PrEP in India’s HIV Prevention Policy in the Era of Social Media and Sex Positivity

Main Article Content

Anindya Kar
Dinesh Bhugra
Shuvankar Mukherjee
Agnibho Mondal
Aaditya Suresh Kumar


Introduction: The global revolution of online social media and connectivity had a tremendous effect on sexual behavior in both developed and developing countries. This global change is influencing the societal structure and existing social principles. Moreover, it has a significant impact on the epidemiology of different infectious diseases, especially HIV.

Discussion: India is one of the most diverse democratic countries that has undergone a social-cultural transition in the last decade. However, having the second-highest HIV infection rate in the world, India does not have any other new prevention tools in their national HIV prevention strategy. Pre-Exposure Prophylaxis (PrEP), a boon of HIV prevention widely used in different countries, is still not implemented in India. The concept of “Digital India” by the Government of India is giving wide access of internet to the people of India. Furthermore, people are exposed to social media, and that is impacting their sex seeking behavior. Interestingly, recent legal changes in India promotes sex positivity. It also calls for introspection on existing HIV preventive strategies.

Conclusion: Given the current scenario of PrEP and other existing preventive measurements of HIV, further research is needed to determine the acceptance and efficacy of PrEP and improve engagement in care for individuals in India. Various international studies recommend effective implication of PrEP to reduce the rate and economic burden of HIV infection.

Article Details

How to Cite
Kar, A., Bhugra, D., Mukherjee, S., Mondal, A., & Kumar, A. S. (2020). PrEP in India’s HIV Prevention Policy in the Era of Social Media and Sex Positivity. Central Asian Journal of Global Health, 9(1).
Author Biographies

Anindya Kar, Department of Psychiatry, Advanced Neuropsychiatry Institute, Kolkata, India

Chief Medical Officer, Department of Psychiatry, Advanced Neuropsychiatry Institute, Kolkata, India

Dinesh Bhugra, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

Emeritus Professor of Mental Health and Cultural Diversity, Health Service and Population
Research Department, Institute of Psychiatry, Psychology & Neuroscience at King’s College
London, London, UK.

Shuvankar Mukherjee, Department of Community Medicine, Calcutta National Medical College, Kolkata, India

Associate Professor, Department of Community Medicine, Calcutta National Medical College,
Kolkata, India.

Agnibho Mondal, Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India

Resident, Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India.

Aaditya Suresh Kumar, Department of Neurology, Institute of Neurosciences, Kolkata, India

Resident Medical Officer, Department of Neurology, Institute of Neurosciences, Kolkata, India.


Jayanta Bhattacharya. HIV prevention & treatment strategies - Current challenges & future prospects. IJMR. 2018 : 148(6). 671-674. doi: 10.4103/0971-5916.252150

Techasrivichien, T., Darawuttimaprakorn, N., Punpuing, S. et al. Changes in Sexual Behavior and Attitudes Across Generations and Gender Among a Population-Based Probability Sample From an Urbanizing Province in Thailand. Arch Sex Behav 45, 367–382 (2016).

Angelina Mao and Ahalya Raguram. Online infidelity: The new challenge to marriages. Indian J Psychiatry. 2009 Oct-Dec; 51(4): 302–304. doi: 10.4103/0019-5545.58299

Vissers DC, Voeten HA, Nagelkerke NJ, Habbema JD, de Vlas SJ. The impact of pre-exposure prophylaxis (PrEP) on HIV epidemics in Africa and India: a simulation study. PLoS One. 2008 May 7;3(5):e2077. doi: 10.1371/journal.pone.0002077.

Hoff CC, Chakravarty D, Bircher AE, Campbell CK, Grisham K, et al. Attitudes Towards PrEP and Anticipated Condom Use Among Concordant HIV-Negative and HIV-Discordant Male Couples. AIDS Patient Care STDS. 2015 Jul;29(7):408-17. doi: 10.1089/apc.2014.0315.

Blumenthal, J., & Haubrich, R. (2013). Pre-exposure prophylaxis for HIV infection: how antiretroviral pharmacology helps to monitor and improve adherence. Expert opinion on pharmacotherapy. 2013. 14(13). 1777–1785. doi:10.1517/14656566.2013.812072

Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 Dec 30;363(27):2587-99. doi: 10.1056/NEJMoa1011205.

Smriti Naswa, Y. S. Marfatia. Pre-exposure prophylaxis of HIV. Indian J Sex Transm Dis AIDS. 2011 Jan-Jun; 32(1): 1–8. doi:10.4103/2589-0557.81246

Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS. 2013 Apr.27(4):248-54. doi: 10.1089/apc.2012.0419.

Saberi P, Gamarel KE, Neilands TB, Comfort M, Sheon N, Darbes LA, et al. Ambiguity, ambivalence, and apprehensions of taking HIV-1 pre-exposure prophylaxis among male couples in San Francisco: a mixed methods study. PLoS One. 2012;7(11):e50061. doi: 10.1371/journal.pone.0050061.

Brooks RA, Landovitz RJ, Kaplan RL, Lieber E, Lee SJ, Barkley TW. Sexual risk behaviors and acceptability of HIV pre-exposure prophylaxis among HIV-negative gay and bisexual men in serodiscordant relationships: a mixed methods study. AIDS Patient Care STDS. 2012 Feb;26(2):87-94. doi: 10.1089/apc.2011.0283

World Health Organization. People most at risk of HIV are not getting the health services they need. World Health Organization. Published July 11, 2014. Accessed April 8, 2020.

PrEP in Europe. The PrEP situation in Europe, European PrEP: a history. Accessed April 8, 2020

Bhattacharya J. HIV prevention & treatment strategies - Current challenges & future prospects. Indian J Med Res. 2018 Dec.148(6):671-674. doi: 10.4103/0971-5916.252150.

Puneeta Vohra, Kahamnuk Jamatia, B Subhada, Rahul Vinay Chandra Tiwari, MS Nabeel Althaf and Chayan Jain. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care. 2019 Oct; 8(10): 3247–3252. doi: 10.4103/jfmpc.jfmpc_767_19

World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. 2nd ed. Geneva: World Health Organization; 2016. Accessed April 8, 2020

Kazemian, P., Costantini, S., Kumarasamy, N., Paltiel, AD., Mayer, KH., Chandhiok, N., Walensky, RP., Freedberg, KA. The Cost-effectiveness of Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis and HIV Testing Strategies in High-risk Groups in India. Clin Infect Dis. 2020 Feb 3;70(4):633-642. doi: 10.1093/cid/ciz249.

UNAIDS . On the Fast-Track to end AIDS by 2030: Focus on location and population. UNAIDS, 2015,, Accessed April 8, 2020

Mayer KH, Chandhiok N, Thomas B. Antiretroviral pre-exposure prophylaxis: A new opportunity to slow HIV spread in India. Indian J Med Res. 2016 Feb; 143(2): 125–128. doi: 10.4103/0971-5916.180194

PT Jyothi Datta. Cipla gets approval to sell its version of Truvada in India. Mumbai. The Hindu Business Line. Published May 23, 2016. Updated January 20, 2018. Accessed April 8, 2020

Seal DW, Benotsch EG, Green M, Snipes DJ, Bull SS, Cejka A, et al. The Use of the Internet to Meet Sexual Partners: A Comparison of Non-Heterosexually-Identified Men with Heterosexually-Identified Men and Women. Int J Sex Health. 2015; 27(1): 1–15. doi: 10.1080/19317611.2014.918921

Lutz C, Ranzini G. Where Dating Meets Data: Investigating Social and Institutional Privacy Concerns on Tinder. Social Media + Society. 2017. 3(1) 1-12.

Seal DW, Ehrhardt AA. Masculinity and urban men: Perceived scripts for courtship, romantic, and sexual interactions with women. Culture, Health, and Sexuality. 2003.5(4).295–319.

Rietmeijer CA, Bull SS, McFarlane M. Sex and the internet. AIDS. 2001 Jul 27;15(11):1433-4.

Georgia W, Wellman E. Tinder Is Big in India-at Least with Men. The Wall Street Journal; 2018 June 24. Published June 24, 2018. Accessed April 8, 2020

Deccan Chronicle. Grindr Lite comes to India, for users on slower phones, poor data network. Deccan Chronicle. Chennai. Published March 12, 2020. Accessed April 22, 2020.

McNeil Jr. DG. Grindr App to Offer H.I.V. Test Reminders. The New York Times. Published March 26, 2018. Accessed April 8, 2020

Hornet User. This Pride Season, ‘Undetectable = Untransmittable’ Needs to Be Your Mantra. Published July 10, 2018. Accessed April 8, 2020

UNAIDS Explainer. Undetectable=Untransmittable Public Health and HIV Viral Load Suppression. Available from: Published July 20, 2018. Accessed April 8, 2020

Prof Alison J Rodger, FRCP Valentina Cambiano, PhD Tina Bruun, RN Prof Pietro Vernazza, MD Simon Collins Olaf Degen, MD et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. The Lancet. 2019. 393(10189): 2428-2438. doi: 10.1016/S0140-6736(19)30418-0

Gayle D. New Facebook hook-up app shows which of your friends want to 'bang' you - (so long as you don't mind your other friends knowing too). Daily Mail; 2013 Jan 25. Available from: Published January 25, 2013. Accessed April 8, 2020

Safronova V. Instagram Is Now a Dating Platform, Too. Here’s How It Works. The New York Times. December 21 2017. Accessed April 8, 2020

Arora K. India has the most FB users: Report. The Times of India; 2017 July 15. Published July 15, 2017. Accessed April 8, 2020

Ivanski C, Kohut T. Exploring definitions of sex positivity through thematic analysis. The Canadian Journal of Human Sexuality. 2017 Dec; 26(3):216-225. DOI: 10.3138/cjhs.2017-0017

Garcia JR, Reiber C, Massey SG, Merriwether AM. Sexual Hookup Culture: A Review. Rev Gen Psychol. 2012 Jun 1; 16(2): 161–176. DOI: 10.1037/a0027911

Bhatta DN, Liabsuetraku T. Social self-value intervention for empowerment of HIV infected people using antiretroviral treatment: a randomized controlled trial. BMC Infect Dis. 2016; 16: 272. DOI: 10.1186/s12879-016-1634-8.

Mandelker DR. The Role of Law in Social Change. Osgoode Hall Law Journal. 1970 Nov; 8(2).

Abel RL. Law and Society: Project and Practice. Annual Review of Law and Social Science. 2010 Dec; 6:1-23.

Venkatesan J. Supreme Court recognises transgenders as third gender. The Hindu. Published April 15, 2014. Accessed April 8, 2020

India Today. Section 377: Supreme Court's Right to Privacy judgment sparked fresh debate on decriminalising gay sex. India Today. Published January 8, 2018. Accessed April 8, 2020

The Times of India. ‘Gay sex is not a crime,’ says Supreme Court in historic judgement. New Delhi: The Times of India. Published September 6, 2018. Accessed April 8, 2020

Express Web Desk. SC hearing on Section 377 highlights: Law violates right to form association under Article 19, say petitioners. The India Express. Published July 11, 2018. Accessed April 8, 2020

The Hindu. ‘Not a crime: on Supreme Court's adultery ruling’. The Hindu. Published September 28, 2018. Accessed April 8, 2020

Sheth AN, Rolle CP, Gandhi M. HIV pre-exposure prophylaxis for women. J Virus Erad. 2016 Jul; 2(3): 149–155.

Goparaju L, Experton LS, Praschan NC et al. Women want Pre-Exposure Prophylaxis but are Advised Against it by Their HIV-positive Counterparts. J AIDS Clin Res. 2015 November; 6(11): 1–10. doi:10.4172/2155-6113.1000522.

Rodriguez-Jimenez J. Op-ed: It Is Time to End Bottom-Shaming. The Advocate. Published October 31, 2014. Accessed April 8, 2020

Centers for Disease Control and Prevention. Anal Sex and HIV Risk. Centers for Disease Control and Prevention. Published October 27, 2016. Accessed April 8, 2020

Moskowitz, DA., Rieger, G, Roloff, ME. Tops, bottoms and versatiles. Sexual and Relationship Therapy; 2008; 23(3): 191-202.

Curry T. How PrEP Empowers Bottoms. The Advocate. Published September 25, 2015. Accessed April 8, 2020

Avert. Transgender people, HIV and AIDS. Avert. Updated: October 10, 2019. Accessed on: April 22, 2020.

Sevelius JM, Deutsch MB, Grant. R. The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. J Int AIDS Soc. 2016; 19(7Suppl 6): 21105. doi: 10.7448/IAS.19.7.21105