Exploring context and dynamics of homosexual experiences among rural youth in India.

There is a lack of community-based studies that have examined level and context of homosexual activity in India among male youth. As part of a larger study on sexual behavior and gender attitudes of rural youth in Northern India, this study identified a subgroup of young men who reported homosexual experiences, even though they did not identify themselves as homosexual. This article attempts to examine the levels and range of sexual practices and attitudes of the homosexually active male youth by comparing them with their peers who reported heterosexual experiences. Study findings indicate that about one-fifth of sexually active male youth reported homosexual experiences. These young men begin their sexual careers early; engage with a higher number of sexual partners, both male and female; and are more likely to report inconsistent condom use, as compared to their heterosexually active peers. With high levels of partner mixing and inconsistent condom, use it appears that, for this subgroup of young men with high risk behaviors, homosexual experiences are only one part of their sexual lives and not the main factor that would contribute to their HIV vulnerability. Interventions need to be mindful of these issues, rather than rushing into labelling youth as homosexual or heterosexual for programmatic purposes. At the same time, as high-risk behaviors are largely unexplored among a general population of rural male youth, there is need for more in-depth ethnographic and culturally specific sexuality research to explore if there is a subculture that may promote sexual practices including same-sex activities that influences HIV vulnerability.

Meeting the sexual and reproductive health needs of people living with HIV: challenges for health care providers.

A trained health service workforce is critical to ensuring good quality service delivery to people with HIV. There is only limited documented information on the challenges and constraints facing health care providers in meeting the sexual and reproductive health needs of HIV positive women and men. This paper reviews information on providers' attitudes, motivation and level of preparedness in addressing the sexual and reproductive health needs of people living with HIV in the context of the human resources crisis and emerging treatment and prevention strategies. There is a need for significant investment in improving the health infrastructure and providers' ability to take universal precautions against infection in health care settings. Additionally, there is need for comprehensive and appropriate training for health care providers to build their capacity to meet the requirements and expectations of different sub-populations of HIV positive people. This includes not only physicians but also nurses and midwives, who are the primary caregivers for most of the population in many resource-poor settings. Supportive and knowledgeable providers are crucial for helping HIV positive people seek and adhere to treatment, prevent sexually transmitted infections, unintended pregnancies and vertical transmission of HIV and support positive living free from stigma and discrimination. Providers, some of whom may themselves be HIV positive, can make an important difference, especially if they are supported in their working conditions, are knowledgeable about HIV and sexual and reproductive health and have the skills to provide good quality care.