Hiv Prevention, Care and Support For MSM in a Post-Soviet Country: Fighting with Old Stereotypes and New Realities Zoryan KIS, All Ukrainian Network of PLWH

Ukraine: key facts HIV among MSM: hidden epidemics “No statistics – no problem” Global Fund and other donors: an agent of change Homophobia NGOs can make a difference Lessons learnt

UKRAINE: KEY FACTS Location: Eastern Europe (borders with Belarus, Hungary, Moldova, Poland, Romania, Russia, Slovakia) Area: 603,628 km² (44th) / 233,090 sq mi Population: –46,372,700 (27th), 2007 estimate –48,457,102, 2001 census

UKRAINE: KEY FACTS GDP, 2007 estimate: –Total: $ billion (29th) –Per capita: $8,624 (83rd) Middle income country (World Bank) Independence: 1991, from Soviet Union

HIV EPIDEMICS 122,000 HIV incidents officially registered since first registration in ,296 PLWH in Ukraine – national estimates - 70% don’t know their positive status 1.63% estimated HIV prevalence in adult population – worst epidemics in Europe

HIV and MSM Estimated number of MSM: 177,000 to 430,000 Estimated number of HIV+ MSM: 40,973 or 16.3% of the whole estimated male population living with HIV

HIV among MSM: hidden epidemics Only 159 incidents of “homosexual” transmission officially registered since 1987 (20 years!) 126 of them registered in the periods of and National data on modes of transmission are not disaggregated by hetero- and homosexual modes Large number of infections reported as “unexplained transmission”

HIV among MSM: hidden epidemics No sentinel surveillance among MSM (unlike among other groups, such as FSW, donors, pregnant women and STI patients) First linked bio-behavioral survey in 2007 initiated by NGO within the GF framework (International HIV/AIDS Alliance in Ukraine) MSM prefer to report being IDU or with multiple [heterosexual] partners, rather than admitting their sexuality [1] [Bondarenko et al.]

HIV among MSM: what the real data say Kyiv - 4.4% Krivyi Rig - 8.0% Mykolayiv % Odesa % *linked survey, International HIV/AIDS Alliance in Ukraine, 2007 Lviv % Kriviy Rig % Ivano-Frankivsk % Odesa % *testing in four cities: All-Ukrainian Network of PLWH,

“No statistics – no problem” National statistics do not reflect the reality MSM remained generally ignored by most stakeholders in the third sector until 2006 (GF round 6) and by the state until 2008 (New National Program) MSM remain invisible due to no national sexual behavior surveys ever done

Resources allocation: historical reasons Since 1995, the epidemic in Ukraine was driven by IDU Most resources were and are directed to respond to epidemic among IDUs, with disproportionally less attention to other groups Since early 2000s, the % of new cases among IDU drops The capacity of NGOs working with IDU is stronger than that of LGBT NGOs

Political instability: a challenge or a chance? 5 Ministers of health changed within 5 years MOH failed to implement the GF round 1 grant, the NGO (HIV/AIDS Alliance) had to take over According to current Minister, the NGOs do most work in the sphere, with the Network of PLWH and the Alliance Ukraine as principal recipients of the GF grant

Global Fund: an agent of change MSM first recognized as a vulnerable group during the GF round 6 application process Lack of data was used as an argument not to include MSM into the application 4 MSM leaders were present at the stakeholders meetings and insisted on the group to be included MSM activists were also members of the PDG

Homophobia In 1991, Ukraine was the first former Soviet Union republic to decriminalize homosexuality “Condemnation” for consenting sex between adult men was removed from the criminal code, but not from “subordinate legislation” (95% of all legislation – instructions for militsia, the statistics committee etc), policy, practice and public opinion

Homophobia Police, medical professionals, media, government officials, religious and political leaders progress in their homophobic activities as the community becomes more visible LGBT activists have to be prepared to confront implicit and explicit homophobia inside the third sector and among other stakeholders

NGOs can make a difference Work with MSM and LGBT in Ukraine is supported only by international donors The funds of GFATM and the Elton John AIDS Foundation are currently used to mobilize the LGBT community in Ukraine Two committed officers work for two principal recipients of the GF r6 grant

Lessons learnt Evidence essential for a successful advocacy work Support of the GFATM, EJAF, other international donors has been crucial Civil society is a powerful tool, even in an unfriendly environment Visibility and presence are key to success

Lessons learnt Lifting of criminalization of homosexuality is not the end of the process, but the start of the job Equality for gay men & MSM is impossible without positive provisions in antidiscrimination legislation Human rights and HIV response have to be integrated Adequate response to the epidemic is impossible without a community

Contact information Zoryan KIS Tel.: ; ext. 752 Fax: Cell: All-Ukrainian Network of PLWH 87 "В", Mezhyhirska St., Kyiv, Ukraine

THANK YOU!