there by a linkage was established through them in which the Kothi’s with MSM (Men Sex with Men) activities were selected as the sample study population. By following this snow ball sampling technique, a sample of 200 Kothi MSM were identified in Puducherry region for the research study.
Puducherry is at present, a union territory with its area scattered over three different states in the country. It lies on the Coromandel Coast in south India. The capital of the union territory of Puducherry is also known as 'Pondicherry'. The total area of Puducherry region is 290 square Kilometres and its population is 946,600.
The study is focused in the Puducherry region and where these Kothi (MSMs) involve for their sexual activities. These activities mostly take places in the public parks, public toilets, bus stations, theatres and isolated public places. Such places are well known among the Kothi (MSM) and where they indulge in sexual activities.
The Kothi group has many similarities with the Hijra group, but the main difference is that they tend to be much less feminine than the Hijra. Their main profession is sex work while dressed as females; however, they do not dress as females when they are not working. During anal sex, Kothi are both penetrated and penetrate, while they are also both the givers and receivers in oral sex.
Attitude is a predisposition or a tendency to respond positively or negatively towards a certain idea, object, person, or situation. Attitude influences an individual's choice of action, and responses to challenges, incentives, and rewards. Attitude can be defined as a positive or negative evaluation of people, objects, events, activities, ideas, or just about anything in the environment. Attitude is, "a psychological tendency that is expressed by evaluating a particular entity with some degree of favour or disfavour.
Attitude of Kothi on HIV/AIDS
Table 1 show that 59.5 per cent of Kothi respondents are aware of the HIV/AIDS. 39.5 per cent of them do not have any knowledge about it. Only 1.0 per cent of the respondents were totally not aware of HIV/ AIDS.
Table 1: Kothi respondents’ opinion on lack of proper information on HIV/AIDS
The researcher tried to know their awareness regarding vulnerability of MSM’s respondent. This has been tabulated and presented in the table 2 which shows that 95 per cent of them understand they are vulnerable group for HIV infection. Only 5.0 per cent of Kothi respondents are not aware of it.
Table 2: Opinion about Kothi respondents are the most vulnerable group to HIV infection
In India, the men who have sex with men are not legally accepted like legal bi-sexual partners. So, an attempt was made to find out the views of the MSM regarding the legalization of MSM and gay man marriage. Table 3.3 shows that 85.0 per cent of the MSM believe MSM needs to be legalized. 14.0 per cent of them do not want to legalize it. Only one per cent of them are not able to express their opinion on legalization of MSM.
|1||Agree, to be legalization||170||85.0|
|2||Not to legalization||28||14.0|
Table 3: Opinion on legalization of Kothi and gay marriage
Table 4 shows that 94.0 per cent of the respondents believe the HIV/ AIDS patients should not be isolated. Only 6.0 per cent of the Kothi respondents believe the HIV/AIDS patients should be kept separately.
Table 4: Kothi (MSM) respondents ‘opinion on whether the HIV/AIDS patients should be kept separately or not?
The MSM respondents’ opinion regarding the way of treating the HIV/AIDS affected victims are treated by the public was examined and presented in the table 5. The study shows that 74.5 per cent of the Kothi respondents view that the HIV victims are being ignored. Majority of the Kothi respondents say that the HIV victims are ignored or hated despite knowing the fact that their dreadful disease is not spread over by touch or any other source except unsafe sexual activity, transfusion of blood and blood products. Further they state that, the public should treat the HIV/AIDS victims humanely.
Table 5: Opinion of the Kothi respondents about the treatment of the HIV/AIDS infected persons in the society.
The Table 6 shows that 95.5 per cent of the respondents’ opinion that the HIV/AIDS affected victims should be treated sympathetically. 25.0 per cent of the respondents believe the HIV/AIDS patients should be totally ignored.
Table 6: Opinion of the Kothi respondents on how the HIV/AIDS infected person should be treated
Table 7 explains about the opinion of the Kothi respondents about HIV/AIDS patients’ treatment in their work place. 67.5 per cent of the HIV/AIDS affected victims are terminated from the job. 28.0 per cent were permitted to work in isolation. 1.5 per cent of them are assigned less work.
|1||Allowed to work as before||6||3.0|
|2||Allowed to work but isolated||56||28.0|
|3||With lesser work load||3||1.5|
Table 7: Opinion of the Kothi respondents how HIV/AIDS infected persons are treated by the employers at work spot.
Table 8 shows that 50.0 per cent of the Kothi respondents have expressed that the HIV/AIDS affected people should be given less work load and 45.0 per cent of the Kothi’s believe their employer should treat the HIV/AIDS patients on par with other employees without any discrimination.
|1||Allowed to work as before||90||45.0|
|2||Allowed to work but isolated||5||2.5|
|3||With lesser work load||100||50.0|
Table 8: Opinion of the Kothi respondents about how HIV/AIDS infected persons are should be treated by the employers in work spot.
2.5 per cent of them have said that HIV/AIDS patients should be allowed to work but isolated in some way. 2.5 per cent of the Kothi respondents have said that HIV/AIDS victims are to be terminated form the job.
Table 9 reveals that 61 per cent of Kothi respondents view that the HIV/AIDS affected victims should continue their life as usual in a professional way without any unusual care. 33.5 per cent of Kothi respondents view that HIV/AIDS affected victims should lead a personally cared life by keeping away or isolating themselves. 5.5 per cent of Kothi’s have no opinion about it.
Table 9: Opinion of the Kothi respondents about how should HIV/ AIDS infected persons lead their life in the society.
Table 10 is about the opinion of the Kothi respondents regarding whether the HIV/AIDS infected persons can get married. 91.0 per cent believe the HIV/AIDS patients should not get married, because there is considerable risk of transmission/spread of the dreadful disease to their spouse.
|1||Yes, they can marry||12||6.0|
|2||No, they can’t marry||182||91.0|
Table 10: Opinion of the Kothi respondents regarding whether the HIV/AIDS infected person can get married.
6.0 per cent of them believe the HIV/AIDS victims should get married because they too need a life partner and further that marriage should not be for sexual activity, but for only lifetime partners.
The above table 11 shows the Kothi’s opinion whether the HIV/ AIDS infected persons can indulge in sexual activity. 73.5 per cent Kothi respondents have said that HIV/AIDS infected person should not indulge in sexual activity because unprotected sexual activity has substantial risk of transmission of HIV. 25.5 per cent Kothi respondents have said that HIV/AIDS infected person can indulge in sex, but they must have safe sex by using condom. It can prevent the spread of HIV.
|1||Yes, they can have sex||51||25.5|
|2||No, they should not have sex||147||73.5|
Table 11: Opinion of the Kothi respondents about whether the HIV/ AIDS infected persons can indulge in sex.
Table 12 shows that almost 97.0 per cent Kothi’s believe the HIV/ AIDS infected person should take precautionary measures, so that should not aggravate or communicate the HIV to others.
|1||Yes, they have to take precaution||194||97.0|
|2||There is no need of precaution||5||2.5|
Table 12: Opinion of the Kothi respondents whether HIV/AIDS infected need to take precautions against further infection.
Table 13 shows that 38.0 percent believe they should be cared at home by family members and 37.0 per cent suggest a super specialty hospital. It is noticed from the study that only 5.5 per cent of the Kothi’s have suggested that they should be given treatment in a general hospital. 18.0 per cent of the respondents have suggested for rehabilitation Centre.
|1||At home by family members||76||38.0|
|2||In a general hospital||11||5.5|
|3||In a specialized hospital||74||37.0|
Table 13: Opinion of the Kothi respondents on where the HIV/AIDS infected persons should be especially cared.
Table 14 shows that 91.0 per cent of the Kothi respondents believe extreme care should be taken to protect themselves. 7.5 per cent of them believe minimum care is enough to protect themselves from HIV.
|1||Not at all important||2||1.0|
Table 14: Opinion of the Kothi respondents regarding the importance of protecting from HIV/AIDS.
About 60.0 per cent of the Kothi’s believe HIV/AIDS is a dreadful disease. 85.0 per cent of them want the MSM marriage to be legalized but at the same time 14 per cent does not want to exhibit their personal relationship to the limelight. The Kothi respondents are of the attitude that NGOs play a key role in consoling and counselling the people living with HIV/AIDS. They believe the MSM living with HIV/AIDS need the moral support from their family and friends which gives them a mental relaxation. The Kothi’s are of the view that the people living with HIV/AIDS should be treated on humanitarian ground. 91.0 per cent of Kothi’s say that the people living with HIV/AIDS should avoid martial relationship but 6.0 per cent of them feel the necessity of marriage for a moral support and not for sexual intercourse.
The mass media can be invaluable associates in changing perceptions and attitude of the public. The mass media people should be given training on HIV/AIDS, sexuality, STI and human rights concerning the Kothi’s. This will reduce the stigma and discrimination against the Kothi’s.
Kothi’s should be given opportunities to participate conferences, social gatherings, and recreational activities, including discussions and debates, poetry readings, film or video screenings, sports tournaments. It would give them more self-confidence and help them to understand each other.
To make welfare measures and policy planning the Puducherry AIDS Control Society should conduct a research survey on the Kothi population in Puducherry.