{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T22:26:29Z","timestamp":1782771989922,"version":"3.54.5"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"crossref","award":["AID-OAA-A-14-00045"],"award-info":[{"award-number":["AID-OAA-A-14-00045"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To ensure a substantial impact and prevent the resurgence of the epidemic, the HIV programmes should effectively reach hidden key populations (KPs). A qualitative study was conducted to understand hidden men who have sex with men (MSM), and their needs and identify outreach strategies for those who were still unreached.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 17 March 2019 and 26 July 2019, 42 In-depth Interviews (IDIs), 40 Key Informant Interviews (KIIs), and 16 Focus Group Discussions (FGDs) were conducted covering 170 participants across four states of India. Data were audio recorded, transcribed, translated and analyzed using NVivo software employing a grounded theory approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A diverse spectrum of unreached men were reportedly practicing same-sex behaviors and new hidden MSM categories have been identified. These hidden MSM demonstrated denial, lack of awareness, and a history of forced sexual experiences. Being elusive, hence no access to healthcare services and education resulted in condom-less sex. The very young adolescent MSM were unaware of the risks and perceived risky practices as the norm. Both at urban and rural settings, MSM respondents shared about sexual abuse by a male while studying in 2\n                      <jats:sup>nd<\/jats:sup>\n                      standard to 6\n                      <jats:sup>th<\/jats:sup>\n                      standard. The \u2018sugar daddies\/ older MSM\u2019 who were &gt;50 years old get disengage from the programme, preferentially practice high-risk behaviors, abusing young boys and men who fall prey for money or easy fun. Peers were the most acceptable persons to reach \u2018hidden\u2019 MSM.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A peer-driven approach based on the inbuilt trust of the community and leveraging networks might be a vital outreach strategy to engage this elusive, vulnerable hidden MSM. The vulnerability of young boys and men calls for an urgent need for fostering safer environment for minor male children in the context of this study and strong integration of POCSO Act in the programme. Additionally, there is an urgent need to revisit strategies for engaging middle-aged MSM, the \u2018sugar daddies\u2019 or \u2018uncles\u2019 in preventing spread of HIV. Policymakers and educational institutions may prioritize comprehensive sex and sexuality education to challenge and transform prevailing social norms affecting young boys in India. It is important for parents and carers to be alert about how these abuse happen, and how to help prevent it.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0340282","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T18:48:56Z","timestamp":1769194136000},"page":"e0340282","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["The hidden\/ hard to reach men who have sex with men (MSM)\u2014Results from the qualitative study in India"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6064-827X","authenticated-orcid":true,"given":"Seema","family":"Sahay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4866-9681","authenticated-orcid":true,"given":"Dhammasagar","family":"Ujagare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Rahane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3182-4734","authenticated-orcid":true,"given":"Tuman Lal","family":"Katendra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amarendra","family":"Mahapatra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivendra Kumar","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinmoyee","family":"Das","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhawani Singh","family":"Kushwaha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinita","family":"Verma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv Ranjan","family":"Tiwari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nupur","family":"Mahajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.S.","family":"Saravanamurthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bitra","family":"George","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sampada","family":"Bangar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"pone.0340282.ref001","volume-title":"Global HIV, Hepatitis and STIs Programmes Geneva, 27","author":"WHO","year":"2025"},{"key":"pone.0340282.ref002","author":"US-Statistics","year":"2025"},{"key":"pone.0340282.ref003","author":"UNAIDS","year":"2024"},{"key":"pone.0340282.ref004","doi-asserted-by":"crossref","DOI":"10.1097\/QAI.0000000000003340","article-title":"New HIV Infections Among Key Populations and Their Partners in 2010 and 2022, by World Region: A Multisources Estimation","volume":"95","author":"EL Korenromp","year":"2024","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"pone.0340282.ref005","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/COH.0000000000000569","article-title":"The arc of HIV epidemics in sub-Saharan Africa: new challenges with concentrating epidemics in the era of 90-90-90","volume":"14","author":"KF Ortblad","year":"2019","journal-title":"Curr Opin HIV AIDS"},{"key":"pone.0340282.ref006","article-title":"Reductions in HIV incidence are likely to increase the importance of key population programmes for HIV control in sub-Saharan Africa","author":"GP Garnett","year":"2021","journal-title":"J Int AIDS Soc"},{"key":"pone.0340282.ref007","volume-title":"Sankalak: Status of National AIDS & STD Response NACO","author":"National AIDS Control Organisation","year":"2023"},{"issue":"7","key":"pone.0340282.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0270886","article-title":"Diversity in HIV epidemic transitions in India: An application of HIV epidemiological metrices and benchmarks","volume":"17","author":"P Kumar","year":"2022","journal-title":"PLoS One"},{"key":"pone.0340282.ref009","volume-title":"Are Key Populations Really the \u201cKEY\u201d to Ending AIDS in Asia? 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