Men who have sex with men (MSM), physicians,
and non-government organizations (NGOs): finding agreement on the HIV risk
environment and service provision for MSM in Russia
A. Peryshkina1, D. Kizub2, I. Deobald1, V. Moguilnyi1, N. Masenior2, A. Wirtz2, I. Kostetskaya1, F. Sifakis2, C. Beyrer2
1AIDS Infoshare, Moscow, Russian Federation, 2Johns Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore, United States
Background: HIV prevalence estimates among MSM in
Russian urban areas range from 0.0-9.2%. The government estimate of HIV prevalence
among MSM was 1.1% in 2007, but is likely low given Russia's name-based reporting system and stigma affecting MSM.
Methods: Focus group discussions and in-depth
interviews were conducted in 2008 to investigate health and HIV prevention
needs for MSM in Russia. Using purposeful sampling, 70 MSM and 68 service
providers participated in Moscow, Kazan, and Sochi.
Results: Common themes included a lack of consensus on
the need for targeted services and concern that targeted efforts would further
marginalize MSM. Providers felt that MSM were aware of sexual
risks, yet some men disagreed and others suggested knowledge did not necessarily
beget safe behavior.
MSM rarely disclosed sexual practices to
physicians and avoided testing due to anticipated stigma; some did
not understand the importance of disclosure. Men stated that stigma often
leads to concealed relationships and high risk sexual encounters.
Migration to larger cities was common among men and perceived to be an important risk factor
in HIV transmission. HIV and STI treatment requires official
residency, yet this requirement limits access to migrant MSM populations.
Though some NGO's offer services for MSM in these
cities, men were often unaware of existing programs. Men suggested that telephone hotlines and the Internet would be beneficial to reaching migrants,
married MSM, and others not gay-identified. Many men expressed desire for
gay-friendly psychological and counseling services.
Conclusions: There is inconsistency in access to care and
prevention services for MSM and in men's and service providers' perceptions of
risk. Low awareness of available services prevents utilization while stigma and
discrimination are real barriers to program access. National funding for HIV
prevention programs is changing but these data suggest prevention programs for
gay and other MSM should be prioritized.
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