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A significant proportion of men engage in sexual relationships with other men which has Bisexual sex New Delhi health implications, but seex unique health care needs of these patients are often ignored or overlooked.

Moreover, due to a fear of stigmatization by the medical community, one of the more significant health risks for men who have sex with men MSM may be that they avoid routine or appropriate health care.

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Physicians Bixexual other providers can help overcome this barrier and improve the health care of MSM by keeping a non-judgmental attitude toward these patients, differentiating sexual behaviour from sexual identity, communicating with gender neutral terms, and maintaining awareness of how their own attitudes affect clinical judgment.

The purpose Bisexual sex New Delhi this article is to help Horny Southaven woman health issues affecting MSM and xex a framework for physicians and other providers to deliver optimum and appropriate health Bisexual sex New Delhi for men who have sex with men in India. Providing high quality ses effective health care to patients requires knowledge about their lives and circumstances.

This may require taking into consideration a patient's religious and cultural beliefs, socio-economic status, and behaviours that have direct health implications.

Because of stigma and ignorance, the health care issues of men who have sex with men MSM have often been overlooked 12.

Sexual variation in India: A view from the west

The lack of attention Bisexual sex New Delhi the health care of this population has had deleterious outcomes for both individuals as well as the general public health 3. To assist physicians and other providers in delivering appropriate care to this population, this article provides Bisexual sex New Delhi brief historical and cultural overview of MSM in India, and outlines some of their medical needs that clinicians can help to address, and finally discusses psycho-social issues impacting the health of this population and what health care providers can do to help address these issues in a clinical setting.

It is important to understand and distinguish between the concepts of sexual identity, orientation and behaviour. One's identity is how one identifies oneself, regardless of orientation or sexual desire and behaviour.

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Sexual behaviour, as the abbreviation MSM usually addresses, does not correlate entirely with sexual identity and orientation in many cases, but rather focuses on a description of sexual practices. For example, a married, self-identified heterosexual male, may still engage in sexual behaviours with other men.

Such a person could be categorized as an MSM, even though he might not view or consider such intimacy Bisexual sex New Delhi be considered as sex in his cultural Kik for sex tonight, and he might not be willing to be forthcoming about his desire to be with other men.

Same sex behaviour and relationships in India Bisexual sex New Delhi to be much more fluid and the associated sexual identities do not always fall into distinctive categories i.

The attitudes to bisexuality and homosexuality in India have been ambivalent Although the Delhi High Court has termed the Act illegal, pending appeals to the . There are no official demographics for the LGBT population in India, However, there are many websites in India which cater to gay, lesbian, bisexual and Delhi (13,), while cities with the highest numbers are New Delhi. of people marched in Delhi in support of the Lesbian, Gay, Bisexual, Homosexuality where an individual is attracted to the same sex.

Sexual roles may vary without regard to one's sexual Bisexual sex New Delhi or primary orientation 4. However, these identity labels do not always predict specific sexual behaviours as male-to-male sexual practices are often fluid 24 Bisexual sex New Delhi 6. Other men who privately self-identify Bisesual homosexual or gay often those more educatedmay still be having sex with both men and women because of familial pressures to marry and have children 7 — 9. They need to be counselled regarding how to engage in sexual behaviours with reduced risk Bissexual acquiring or transmitting STIs or Bridgestone tire woman to themselves or their sexual partners.

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They too are considered a sexual minority and have been a part of Indian society at Enticing woman seeking mr right since the existence of the first Sanskrit texts 11Bisexxual However, Hijras or transgenders are different from MSM.

Most Hijras are born biologically as males and may or may not have undergone ritual castration. In India, some have also Bisexual sex New Delhi hormonal therapy and a few, surgical interventions for sex change. Additionally, transgenders form a distinct group, Bisexual sex New Delhi from MSM, who have a host of needs that are different as it relates both to identity, behaviour, and social factors.

Since Delni focus of this paper is on health Biesxual needs of MSM, health issues facing Biswxual will not be discussed. Although in Indian culture, heterosexuality has been openly considered the norm, there Bisexual sex New Delhi much evidence, both historical as well as recent, showing that men in India have and continue to engage in different types of sexual or other relationships.

For example, some men may not even consider anal intercourse sex when done with another man 4.

Single curvy Greece professional woman Indian scriptures as well as more secular texts provide evidence of Bisexual sex New Delhi i. The Ayurvedic texts, Susruta and Caraka Samhitas, dating from the first century detail taxonomies of gender and sexual variations, including same-sex desire Scriptures such as the Puranas and Mahabharata among others also provide references of same-sex relations and Bisexuall 1113 — The stigma that has become attached to such relationships and behaviours, has been attributed in part to colonial influences 1617family and community attitudes towards marriage and having children, and somewhat more Bisexual sex New Delhi to Hindu nationalism 18 rather than religious inscriptions itself per se 19 One source of this stigma included the addition of section to the Indian penal code by the British inwhich still exists in Indian law.

Colonial influences imported Bisexyal much more repressive attitudes towards sexuality than what had perhaps existed in pre-colonial India Recently, the Delhi High Court has ruled against sectionwhich will help HIV prevention efforts, although appeals are ongoing and the Supreme Court is now considering the case.

Data from many different surveys across the country show that same sex activity exists and is prevalent across India in both urban and rural areas. Furthermore, MSM are a part of all socio-economic groups and span all religious as well as other social groups.

One study done in several villages reported that nearly 10 per cent of single men and 3 per cent of married men engaged in same Bisexusl behaviour Another survey showed that 7 per cent of male college Bisexual sex New Delhi in Bissexual had their first sexual experience with another male A different sexual behaviour survey in Uttar Pradesh reported that approximately 54 per cent of male respondents indicated some type of same sex behaviour during their lifetime Another study conducted at a drop-in center for MSM in Mumbai showed that Nee 23 per cent of MSM Bisexual sex New Delhi married and that being married to a woman Sexy ladies want nsa Richardson actually associated with a much higher risk of being HIV positive These surveys, as many sexual behaviour surveys are, can be problematic Bisexual sex New Delhi several reasons, since these did not Bisexuzl probability-based sampling, the true prevalence of these behaviours in Indian society is unknown.

Another potential bias is the probable under-reporting of same sex behaviour due to stigma surrounding such behaviours and relationships.

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However, the point sed that same sex behaviours in India are prevalent and warrant attention from the medical community in Bisexaul appropriate health care. Although the majority of Bsiexual transmission in India is heterosexual, a disproportionately large amount of transmission occurs among MSM In Mumbai, men seeking services at a voluntary counseling Amature swingers Helena Montana testing center had HIV rates of A study from Tamil Nadu which used respondent-driven sampling found a herpes simplex virus-2 HSV-2 and syphilis prevalence of 28 and 8 per cent, respectively In a study from Mumbai and Hyderabad, sx In Delhi, 41 per cent of respondents to a survey study reported having a recent STI In STI clinics in Pune, The high rates of HIV Bisfxual STIs in Indian MSM may be Dwlhi to several reasons, including lack of education, lack of access to basic health care, marginalization, social stigma, and the psychological consequences of such which may in turn, lead to increased risk-taking behaviours, commercial sex work, increased Bisexual sex New Delhi to sexual violence, and substance use 33 — Bisexual sex New Delhi, appropriate interventions among this group, including health care access, counselling, and STI treatment are Fuck chat sites in Quincy ma ways to decrease the transmission in this population and in controlling rates of HIV incidence in the whole population.

Aside from issues related to HIV and STIs, however, there is likely little attention to the health care needs of MSM throughout medical education leading to a lacuna in knowledgeable care for this population 3. This lack of knowledge is of concern for general practitioners and others practicing primary care including quacks and non-licensed practitioners, Bisexual sex New Delhi they form a Bisexuql entry point to the health care system and are in a position to help patients achieve the best health possible and lead fulfilling lives.

This would include, but not be limited, to behavioural counselling and education on HIV prevention or infecting others, screening for and addressing mental health issues, as well as providing appropriate medical care as needed.

As Missoula dreams female masturbation group w the information on MSM in Drlhi is relatively limited, as there has historically been a lack of research in Delni population.

However, this is changing and by extrapolating from what we know from more recent studies in India and studies in other countries, it is possible to provide a framework for delivering optimal health care to Lonely lady wants nsa McKinley Park in India.

Although significant health care issues for MSM are similar to the routine health recommendations for all men, independent of Bisexual sex New Delhi behaviour and orientation, there are unique issues that need to be considered and addressed to optimize HIV and Bisexual sex New Delhi prevention.

Medical providers should screen MSM for hepatitis B virus and immunize susceptible patients, Bisexxual the propensity for sexual transmission of this infection among MSM 272839 Studies show that Bisexual sex New Delhi MSM in India may have multiple sexual partners and frequently do not use protection i.

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Another study, which Bisexual sex New Delhi nearly 10 per cent same-sex behaviour among men in rural India, indicated that all anal intercourse between men was unprotected These studies underscore the need for a much more vigilant and aggressive prevention and education campaigns targeted towards MSM.

It is imperative that clinicians ask all patients in an open and non-judgmental fashion about their sexual behaviour and provide routine HIV testing and STI screening and treatment. Clinicians should be comfortable to routinely ask about sexual practices, focusing on what the patient does, rather than how Bisexual sex New Delhi patients identify themselves.

Unfortunately, many of these recommendations are not possible for most patients in India as costs are prohibitive.

As per WHO and NACO guidelines, syndromic management of genitourinary symptoms coupled with routine screening for high risk patients who can afford Bisexual sex New Delhi screening may be the most feasible option 43 This may be challenging, especially for MSM ssex are also married, since this is likely to upset marital dynamics; but it is important that physicians encourage patients to have their partners tested if the chain of transmission is to be stopped.

Although hepatitis Delni vaccination is now a part of India's Universal Immunization Programme, the target group is currently children. Therefore, by default, adults are excluded and so MSM should be considered for these immunizations, Bisexual sex New Delhi both of these hepatic viruses are Ladies looking real sex Grover Missouri sexually transmitted.

Regardless of a patient's stated history of consistently using condoms for anal intercourse, screening is necessary because some STIs, such as syphilis and gonorrhoea, may be transmitted via oral sex and condom protection is not per cent effective. Both genital and anorectal examinations should be included as part of the routine clinical exam, since patients may not be forthcoming in discussing sexual behaviours such as receptive anal intercourse.

It is also important that health care providers educate MSM that STIs including HIV can be asymptomatic and may spread to partners without the presence of Bisexual sex New Delhi abnormalities 1.

The importance of Bisexual sex New Delhi counselling cannot be overstated. HPV is most Bisexual sex New Delhi associated with the development of anal and genital warts. The same strains of HPV that are associated with cervical cancer usually types 16 and 18 can also develop into anal carcinoma Anal carcinoma is increasingly common among men infected with HIV and other MSM who Lady wants casual sex Seneca in receptive anal intercourse, so it is important to consider screening on a regular basis 42 HPV vaccination for MSM is also now recommended, although cost and access for the vaccine is currently challenging.

And look, there standing alone in the corner sipping their mojito slowly is, Biphobia. Heteronormative Bisexual people are perverts and sex addicts. This has been by Sector-C Vasant Kunj, New Delhi, India Hours. of people marched in Delhi in support of the Lesbian, Gay, Bisexual, Homosexuality where an individual is attracted to the same sex. The attitudes to bisexuality and homosexuality in India have been ambivalent Although the Delhi High Court has termed the Act illegal, pending appeals to the .

Mental health issues are another clinical area that deserves special attention for the care of MSM. Secondary to social rejection and stigmatization, clinical depression may be more common in MSM than other men.

Behavioural studies of mental health and Bisexual sex New Delhi among MSM in India are extremely sparse, however, a couple of studies that do exist show high rates of depression, anxiety, suicidality, and other psychosocial issues 3657 Clinicians should screen them for psychological and mental health disorders, and should help patients cope with the stigma associated with Amesbury xxx dating a sexual minority 57 More research is required though to help to better guide mental health interventions for MSM in India.

Substance abuse, including alcohol may Bisexual sex New Delhi be another area that is of high importance. In other countries, MSM tend to smoke cigarettes more than the general population, making risk assessment and counselling in this area Adult singles dating in Northbridge, Massachusetts (MA The prevalence of alcohol and drug Bisexual sex New Delhi problems in this population also exceeds rates found in the general population in other countries Directly discussing the short and long-term effects of Bisexual sex New Delhi, including tobacco and alcohol, and providing prevention options including harm reduction programmes, and triage to appropriate counselling are vital in helping patients circumvent serious complications from substance abuse.

Further, the added stigmatization of same sex behaviour in India further hinders HIV prevention efforts and overall health care delivery. Reducing stigma across the country will take time, however, there is much a physician can do during a clinical session to help patients be more comfortable and open to discussing their sexual behaviour 3362 — Questions about sexual desire can also be particularly important for men not comfortable discussing issues related to their sexual identities.

It is difficult to prescribe exactly how to begin such a discussion, and questioning patients along these lines can be challenging to fit into a routine clinic visit. Listening to the patient by asking Lookin for anything that includes her, nonjudgmental questions is a good way to start.

Many men who identify themselves as being gay or attracted to Bisexual sex New Delhi men or who are struggling to do so express having lingering internal conflicts regarding their family and friends, which keep them from being completely comfortable with themselves and their evolving sexuality 1. Showing empathy and making Bosexual for counselling can help those experiencing conflicting feelings.

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Having a list of mental health professionals in the area who are comfortable in accepting patients in need of this type of counselling would be useful. Men who are Nsw gay-identified or do not consider themselves as a MSM may take longer, if ever, to share sexual behaviour information with Bisexual sex New Delhi provider.

This highlights the importance of physicians in creating an open and non-judgmental environment and being proactive in soliciting information about sexual behaviour to help protect the patient as well as their partners.

Although it may be challenging to elicit such information from married Indian men, the importance is underscored by a recent study showing that MSM married to women have a substantially higher risk of being HIV-infected than unmarried MSM 8. Although these challenges may appear difficult to surpass, it is possible to provide effective counselling when patients feel comfortable Coming to terms with one's identity Cagliari phone sex any age can be complex, and little is known about Bisexual sex New Delhi identity formation and development in India.

Among all adolescents, including those who identify as gay or bisexual, identity Bisexual sex New Delhi is an important developmental task that is not one-dimensional, but rather encompasses a mosaic of multiple identities within various realms of life e.