Experts have warned that India's success in slashing HIV/AIDS infection rates by 50 percent in the last decade masks a high rate of infection among homosexual and transgender people.
This anomaly was highlighted last month by the country's Health Minister Ghulam Nabi Azad in a now notorious speech at an AIDS conference that will be remembered for other reasons.
AdvertisementAzad went on to call homosexuality "a disease which has come from other countries" and "unnatural", in comments widely condemned by gay rights activists and AIDS workers.
At the Pahal Foundation in the northern state of Haryana, which provides free HIV tests, condoms and counselling services to gay and transgender people, project manager Maksoom Ali says he faces a constant battle against ignorance. Most gay men, fearing homophobia, are forced to hide their sexual activity, and others have no idea about the dangers of unprotected intercourse, he said.
"Many people think that men having sex with men cannot get HIV and that's one reason why (homosexual and transgender) people have a lot of unsafe sex," Ali told AFP.
The country's National AIDS Control Organisation (NACO) estimates that 7.3 percent of India's homosexual population lives with HIV, compared with 0.31 percent of the total adult population.
The UN AIDS agency estimated that around a third of men who have sex with men in India fail to access services like HIV testing, sex education and free condom supplies.
Many of the people who use Pahal's services are low-paid factory workers, labourers, or sex workers like 25-year-old Sanam who first came to the centre three years ago.
Sanam, a transgender whose original name was Sushil Kumar Pandey, told AFP she knew nothing about sexually transmitted diseases when she entered the sex trade.
"I never used to take it seriously, we used to do it without condoms," she said.
She learnt about HIV/AIDS only after visiting the Pahal premises.
"They first conducted a blood test on me, then they told me about HIV, what it is, how it spreads. Because of that I always use condoms," she said.
Although the Indian government has committed funds to HIV-fighting organisations that work with the gay and transgender community, many NGOs say that financing falls short.
The Pahal Foundation says it treats 50 percent more people than it has budgeted for.
Gay rights activist and UNAIDS technical officer for sexual minorities, Ashok Row Kavi, said that authorities lack a true awareness of the problem in the gay community.
"We don't have a proper denominator for the number of MSM (men having sex with men), and that number is much higher than what we are willing to accept," he told AFP.
"It's very worrying because hardly four percent of the (government) money for fighting HIV is coming to MSM groups," he added.
Attitudes to homosexuality are slowly changing in India, although it is still often viewed as a mental illness or something shameful to be ignored, particularly in rural areas.
Two years ago, a landmark Delhi High Court ruling decriminalised homosexuality, which was illegal under a 150-year-old British colonial law that banned "carnal intercourse against the order of nature".
Conviction carried a fine and maximum 10-year jail sentence.
But many gay and transgender sex workers who spoke to AFP said they continue to face verbal and physical abuse on a regular basis.
Rupali, a 24-year-old transgender sex worker whose original name was Lalit Sharma, said she feared for her safety nearly every day.
"There are people who turn up drunk, local goons, we have to convince them that there is such a frightening disease going around, there can be a problem like this, so use a condom," she told AFP.
But sometimes, she said, customers used force to pressure her and other sex workers to have unprotected sex.
Most of all she feared the police. "They force us to have sex, they take our money and then they beat us up," she said.