16–18 A study of MSM in Andhra Pradesh found that 51% had engaged in sex with a female partner in the past 3 months, but condom use was 44% and 16% with their last male and female partner, respectively.6 A report from Bangalore found that 15% of MSMs were full-time commercial sex workers and 63% engaged in same-sex relations for pleasure.12 A study of MSM in Chennai reports that new product 22% had unprotected anal sex and 36% had engaged in paid sex with another male.19 The surveillance conducted

in Maharashtra reports that 75% of MSM engaged in anal sex, of whom >20% did not use condoms with their sexual partners.20 In the context that HIV prevalence among MSM continues to be high, this paper provides recent evidence on the HIV epidemiology and

an overview of HIV prevention programs for MSM in India. Specifically, the paper aims to document national and state level data on current HIV prevalence and trends over time, MSMs’ HIV-related sexual risk behaviors, and the national response to the epidemic. This information could help program implementers and policymakers plan, design, and implement appropriate programs in the future to contain the epidemic in this vulnerable group. Materials and methods Data on the levels and trends of HIV and associated risk behaviors among MSM are drawn from the following sources: 1) annual HIV Sentinel Surveillance (HSS), 2) high-risk group mapping and size estimation exercise,

3) integrated behavioral and biological assessment (IBBA), and 4) the Behavioral Surveillance Survey (BSS). Annual HIV Sentinel Surveillance The HSS in India was carried out in representative populations among various subgroups, including female sex workers (FSWs), MSM, IDUs, and patients attending STI clinics. Although the first HSS was conducted in the year 1985 by the Indian Council of Medical Research, the formal annual survey among high-risk groups started in 1998, after the National AIDS Control Organization (NACO) implemented it as part of monitoring the national level program. MSM sites were first included in the HSS in the year 2003 at three different GSK-3 locations. These surveillance sites were increased to 98 by the year 2010. The target sample size for the surveillance was set at 250 MSMs at each sentinel site (usually held during June to August every year). Respondents for the surveillance are usually drawn from one of the following service points located in each of the sites: deaddiction centers, drop-in centers, and nongovernmental organization (NGO) clinics. With coverage of over 85% of the MSM population by the year 2006–07, little may be the bias with regard to generalization of the MSM epidemic using HSS data.