As Harvard-affiliated physicians and behavioural scientists who have conducted HIV prevention research and education in India for more than 15 years, and who have cared for people living with HIV/AIDS since the first days of the epidemic, at Fenway Health (www.fenwayhealth.org) in the U.S., we write to express our concern over the recent Supreme Court ruling upholding Section 377 of India’s Penal Code. We respectfully ask the government and people to repeal this colonial-era law criminalising same-sex behaviour.

We want to express our admiration for India’s successful management of the HIV/AIDS epidemic. While India has the third largest HIV-infected population, HIV there has not become an uncontrolled, generalised epidemic (as is the case in southern Africa) as many feared it would when the first cases were reported among sex workers in Tamil Nadu in 1986. India’s HIV success story has much to teach the rest of the world. Nevertheless, it is also important to recognise, as we noted in a special issue of the Indian Journal of Medical Research (IJMR) two years ago, that while more than half a million Indians are currently receiving life-saving antiretroviral treatment, substantial unmet need remains.

In 2005, we surveyed men who conducted HIV prevention work among men who have sex with men (MSM) Chennai. We found that 85 per cent reported harassment from the police, and 86 per cent reported harassment from “thugs,” individuals or groups of men with criminal records. Two-thirds said they were harassed at least once a week. In a survey with MSM in Chennai, we found that 39 per cent experienced high rates of stigma. We surveyed MSM in Mumbai and found high rates of suicidal ideation, depression and anxiety. Laws criminalising homosexuality, and social pressure to marry, negatively affect the mental and physical health of MSM and place female partners at increased risk of HIV.

Some argue that India’s unique cultural and religious traditions preclude social acceptance of homosexuality. As U.S. Secretary of State Hillary Clinton said two years ago on International Human Rights Day, “Some seem to believe [homosexuality] is a western phenomenon, and therefore people outside the West have grounds to reject it. Well, in reality, gay people are born into and belong to every society in the world…. Being gay is not a Western invention; it is a human reality.” United Nations Secretary General Ban Ki-moon said much the same earlier this year, when he said that culture, tradition and religion “can never justify the denial of basic rights,” and called for an end to the criminalisation of same-sex behaviour.

As we noted in the IJMR, “currently available tools can arrest, if not end, the [HIV] epidemic.” These include increasing the number of people living with HIV who are on treatment and who are virally suppressed, promoting pre-exposure prophylaxis (the use of antiretrovirals to make one less likely to become infected if he or she is exposed), and targeting those who bear the greatest burden of HIV in India and in many other parts of the world — sex workers, MSM, and people who inject drugs. Key to reducing the burden of HIV among MSM and transgender Indians is decriminalising same-sex behaviour and reducing cultural stigma toward LGBT people.

We respectfully urge India to repeal this law and move forward on the path toward equal rights for all.

This is the right thing to do, and it will also have a positive impact on public health.

Kenneth Mayer, Sean Cahill, Steven Safren, Matthew Mimiaga and Harvey Makadon,

The Fenway Institute, Boston, U.S.

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