Eastern Europe and Central Asia remain the only part of the world where HIV incidence is on the rise. Based on statistical evidence, the MSM population is the main driver of the HIV epidemics in this region. A recent epidemiological review suggests that “in most EECA countries HIV prevalence among MSM exceeds 5%, which is a sign of a concentrated epidemic.” The available data on trans people are so scarce that there is no evidence base for a discussion on the prevalence figures in this community. However, this does not diminish their vulnerability to HIV, TB or other sexually transmissible infections.

Increased vulnerability of the MSM/LGBT communities to HIV infection is strongly linked to the lack or inadequacy of specific health services, which also limits the realization of their health rights. According to the Eurasian Coalition on Male Health’s regional report on violations of the right to health of gay men, other MSM and trans people, legislative gaps vary from country to country in the EECA, but there is one common denominator across the region for any type of legislative or policy issue related to MSM, LGBT and trans communities: Widespread stigma and misconceptions that lead to internalized homo-negativity, or so-called ‘self stigma’, forcing people from these communities to hide themselves and their problems from the public.

Unfortunately, the negative attitude to MSM /LGBT is often defined by the state and parliamentary officials, including those in the prison, law enforcement and public health systems. Their reluctance to acknowledge homophobia and trans-phobia leads to HIV criminalization, and absence of anti-discriminatory legislation or appropriate law-enforcement mechanisms, and a dearth of state-funded programmes for MSM and LGBT (i.e. legal, medical or psychological counselling).

To explore what is behind the numbers and official reports of the interlinked problems of stigma, discrimination, unfair legislation, inadequate services and increased HIV-vulnerability, the GFO talked with experts from the Eurasian Coalition of Male Health (ECOM), a regional network of 53 community-based-organizations (CBOs) from 14 countries. The majority of leaders, technical experts and activists in this organization represent MSM/LGBT communities, and serve as role models for thousands of MSM or LGBT people from different countries, calling for coming out and standing up for individuals’ rights.

Currently, ECOM is a main recipient of the Global Fund-supported regional programme “Right to Health”,  which has sub-recipient CBOs in Armenia, Belarus, Georgia, Kyrgyzstan and Macedonia. The programme focuses on empowering communities, that then advocate for improved policy and increased domestic funding. The program has so-called ‘extended engagement’ of seven countries that can also benefit from capacity building and knowledge-sharing events. These countries are Azerbaijan, Estonia, Kazakhstan, Moldova, the Russian Federation, Tajikistan, and Ukraine.

Since 2017, the CBOs led by ECOM have been documenting the human- and health-rights violations cases of MSM and LGBT in Armenia, Belarus, Georgia, Kyrgyzstan and Macedonia. Collected cases were analyzed in a report by ECOM in 2017; the next annual report is currently in process and is expected to highlight what has changed over the past year.

Why is it important to document cases of rights violations?

Yuri Yuorsky, human rights and legal issues officer at ECOM has explained that the ultimate goal of documenting cases is to achieve an enabling legal environment for MSM and LGBT health rights. The change process starts by promoting legal reforms, but governments in this region tend to underestimate or diminish issues related to homophobia and trans-phobia, making the role of civil society crucial to highlight the problem and “show ‘the real picture’ of rights violations,” said Yuorsky.

“The cases documented in our programme are illustrations of widespread ignorance of the needs of MSM/LGBT communities in terms of healthcare. When we use International Human Rights Mechanisms or prepare national alternative reports of rights violations,” Yuorsky said, “the documented cases serve as a basis for building arguments while justifying the need for legal reforms.”

The cases describe offensive and discriminatory treatment by medical personnel, police and in prisons, as well as refusal of institutional personnel to provide psychological counselling or medical treatment; breaches of confidentiality around HIV diagnosis at medical institutions, aggression in banks, prisons, civil registries, health service clinics; verbal and physical assaults in the streets and by state officials; and even (allegedly) murder on the basis of sexual orientation. Specific examples can be found in the ECOM report.

“These cases are real human stories, illustrating how MSM and LGBT people are treated in the real world and how they feel as a result of such negative treatment,” says Vitaly Djuma, executive director at ECOM. “We know that public health is mostly about figures and statistics, but these human stories are very valuable in exemplifying the [widespread] stigma, to describe the attitude of medical personnel and other officials. The cases help us to show discriminatory actions that lead to devastating self-stigma and [patients’] despairing decisions not to use health services anymore,” he said.

According to ECOM experts, these cases are more powerful than statistics when attempting to change attitudes and when talking with state officials or with medical personnel. “We are moving from the medical histories of the body towards human stories”, said Gennady Roschupkin, community health systems coordinator at ECOM. He explained that these stories help officials and doctors to see the person beyond the diagnosis and policies, and they realize how their work influences the lives of the real people.

What is the Global Fund’s role in protecting key populations’ health rights?

The community empowerment strategy promoted and financially supported by the Global Fund is considered by ECOM experts to be a game changer for the NGO scene in EECA. Technical support, capacity building and engagement in activities such as research, assessments, collection of cases, and round-table discussions have significantly increased confidence and the ability of all key population communities to overcome ‘self-stigma’ and to stand up for their rights. “Self-stigma is a serious problem for our community,” Vitaly Djuma said. “If we are not willing to speak about our problems, our rights, our lives, who is going to change this world? Empowering communities and their engagement in state decision-making was a huge step on the way to resolving our problems. MSM and LGBT community representatives are becoming equal partners in discussing issues at Country Coordinating Mechanism level,” he said.

Can elimination of discrimination against MSM and LGBT be sped up?

Yuri Yuorsky believes that legislative reforms to implement comprehensive anti-discrimination legislation would be the first step towards changing public attitudes: “To speed up a process, it is crucial to involve “gate-keepers” such as law enforcement bodies, public officials, other decision makers and medical personnel in prevention of rights’ violations of vulnerable groups,” he said.

All the ECOM experts consulted for this article agreed that empowering communities with knowledge and skills, and involving them in decision-making processes, could speed up the initiation of legal reforms and support for developing specific, state-funded programmes to improve services (i.e. counselling, psychological or legal support) for MSM and LGBT communities.

Further reading:

• HIV among MSM in EECA, epidemiological review, 2018
• Regional Report on violations of the right to the health of gay men, other MSM and trans people in the CEECA region in 2017
• Study of Internalized Homonegativity (internal homophobia), ECOM, 2018
• MSM and Trans community participation in HIV decision-making processes in Armenia, Belarus, Georgia, Kyrgyzstan and Macedonia, Baseline Study, ECOM, 2018