Acknowledging%20gender%20variance%20and%20sexual%20identities%20and%20their%20impact%20on%20successful%20HIV%20prevention%20programming

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Acknowledging gender variance and sexual
identities and their impact on successful HIV
prevention programming
2nd International Expert Meeting on HIV
Prevention on MSM, WSW and Transgenders 5th
6th November, 2009 Amsterdam, Netherlands
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Religious beliefs and customs, gender roles and
idenitities, denial, ignorance, illegality,
myths, fears, violence, abuse, exclusion, and
invisibility create a discourse that often denies
much of male-to-male sexual behaviour in society
along with shaping its expression. At the same
time, current discourses on sexual identity,
sexual orientation, and sexual minorities, also
can increases the invisibility of much
male-to-male sex.
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The problem with naming! First gay 'marriage' in
Pakistan A gay couple have become the first to
get "married" in Pakistan, according to reports
from the region.Witnesses said a 42-year-old
Afghan refugee held a marriage ceremony with a
local tribesman of 16 in the remote Khyber region
bordering Afghanistan.. BBC news 5 October
2005
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A binary, hierarchal and oppositional world
Mind Body Man Woman Male Female Masculine
Feminine Young Old Heterosexual Homosexual
Straight Gay
The world is not so simple
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A trinary world?
South Asia Man Not-man Woman
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Male-male sexual frameworks

• Gendered framework
• Male to male desire based on feminised gendered
  roles
• and identification - sexual acts based on gender
  roles,
• i.e. man/not-man

Note that these are not transgendered persons
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Why do men have sex with men? This is not
normal. We kothis/zenana are here for them. I
dont mind if my girya beats me up. It only shows
how manly and powerful he is. When my parik
(husband) beats me, I feel as helpless as a
woman. Since I want to be a woman, it actually
makes me feel good.
Kothis/metis/zenanas/hijras recognise that they
are neither women or men, but some other.
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Discharge framework Male to male sexual
behaviours arising from immediate access,
opportunity, and body heat. They
involve boys/men from the general male population
using receptive, feminised males for
discharge.
Also involves males in all-male institutions
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Doing masti Opportunistic - body heat, mutual
desire and friendship usually
pre-marital Often no significance in terms of
orientation and/or identity These males do not
perceive themselves as homosexuals, but rather
doing masti.
Across the region
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Beardless boys Older men form relationships with
adolescent males - usually between 12 and 18
years - before these males grow beards. Beardless
boys Beautiful boys Dancing boys Such boys are
not men
Primarily in Afghanistan and in Pakistan, but
also exists to some extent across the region
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Emergent gay framework Male to male desire framed
by sexual orientation. Egalitarian the same
- Primarily used by middle and upper classes.
Such gay identified men usually seek other gay
identified men as sex partners.
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Identities and/or behaviourCommunity versus
individualShame versus guiltToxic
masculinityGenderphobia
Of course this is all much more complicated than
presented.
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Key issues

• Sexual diversity and polymorphous sexual
  behaviours
• A primary gendered framework of male-to-male
  sexual behaviours
• Many MSM perceive themselves as a part of a
  real man/not-man binary
• Marriage as socially compulsory
• Early sexual debut often arising from gendered
  performativity
• Gender segregation and social control of females
• Often male-to-male sex perceived within a context
  of play - not sex

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• Denial of social justice and human rights
• Low to non-existent financial and social
  investment in HIV prevention, treatment, care and
  support
• Apart from possibly infecting each other through
  high-risk activities, many MSM are also married,
  and/or have sex with other females.

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Stigma and violence

• 42 reported that they had been sexually
  assaulted or raped by policemen.
• 60 reported sexual assault or rape by goondas
  (goons).
• 75 of those reporting being sexually assaulted
  or raped by either policemen or goondas, stated
  that this occurred because they were effeminate.
• 70 of respondents reported facing harassment
  from police, ranging from extortion, blackmail,
  beatings, restrictions to movement, and
  disclosure of sexual practices to goondas and
  family members.

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Stigma and violence

• Education, poverty, vulnerability to violence
• 50 stated that fellow students or teachers
  harassed them in school or college because they
  were effeminate, drastically effecting their
  education and employment opportunities.
• 70 stated that the fact that they had sex with
  other males has had negative impact on their
  economic prospects.
• 45 respondents stated that their effeminacy had
  affected their work opportunities.
• 82 respondents stated that if they were not
  kothis, they would have better job opportunities.

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• What would the psychological and social
  experience be of a person who experiences a major
  conflict between what these social, religious and
  cultural expectations and roles he is expected to
  express and perform, and his own sense of self?
• Disempowerment
• Low self-esteem
• Low self-worth

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A word about women who have sex with women
Women socially policed Early marriage Public
space as a male space Low opportunities Almost
no data HIV prevalence no data
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A word about transgenders in South Asia
Problematic term Hijras often defined as
transgenders Surgical interventions? Biological
males, femininity, anal receptivity Cross-dressin
g HIV prevalence hijras have the highest rate
in South Asia because of the frequency of
penetrating partners
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The legal framework
Section 377 of the Bangladesh/Indian/Pakistan
Penal Codes Anyone who voluntarily has carnal
intercourse against the order of nature with man,
women or animal, shall be punished with
imprisonment of either description which may
extend to life, or to ten years and shall also be
liable to a fine. Explanation Penetration is
sufficient to constitute the offence as described
in this section.
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A similar law in Sri Lanka was amended to
specifically make it gender neutral Section
365a. The Afghanistan Penal Code has a specific
Article on pederasty seen as sodomy this
can be treated as subservient to the
Sharia. While Nepalese laws did not explicitly
criminalise homosexuality, unnatural sex act
currently carries a prison tem of up to a year.
However, the Nepal Supreme Court ruled in
December 21 2007 that the rights of sexual
minorities under the concept of a third gender
need to be respected, and that all laws which
impact on these rights need amendment.
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The social and religious framework
The threat of exposure in a culture where shame
is the dominant mode of social control creates
an environment of blackmail, suicide and
coercive sex with no redress. Under Sharia law,
male-male sex is also punishable by whipping,
and at times, death.
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Where we are
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A way forward

• Addressing social exclusion and human rights
• A rights-based approach that addresses legal,
  social and cultural impediments to HIV
• programming for MSM and sensitising of law
  enforcement agencies, judiciary, media,
• government, and donors
• Rapid scaling up of self-help interventions
  providing
• prevention, care and support
• Gender/sexual orientation self-help groups
  towards community building and
• mobilising, along with recognition of gender
  variance and diversity
• Increasing financial and technical investment
• To achieve the above, there will be a need to
  significantly increase the levels of
• financial and technical investment for MSM and
  HIV programming across the region,
• along with new prevention technologies including
  rectal microbicides

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But..
Unless we also address the social construction of
penetrative masculinity that allows genderphobia
be a part of this construction and which enables
violence against feminised males (and females)
to be socially permissible - in a society that
socially excludes such males - and says they are
less than human, there will always be a
difference between policy and implementation.
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Thank you