And there was evidence to show that such community-led structural interventions

helped reduce the rates of HIV and STIs,39 stigma, and violence, and have improved utilization of services from public health care facilities,40 safe sex behaviors, and self- and collective empowerment.41,42 While there were some similar interventions selleckchem undertaken for the MSM population in selected parts of India, those interventions were less effective due to the fact that MSM operate in an environment in which it is considered not only illegal and thus “hidden” but also socially abhorrent. Notwithstanding, there was some evidence-based development and implementation of MSM community-led interventions for the HIV prevention in selected cities in India.41 Lessons learnt from such interventions and the program experience suggest that targeted interventions with intensive peer-led education and condom promotion, building an enabling environment by networking with stakeholders at different levels, promoting community-led program planning and execution, and active

linkages to integrated testing and treatment services may help to further reduce HIV. Further, involving communities actively in district and state program units and provision of project-based STI clinics may further HIV risk reduction among MSM. Efforts should also be made to address the legal barriers that prevent expanded outreach of HIV services to MSM, and to address the stigma and discrimination faced by MSM in the country. Further, as the program marches ahead, sustaining the coverage and intensity of prevention interventions where declines in HIV prevalence have been achieved is critical. The existing interventions shall make concerted efforts to empower MSM for access to health care and

other services, strengthen networking, and address specific needs of the community such as ensuring access to thicker condoms and lubricants, and treatment of anal STIs. Interventions should be implemented to bring about behavior change through innovative communication strategies and materials, and to provide them with access to preventive care, support, and treatment in efforts to stop the HIV spread among MSM and their sexual partners. Acknowledgments This paper was written as part of a mentorship program to the first author, under the Knowledge Network Brefeldin_A Project of the Population Council, which is a grantee of the Bill and Melinda Gates Foundation through Avahan, its India AIDS Initiative. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the National AIDS Control Organization or the Bill and Melinda Gates Foundation or the Population Council. Footnotes Disclosure All authors verify that they have no conflicts of interest regarding this work.