Nikolay highlights three key areas of concern for the LGBT community in East Europe and Central Asia.

First, the rising numbers of new cases of HIV in the EECA region. Access to HIV-prevention programmes and -healthcare differs between countries in terms of availability and accessability. Many countries have free systems. The situation in the Russian Federation is quite different despite being the regional hotspot for HIV-prevalence. The negative consequences aggregate as Russias big cities attract many working migrants who lose their access to prevention prevention programmes which give some protection against HIV or other sexually transmitted infection. Furthermore, free HIV treatment is not accessible in Russia, and persons with an HIV infection who do not have Russian citizenship must be deported.

Second are services for trans people because trans people are one of the most vulnerable populations in the EECA region as e.g. gender-affirming therapy does not exist in many countries of EECA and they face fuge discrimination from state institutions.

The third point highlighted is mental health. Being a person who belongs to an LGBT population or identifies as queer is a huge emotional and mental burden, especially if you face discrimination from your social or state system. This personal stress can lead to unhealthy coping strategies as alcohol consumption, drug use, and or chemsex.

This aspect also has more general extents: What life is like depends on where you live but, in general as a gay man you are very likely to experience discrimination and most countries do not have legal protection such as the so-called ‘hate crimes’ that are commonly recognised in western Europe, and some countries criminalise homosexuality, even using methods which can be desribed as torture to detect whether men had sex with other men as a mean to decide about prison sentences for several years.

Another point that was mentioned was that, in western Europe, doctors are viewed as being on the patients side, helping you and respecting the patients rights, and if not that one can rely on sanctioning measures and the state to be guaranteed ones rights. This can be very different in the EECA region as doctors are often seen as or part of a LGBT- and or queer-oppressing state. This makes access and trust to medical professionals very difficult. It is of great help that the LGBT and queer communities in these countries are very supportive among eachother to know trustworthy doctors, or help in other situations of life in those challenging settings.

On a more structural level, a big problem for organisations working on LGBT health and prevention is the funding of programmes. Sourcing out prevention services to community-based organisations is not we openly accepted of promoted in all countries, especially if those organisations receive funding from abroad. From a evidence-based view, strengthening such community-based organisations can greatly improve the communities health as they have contact, trust and knowledge by and of their communities.

Despite this negative situations, there is also reason for confidence and optimism. EECA countries make changes in health policies and improve the situaitons of community-based organisations effectively fostering prevention programmes, PrEP-access, and data gatherings. A leading country here, even in times of war, is Ukraine.
Nikolay also shortly described some of ECOMs current projects in the region: They roll out the European MSM Internet Survey (EMIS) in the EECA region, are part of the Sustainability of Services for key populations in EECA region project (SOS 2.0) funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria and herein focus on PrEP advocacy, monitoring of the SOS 2.0 in general, and could get insights regional data to as a value to compare to the goals of UNAIDS. Their finding highlights that the EECA region has a major gap in testing.

For more information about Nikolay and his work you can visit Nikolay Lunchenkovs profile. In the course of his doctorate, he working on chemsex in Kazakhstan currently.

You can read the full article on the website of AIDS.map.

Last year, Nikolay also organised a webinar on PrEP. You can find a video of it and the programme of the webinar here.