| Center for Public Health and Human Rights |
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High Risk Men, HIV, and Human Rights in Moscow, Russia The objectives of this project are: 1) Describe the gay, bisexual, and MSM communities in Moscow. Investigate approaches to sampling and recruitment, explore the universe of physical and internet venues frequented by these men, and explore sexual orientation, identity and sexual risk taking across these domains. Investigate the social, structural, and human rights contexts in which these communities exist. 2) Assess optimal recruitment methods to access GB&MSM in Moscow and the relative efficiency of these recruitment methods to bring GB&MSM men in for HIV/STI counseling and testing. 3) Investigate the epidemiology of self, perceived, and experienced stigma among gay identified and non-gay identified men in Moscow, measure the prevalence of stigma in these groups, and investigate the associations of stigma with behavioral risk, HIV/STI infection, and human rights stratified by recruitment method. To accomplish these specific aims, the project team will conduct a formative research phase, which will include the recruitment of 120 participants for key informant interviews and focus groups and an additional 120 participants for survey instrument cognitive testing and scale validation. The policy and structural components of Aim 1 were initiated in April, 2008 and are ongoing (see "Advocating for MSM", below). This will be followed by an enhanced RDS recruitment among 1,140 GB & MSM in Moscow, and an IBS conducted concurrently among 1,140 men recruited onlineWe are proposing an epidemiologic investigation of identity, health risks, and stigma among gay, bisexual, and men who have sex with men (GB & MSM) in Moscow, Russia. Background: Same-sex behavior between consenting adult men was criminalized and highly stigmatized in the Soviet era. The collapse of the USSR, and the social, political, and economic changes which followed it, dramatically changed the legal and social contexts for these men: homosexuality was de-criminalized in 1992 and gay bars, clubs, saunas, escort services, websites and cruising areas have emerged, including in Russia’s largest city, Moscow. But social stigma and the harassment of GB & MSM continues in 2009. Moscow GB & MSM are engaging in same sex behaviors in a complex and challenging environment marked by an HIV/AIDS epidemic; epidemics of several sexually transmitted infections (STI); high rates of substance use, notably alcohol; injection and non-injection drug use; and by abrogation of human rights including dignity, sexual rights, and health rights. Epidemiologic investigation among these men is urgently required to explore their emerging identities, optimize epidemiologic approaches to researching their health risks and health seeking behaviors, enhance Respondent-Driven Sampling (RDS) and investigate the utility of internet-based sampling (IBS) as an outreach, surveillance, and prevention tool to optimize recruitment for hard to reach subsets, particularly hidden and ethnic minority GB & MSM, and to understand the role that self, experienced and perceived stigma play in their lives. We are proposing a social ecological framework for this investigation and both descriptive and methodologic aims. This proposal is a continuation of a unique collaboration between AIDS infoshare, a long-standing Russian non-governmental organization (NGO), the SANAM Clinic, a gay-friendly clinical care provider in Moscow, D.I. Ivanovsky Institute of Virology, the Russian National GLBT Center “Together,” and the Johns Hopkins Bloomberg School of Public Health, Departments of Epidemiology and Health Behavior & Society. Our group recently completed an epidemiologic HIV probe study among 401 GB & MSM in Russia and found that HIV infection was highest (7.7%) among the youngest GB & MSM, those aged 18-22 years, underscoring the emergent nature of this epidemic. Independent predictors of HIV infection included never having been tested for HIV (AOR=7.5; 95% C.I.: 1.9, 29.9) and having ever injected drugs (AOR=9.8; 95% C.I.: 2.0, 47.3). Our proposed research is urgently needed to better understand these men, their risk taking behaviors, and the social and ecological context within which they are occurring. Results: To follow Funded by the National Institute of Health Advocating for HIV and STI Prevention Services for Men who Have Sex with Men in the Russian Federation AIDS Infoshare, a Moscow-based Russian NGO, in collaboration with CPHHR, is working to expand its advocacy efforts on behalf of men who have sex with men (MSM), a group that has been overlooked by the Russian government’s HIV/AIDS prevention programs. While MSM communities in the U.S. and Western Europe have made a large contribution to stalling the spread of HIV among its members, the mobilization of MSM around basic human rights and health issues in Russia is still at an early stage. The project includes the use of both quantitative and qualitative scientific evidence to elucidate the barriers to inclusion of MSM into national HIV/AIDS prevention programs. Advocacy on behalf of MSM will be conducted primarily through the project’s Advisory Board, which will be responsible for constructing a written statement containing concrete data from a wide range of influential professionals. In the past, the involvement of vulnerable populations in the design and implementation of HIV/AIDS prevention programs has proven to be very effective, as have grassroots efforts by MSM communities in other countries to stop the spread of HIV. Therefore, members of the MSM community will be engaged as much as possible in the project and will receive training that will enable them to advocate for improved health care on their own behalf. Results: Qualitative findings from Focus Group Discussions and Interviews Poster Supported by: The Ford Foundation |
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