Men Having Sex with Men: Implications of a Hidden Epidemic in Eastern Europe

Men Having Sex with Men: Implications of a Hidden Epidemic in Eastern Europe

Originally appeared in GLOBAL HEALTH magazine.

Men who have sex with men (MSM) bear a disproportionate share of the HIV/AIDS burden in Eastern Europe and Central Asia, but data on and services for this population are woefully inadequate. With a better understanding of this marginalized community's needs, donors and implementers can help support effective policies and programs for MSM infected and affected by HIV.

In Eastern Europe and Central Asia, as in many parts of the world, the HIV epidemic among MSM is underreported and under”acknowledged. The lack of official reports on HIV among men who have sex with men might enable governments to avoid prioritizing or even offering interventions, and HIV programmers can fail to reach those most in need.

Without the data and analysis of MSM issues it is easy for governments and HIV/AIDS programmers to not develop MSM programs and interventions as: (a) no data means it can look like MSM is not a problem and therefore not a priority and (b) lack of recognition of the issue means that it is easy for governments'/programmers' own homophobia to get in the way of developing programming.

Most programs in the region do not support HIV-positive MSM. The social hostility, stigma and discrimination that compound this lack of programs discourage MSM from seeking testing or treatment, accurately reporting how they contracted HIV when they are diagnosed, and sharing their status with sexual partners. Moreover, these factors distort the little data available on MSM and HIV. They may also accelerate HIV transmission within the community and contribute to generalizing the epidemic.

Programs aimed at MSM are usually from a "prevention for negatives" perspective - that is, to protect those who are HIV-negative from becoming infected; leaving no place for HIV-positive men to discuss their issues. The prevention for negatives approach, when used as the sole method, compounds the stigma and isolation that HIV-positive MSM feel.

The (ex) Soviet medical model that is still in widespread use in Eastern Europe also makes it difficult to provide support to HIV-positive MSM. This model treats the disease in isolation of the individual and does not take into consideration the compounding social factors that inhibit a person from taking control of their health.

Financial support for MSM and HIV programs in Eastern Europe primarily comes from outside the region. Few, if any, local funds support MSM programs. However, country ownership is vital to the success of any development intervention, and is no less important to HIV programs targeting MSM.

Interventions for MSM and HIV lack a consistent approach and effective approaches are not widely known or implemented. There are few opportunities for MSM to network, discuss or advocate for their needs, or to strategize about how to address those needs.

Peer education is widely accepted as the backbone of effective MSM HIV programs, but in Eastern Europe there are many different interpretations as to what the term actually means, even within one country. This means that there is no way to determine what actually works. One important way to address this is by creating opportunities for people to network and discuss and develop common understandings and more consistency in their approaches to their work.

If outreach is seen as something that works within a peer education program - what does "outreach" mean? Handing a condom to some guy in a sauna? Sitting and having coffee with that guy for 30 minutes to talk about safe sex? Repeated contacts with the same guy over a period of weeks or what? Each of the above is an interpretation of outreach, so if we don't know what we mean when we refer to outreach as part of a peer education program- how can we know what works?

In May, stakeholders from Albania, Armenia, Azerbaijan, Belarus, Georgia, Moldova, Russian Federation and Ukraine met in Armenia and agreed that an important first step is to develop a core package of HIV services for MSM in Eastern Europe. The package will build on similar work undertaken in Southeast Asia and Latin America, but address the specific challenges of MSM in the region, for example: no reliable baseline data, widespread drug use, high HIV prevalence, and the need for much stronger organizations and networks supporting and providing services to MSM.

Join the Global Forum on MSM & HIV (MSMGF) at their two events at The XVIII International AIDS Conference.

Elden Chamberlain, of the International HIV AIDS Alliance, is the Network Capacity Building Specialist for the AIDSTAR-Two Project. AIDSTAR-Two, funded by USAID, contributes to stronger and more sustainable, country-led HIV/AIDS programs, organizations, and networks by offering systematic organizational capacity building assistance.