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Sexual Health, HIV/AIDS and Human Rights among MSM, Kazakhstan

Led by: Dr. Beyrer, Mark Berry, and Dr. Baral
In partnership with: Amulet and the Global Health Research Center of Central Asia (GHRCCA)

Objectives: Generate estimates of HIV prevalence and risk factors for HIV infection among MSM; explore individual and structural level risks for HIV infection, including measures of stigma, discrimination, and access to existing health services; support local and international advocacy campaigns for improved access to HIV programs and civil rights of MSM.   Researchers from CPHHR are collaborating with local organizations, Amulet and the Global Health Research Center of Central Asia to enroll 400 men through RDS to assess prevalence of HIV, risk behavior, and discrimination of gay and other hidden MSM.

The goal of this project is to inform advocacy efforts aimed at improving the human rights and public health situation among gay men and other MSM in Kazakhstan. The project will build capacity among local lesbian/gay/bisexual/transgender (LGBT) groups to partner on health and rights work with other stakeholders in Kazakhstan, be used to advocate for inclusion of MSM in Kazakhstan’s upcoming Global Fund application, and inform MSM-focused interventions in the national AIDS program. The findings will form the basis of a public health argument which, in conjunction with a human rights argument, will show how the HIV prevention, treatment and care needs of MSM have been underfunded. Finally, these results will be leveraged to draw more international resources for human rights and civil society inclusion among sexual minorities in Kazakhstan.

Background: HIV risk associated with injecting drug use (IDU) has dominated the discourse of HIV risk in Kazakhstan and regionally in Central Asia.  Although IDU likely comprise a majority of HIV transmission, there is a need to better characterize the role of sexual transmission in the spread of the virus.  Epidemiologic data regarding MSM in Central Asia are among the sparsest globally, and a recent systematic review found no peer-reviewed publications characterizing risk among MSM in the literature.  The National HIV/AIDS Programme in Kazakhstan has estimated that there are approximately 100, 000 MSM living in the country, corresponding to approximately 1.9% of men older than 15 years (13)(14).  This may be a conservative estimate as many of the rapid assessments in which this value is based did not include bisexual men.  Limited surveillance has been done in the country, including a convenience sample of 450 men from Astana, Almaty, Karaganda and Taraz that found very low HIV prevalence, but high HIV risk behaviours.  And while MSM-prevention activities have been included in the GFTAM, estimates are that only between 1-8% of MSM have been reached by any prevention programming.  It is likely that MSM are an emerging risk group for HIV, given low levels of targeted education and very high rates of unprotected anal intercourse.

To date, there has been no systematic assessment of the human rights contexts of MSM in Kazakhstan.  It is critically important to characterize the level of stigma, discrimination and human rights abuses that these men face in their everyday lives, including denial of housing and healthcare, being afraid to walk down the streets of one’s community, or being afraid to seek health care services.  It is also important to describe the relationship between rights abrogations and associations with HIV or HIV risk status.  Our previous studies from Russia and from Southern Africa have demonstrated that having disclosed sexual orientation to family members was significantly associated with blackmail, and, having disclosed sexual orientation to a health care provider was significantly associated with having been denied health care.  In the short term, these two factors will continue to limit disclosure of sexual orientation.   In addition, those who reported blackmail were also less likely to have been tested for HIV in last 6 months.  It is important to assess whether there are similar structural barriers to available health care services in Kazakhstan.  If these structural barriers exist in Kazakhstan, they will limit the efficacy of any intervention targeting individual level determinants of HIV transmission among MSM and must arguably be mitigated to effectively decrease HIV incidence.

Partnering with GHRCCA and JHSPH will allow Amulet, the local LGBT organization, to take on a more prominent role in health advocacy and in rights advocacy, and will provide training and technical support to the organization.  We have found that while many governments are unwilling to engage LGBT groups in rights issues alone, they are much more responsive when NGOs partner on HIV prevention activities—and indeed, in future rounds of the Global Fund, Governments may be mandated to partner with LGBT groups to receive funding. 

The goal of this project is to inform advocacy efforts aimed at improving the human rights and public health situation among gay men and other MSM in Kazakhstan. The project will build capacity among local lesbian/gay/bisexual/transgender (LGBT) groups to partner on health and rights work with other stakeholders in Kazakhstan, be used to advocate for inclusion of MSM in Kazakhstan’s upcoming Global Fund application, and inform MSM-focused interventions in the national AIDS program. The findings will form the basis of a public health argument which, in conjunction with a human rights argument, will show how the HIV prevention, treatment and care needs of MSM have been underfunded. Finally, these results will be leveraged to draw more international resources for human rights and civil society inclusion among sexual minorities in Kazakhstan.

Funded by Open Society Institute (September 2009 – August 2010)

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