The following interview is republished with permission from TREAT Asia/amFAR.

Ashok Row Kavi is the founder of the Humsafar Trust. Based in Mumbai, India, Humsafar is one of the first organizations in India to advocate for the rights of men who have sex with men (MSM) and one of the first and most successful gay and transgender sexual health outreach programs in the country.

Under Row Kavi's direction, Humsafar has taken the lead in developing community-based programs to reduce the vulnerability of MSM to HIV infection and to support its members already living with the virus. Formerly a journalist, the 61-year-old pioneer gay activist now works as a consultant for UNAIDS MSM/TG in New Delhi.

TREAT Asia Report: What is the attitude in India towards homosexuality?

Ashok Row Kavi: In ancient India, transgendered people were recognized by nuns and Buddhists in the monastery as a sacred sexual minority. Throughout the Vedas and in Middle Eastern literature, many texts talk about feminine males. India drifted from its acceptance of homosexuality because of the influence of colonial British education. Accepting homosexuality isn't something new for India—but we have to recover that tradition.

Homosexuality is being normalized in Western societies but not without a bitter fight. It's going to be a bitter fight here, too, because modern India is a product of many other cultures.

Today, the attitude in India toward MSM is conflicted. On the whole, nobody cares about your sexual identity, but they certainly care about your gender identity! Having a feminine gender identity drops a man down the power scale, but this is mostly mitigated if a man adheres to traditional social obligations like getting married and looking after his parents. However, transgendered males can be in serious trouble if they cross dress. Then, one is usually asked to leave his parents' home and join outside cults such as the hijras, which is the traditional group of transgendered people in India.

At least 80 percent of gay men in India are married. If you look at Humsafar, you'll find more than 40 percent of men who are having sex with other men do not identify as gay. And they're not always just sleeping with men—those who do not strictly identify as gay have an average of two female partners a month.

TA Report: You are often described as one of the first gay men to come out of the closet in India. What was that experience like?

Kavi: I may be homosexual in a Western sense, but I don't come from that tradition. I'm trained as a Hindu monk in the Rama Krishna order, and I was in this training when I first came out as a gay man. My counselor in the monastery, who was an older monk himself, said it was my mission to go out into the secular world and organize and work with my people. The monastery and the ashram are not places for you to hide—you need to go and sort it out. So that's what I'm doing.

When you come out in India, gay identity becomes your primary identity. If you come out as an openly homosexual man and refuse to get married to a woman, then your homosexual identity becomes a form of rebellion and attracts a great deal of attention. All the other identities—being a good journalist, for instance—become back-ups. When I came out in 1984, I didn't realize it would create such a ruckus, but I nearly lost my job. My boss stood by me, though. Fortunately, I had come out to him before I had accepted the job.

There were problems among my brothers and their wives, but not my mother—she's incredible. When I was being attacked by a politician, for instance, she told him to lay off. I've had a lot of support as a gay man in India, but going public did affect my job and career prospects.

TA Report: How did you start Humsafar?

Kavi: When I returned to India from Montreal in the late 1980s, I was very worried because gay men were fighting for their very lives in ACT UP. Eighty percent of HIV infections were among gay men at that time—but hardly eight percent of government funding was going to gay organizations! I thought, what would happen in Asia where there were no gay communities, only large networks of men having sex with men?

So some of us got together for informal workshops and meetings. We finally decided to form a support system for gay men—that is, gay in the Western sense meaning men who identify themselves primarily as homosexual. (Humsafar has a policy that it will not accept board members who are married because that could divide us politically. So the board consists of unmarried gay men.) Humsafar eventually became the only gay organization in Bombay to be given space by the city government. When we first got started, poorer men from Bombay started coming. Sometimes they had alternative gender or behavioral identities but many were just men having sex with other men. And it grew from there. Last year we provided health services to over 60,000 men.

Humsafar has approximately 185 full-time staff, and we reach way across the spectrum of men who have sex with men: gay-identified men, MSM, hijras[transgendered men known as "the third sex"], male prostitutes, and transgendered sex workers.

Services start with a drop-in center and offices. We offer counseling over the phone or by appointment. We have a clinic with regular doctors checking for sexually transmitted infections or other illnesses. We have referral services to the public hospitals, Friday meetings, a small library, and a confidential HIV testing and counseling center with same-day results. We also have a massive outreach program that covers more than 150 sites in Bombay, its outskirts, and neighboring towns.

TA Report: What sort of HIV/AIDS treatment services are available to MSM in India?

Kavi: Some doctors will test for sexually transmitted infections, but they are very inquisitive about sexual behavior and suspicious of MSM. The women and children get the HIV drugs first; gay men and hijras don't get treatment. India is the only country where transgendered men can get a passport under a third sex and yet they can't even get past the gate of the hospitals. It's taken nearly five years fighting with the HIV/AIDS centers to get treatment for MSM. Humsafar's services are a drop in the ocean for men who need access to treatment.

TA Report: Are government programs for MSM successful?

Kavi: HIV among MSM is out of control, and only now does the government realize it needs to turn its attention to working with gay men, MSM, and transgendered people. They are scaling up national programs and want to conduct 200 targeted interventions, each of which reaches 1,000 men. That figure is very low, but it's better than nothing.

It's good news that the government wants to establish programs for MSM. The bad news is that the NGOs they entrust don't all know how to go about it. They have to be run by gay men and they have to be community-based. That is the plan I have suggested to the government of India. Where there are transgendered people, you send in transgendered workers. When you need to reach kothis—queens, in the West—you don't send a macho man because he'll intimidate them; you send one of their own!

TA Report: Are you optimistic that progress is being made?

Kavi: There is no other option but to make progress. Otherwise, we will see large numbers of my community die. If HIV prevalence is at 10 or 25 percent, can you imagine the time it takes to get treatment to everyone? Many of these men are very poor! Forget about knowing about their sexuality—they are going to die unknown and unsung deaths.

TREAT Asia (Therapeutics Research, Education, and AIDS Training in Asia) is a network of clinics, hospitals, and research institutions working with civil society to ensure the safe and effective delivery of HIV/AIDS treatments throughout Asia and the Pacific.