¹University of Sussex, Brighton, United Kingdom,²Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India, ³Futures Group International India Pvt. Ltd., New Delhi, India, ⁴National AIDS Control Organization, India, Delhi, India

Background: Men who have sex with men (MSM) occupy an increasingly central place in HIV prevention in India and the Indian National AIDS Control Organisation has announced plans to prioritize MSM within its next five-year plan (from 2012 onwards). Against this background many MSM remain hard to reach for the purposes of HIV prevention. The present study sought to develop context-based insights into why some MSM remain hard to reach

Methods: Qualitative field research collected data from 11 sites (Delhi, Mumbai, Sindhudurg, Lucknow, Bhubaneswar, Ganjam, Kolkata, Jaipalguri, Chennai, Pudukottai, Imphal) in seven Indian states among 401 study participants. Fifty-seven focus groups (with 364 MSM participants overall) and 37 key informant interviews were conducted. The research team was comprised of MSM with close contacts to the social milieu under study, which included openly-identifying MSM and those who do not self-identify.

Results: HIV prevention in India has largely been organized around the activism of openly-identified MSM, most often those with an explicitly feminine subject position. Research findings indicated a strong reluctance among non-self-identified MSM in using designated HIV services, because access to services appeared to be predicated on self-identification. Research data also shed new insights into ways in which gay-identified men tend to dis-identify with HIV vulnerability and risk in India, because they feel little connection with the social milieu of community-based HIV prevention. As such the research offered important new insights into different contexts of exclusion from HIV prevention, oriented around contrasting experiences of sexual subjectivity.

Conclusions: Difficulties in reaching MSM for HIV prevention appear to reside not only in the cultural and personal characteristics of so-called 'hard-to-reach MSM' but also within the way HIV prevention is socially organized around specific sexual identities. Recommendations for research, policy and programming are put forward from this perspective.