This will initially examine the legal MSM position in Ukraine to give a background, and then discuss the position of HIV positive MSM. In discussing the overall discrimination of MSM people in Ukraine it is important to mention the following facts.
First of all, MSM community members face discrimination as citizens. Despite the recognition of Human Rights principles at the legal level, Ukraine is still far from reaching real equal rights for homosexual people.
Homosexual people are left beyond state legislation as it practically ignores their existence. In Ukraine, where the Constitution proclaims equality, gay men do not share the same rights with other citizens. On the contrary to heterosexual people, they do not have the right to marry or register civil partnership that assumes certain rights and obligations, to adopt a child (sharing custody over the child).
There are no regulations on property rights, medical rights in case of same-sex couples even if they live in partnership for years and share common household. The law also does not assume that discrimination on the basis of sexual orientation really exists. There is also no protection against discrimination of homosexuals at work. Sexual orientation is a disadvantage when a MSM person intends to defend herself/himself legally.
The Grand Mufti in Moscow in the 3rd week of February 2006, called for the killing of all MSM in the NIS. In 2004 at Race For Life event at the heart of Kyiv (which is not only the capital of Ukraine but also the most democratic and tolerant city in the country so far) the religious fanatics and skinheads beat gay men which took part in the carrying out this charitable social event and used and attempt to stop the first gay-pride in Ukraine – quite successfully. Since then no one would like to try to organise another “first gay-pride” in Ukraine again.
An attempt to defend one’s own dignity with the help of present norms of law by the MSM person in court it is not encouraged by the state and society, even in case when an offence, abuse or other violation of rights (e.g. robbery, violence and murder) was not connected with sexual orientation.
The medical systems in Ukraine have inherited to a large degree the Soviet approach to homosexuality which is still viewed as „related to sexual motivation hysterical type of the psychopath syndrome” or „hyperbolized sexuality”, schizophrenia. In spite of the fact that officially the WHO does not define homosexuality as a disorder, it is still considered to be and approached as perverse. In some of the regions of Ukraine some official medical professionals and psychologists still proclaim that they can “cure homosexuality” or “this disease can be cured – given profound medical knowledge”. Homosexuals are still included into so-called “groups of risk regarding sexually transmitted diseases and spreading of HIV/AIDS”.
However, despite being part of the identified high-risk groups for the HIV epidemic, they are invisible in national statistics on HIV and AIDS, and subsumed in the IVDU figures. Moreover, it is an issue to get adequate medical help that takes into account special needs of a homosexual person. Homosexuality as a topic is ignored in syllabi in medical colleges and universities.
The Mass Media do not give any tolerant or reliable information about homosexuality and MSM community members. The media tend to reflect common stereotypes and prejudices. The images portrayed usually include psychically ill, criminal, aggressive, nymphomaniac, lecherous, stupid and marginalized people. These unprofessional approaches of the Mass Media reinforce and feed the negative attitudes towards MSM.
In the social institutions of in Ukraine, MSM people are invisible or visible through the lens of stereotypes and negative treatment. Institutional activities do not take into account the existence of MSM people nor take into account that their needs differ from the needs of the heterosexual mainstream. There are the so-called „preventive actions” of police and other repressive bodies, such as rides swoops, etc. still exist.
Plus there is a great interest of criminal organisations to the gay community, especially as a means of easy extraction of private property and money of gay men. This interest frequently leads to death for the gay victims. Though the official statistics are inaccessible, a sharp increase in the number of armed assaults against gay men and their property with a fatal result is well known among the police and the gay community. A hiddenness and isolation of this community just promotes and stimulates interests and activity of criminal bodies against gay men, and simultaneously sharply complicates any investigations led by police.
MSM & HIV in Ukraine
Often MSM are either clients or workers of commercial sex services. Many of them come to cities from small towns searching for jobs, but do not succeed; thus, their social life becomes very limited, and their poverty increases. Because of stigma and discrimination associated with HIV/AIDS, MSM engaged in commercial sex are afraid to be open about their status, because they are afraid of losing their jobs, of social alienation, of violence, and threats to their life. So they go on infecting their clients and other partners.
MSM who do not know their status do not get tested because they are afraid that results will be disclosed to the public and they will face stigma and discrimination not only by general public but also within MSM community itself. The MSM population is so poorly informed about the problems of PLWH, that stigma and discrimination are considered to be a normal phenomenon in the MSM Community itself.
The majority of gay men are poorly informed about ways of infection transfer and preventive measures against being infected. The cruising places are badly adapted for effective communication, such as WC at railway stations, parks, wild beaches, subways, etc. with drugs, crime, unsanitary conditions, etc. being natural satellites for such environments. There are a few MSM clubs in Ukraine at all, one each in Lviv and Kryvyy Rih (all unofficial, but “known” as such), two “official” ones in Odessa and five “official” gay-clubs in Kyiv.
Within this picture, the facts only get worse, because of the stigmatization of PLWH and the stigmatisation of MSM, many MSM refuse to get an HIV test and refuse to accept that HIV is a risk for them (this is shown in the official statistic report of social research on MSM behaviour conducted by International HIV/AIDS Alliance in Ukraine). They pretend that HIV is still only an intravenous drug user issue and not a gay one. In Lviv, and Kryvyy Rih, and Odessa, where some basic research has been done by local activists of the Network, up to 98% of MSM in 2005 still practice unsafe sex (this is despite “official” statistics).
In Merchants, province town in the South of Ukraine (Kryvyy Rih region) there is a sexual network of about 200 MSM who have all had sexual relations with each other (because of the small number of MSM in the town and its isolation from “MSM newcomers”), all practising unsafe sex. When one became ill and was found to be HIV positive, he was ostracized from the network. But the sexual practices within the group carry on, with no one going for VCT.
Within the MSM community, becoming HIV positive, is social suicide. People are ostracized from their social networks. A few may retain a couple of loyal friends, but there is no social life outside the home. Testing for HIV is thus limited within the MSM community in Ukraine. In Zaporizhzhya, within one social network of 300 MSM, only 15 have taken and HIV test (and that some time ago).
In most cities in the regions, despite there being a law mandating free HIV testing, many will be asked to pay from 15 to 60 hrn. For the test. This can be a lot of money when the minimum wage is about 350 hrn. (US$ 70) a month.
MSM Surveys in Ukraine
The only survey data for MSM come from seven surveys undertaken from 1999 till 2004 in 5 cities. Even though the findings of these seven studies must be viewed with caution given the size and make-up of the samples and the way the surveys were conducted, results paint a worrying picture:
• The majority of MSM rarely use a condom and about 50-60% never do. This is also confirmed by assessment undertaken by UNAIDS (AIDS Epidemic Update Eastern Europe & Central Asia, 2001).
• The majority of MSM has multiple sexual partners and good basic knowledge of HIV/STI transmission. However, accurate information about prevention, symptoms and treatment options are lacking.
• Virtually all men who participated in the survey (International HIV/AIDS Alliance & Gay Alliance, 2002) and in two focus groups pointed out the inadequacy of available informational material for their community. They would like to receive targeted support and information, preferably from specialised gay sources, including gay centres, educational events, self-help groups, gay press and websites.
• The majority of respondents practice both anal and oral sex (over 60%). 49% of the respondents stated that they have regularly sex with women. Many of these men prefer to meet their male partners through the Internet or through advertisements in newspapers due to fear of stigma and discrimination (International HIV/AIDS Alliance & Gay Alliance, 2002).
• 60% of the sample never tested for HIV (Nash Mir, 2004). The main reason given was fear of stigma and discrimination in regards to HIV, as well as to their sexual orientation and fear that confidentiality will not be kept (26%), not knowing where to go for an HIV test (18%), price of a test (6%), thinking they are not at risk (43%) and not wanting to know about their HIV status (7%). About 60% do not know where to go for an STI test.
• Sex work among MSM in Ukraine is relatively common, mainly due to the poor economic and social conditions (UNAIDS, AIDS Epidemic Update Eastern Europe & Central Asia, 2001). Sex is traded either for money or in-kind remunerations. 21% of the survey sample sells sex regularly or occasionally. The majority of them practice unsafe sex, if the client demands it, and usually do not get tested for HIV and other STIs (International HIV/AIDS Alliance & Gay Alliance, 2002).
These findings show that MSM in Ukraine are at high risk of HIV/STI transmission. And there are other common issues for MSM, which also hold true for Ukraine and must be considered, such as:
• Lack of awareness regarding the reality of the HIV epidemic in Ukraine. MSM often assume that the epidemic is ‘only’ amongst injecting drug users and sex workers and that they are therefore ‘immune’ to infection.
• Unavailability of condoms and information on HIV/AIDS in major gay settings, in particular cruising places and very limited access to appropriate lubricant (water-based lubricant is currently only available in sex shops).
The official estimates from the “National Report on Universal Access to HIV/AIDS Prevention, Treatment, Care and Support in Ukraine by 2010” (March 2006), show an average number of HIV+ MSM as being 27,315. With an estimated MSM population of between 177,000 and 430,000 – and from Kinsey we should always err on the upward figure. Thus at its worst estimate of 430,000 MSM in Ukraine with 15% prevalence then the number would be 64,500 HIV+ MSM.
The All-Ukrainian Network of PLWHA (AUN PLWHA), as of January 2007 a pilot project “Improving Quality of Life of MSM” by means of providing access to ARV therapy and other necessary services has been launched in 8 Ukrainian regions with support from the Elton John AIDS Foundation. The project will last till December 2009. It is aimed at improving HIV/AIDS awareness among HIV+ MSM and other MSM; developing organizing capacities of AUN PLWHA; providing care and support for HIV+ MSM and protection of their rights and interests in Ukraine. It is expected that all these aims will be reached: HIV+ MSM in 8 regions will receive all services needed (self-help groups, care, socio-medical support, assistance in access to medical services etc.); no less than 120 medical workers will improve their competency in support work with MSM; at least 2700 people will take HIV and STDs tests; 100 HIV+ MSM will be constantly tested for СD4 level and viral strain; 25 people from 8 regions of Ukraine will improve their knowledge by taking part in trainings on HIV/AIDS, outreach-service, creation of self-help groups, peer consultations, ARV treatment, healthy life style etc. Besides, a new web-portal to be created for HIV+ MSM will give all necessary information about HIV/AIDS, treatment, healthy life style, and services provided by the AUN PLWHA and other NGOs; MSM’s rights and interests will be protected by representatives of AUN PLWHA on national and regional levels.
Mission of the All Ukrainian Network of PLWH
Based on humanistic ideas to enhance the quality of life of people living with HIV by means of joint efforts of all concerned in order to offer psychological, social, counselling and legal support and to advocate accessibility of treatment and diagnostics for people living with HIV in Ukraine.
Strategic directions of the organization
1. To promote access to non-medical care, treatment and support.
2. To lobby and advocate rights of people living with HIV/AIDS.
3. To promote a tolerant attitude towards people living with HIV/AIDS.
4. To enhance the All-Ukrainian Network’s organizational capacity.
The organisation has a central office in Kyiv, and Regional Offices in 14 regions. Its has a core staff of some 34 people, and up to 150 employed in the regions and simple and complex community centres, including their Social Workers.
The organisation has a central office in Kyiv, and Regional Offices in 14 regions. Its has a core staff of 34 people, and up to 150 employed in the regions and simple and complex community centres, including their Social Workers.