Posted by Kent Klindera June, 25, 2013

I’m just returning to New York after my site visit tour in Eastern Europe.  For my final stop, I visited Nikoleav, Ukraine to check in on grantee-network partner The Penitentiary Initiative.  For the past four years, the GMT Initiative has supported this project to work with GMT individuals living in Ukrainian prisons.  I visited two different prisons (Colony 47 and 53), spending time with some of the men involved in the program. 

The Penitentiary Initiative works with three types of prisoners:  General prisoners who are involved in an HIV prevention program, those living openly with HIV, and those deemed as “outcasts” based on their real or perceived GMT sexual orientation.  For decades, these “outcast” prisoners have represented the lowest rank of the prison hierarchy in the Ukranian prison system. They are often the targets of violence (both physical and sexual) and are forced to continuously perform menial jobs that other prisoners would never do (such as cleaning the bathrooms).

 
An “outcast” prisoner support group meets in a prison near Nikoleav, Ukraine.

The Penitentiary Initiative works in seven different prisons, visiting each twice a month to conduct three hour sessions with the three different groups of prisoners.  amfAR has been supporting the “outcast” group, and has helped the Penitentiary Initiative develop a manual based on the best practices of the program. The initiative is now using the manual to train Ministry of Justice employees to implement a similar program for “outcasts” in other prisons.

The guys were so appreciative of the Penitentiary Initiative visits.  They spent time learning more about HIV, as well as time having a support group meeting during which they discussed various issues of prison life.   The Penitentiary Initiative staff also helps the men provide peer support for each other and provides toiletries that these “outcasts” can trade to avoid some of the abuse they suffer from other prisoners.  The program also raises their self-esteem, which empowers them to defend themselves.  The prison guards allow the Penitentiary Initiative staff to offer all the prisoners they work with condoms and lubricant—the only source of either in the prisons— to protect themselves and other prisoners from the spread of HIV. 

Talk about a humbling experience.  amfAR is truly providing support to some of the most marginalized human beings out there—vital support that not only effectively prevents the spread of HIV, but also provides some humanity to vulnerable individuals truly in need.  I leave with a greater sense of resolve that what we are doing—supporting community-led programming for GMT—is truly making a difference.

Posted by Kent Klindera, June 12, 2013

I am now in Odessa, Ukraine, visiting our colleagues at Life+ —an organization by and for people living with HIV.  amfAR supports a Life+ project that targets GMT individuals living with HIV and provides them with psychosocial counseling, group support, and “patient navigation” at the local AIDS Center. Patient navigation involves a staff member or volunteer accompanying clients to seek healthcare, thus helping them get comfortable enough with specific health centers to visit them regularly on their own.

 
Nic, Life+ program coordinator and patient navigator, and Marian, program director, in downtown Odessa. (Credit: Chris Vail)

Homophobia and HIV-related stigma are rampant in Ukraine, and in the past too many GMT refused to seek support and healthcare because of their own “self stigma,” as well as fearing intense discrimination from others, and subsequently died.  Through the project, Life+ has also been able to engage doctors and social workers at the local AIDS center to help create a strong referral system to help GMT living with HIV obtain their life-saving medications.  Additionally, the social support provided by Life+ clearly empowers these men to access healthcare and adhere to their medication.

And boy is it needed!  After we had a support group session with about 15 GMT clients at the Life+ unmarked and nondescript office, I walked through Odessa with my colleagues Marian, Life+ program coordinator, Nic, a peer counselor/patient navigator, and Nikita (a good friend to both).  I was shocked at the “in your face” homophobic responses that confronted us as numerous people made reference to Nic and Nikita’s somewhat effeminate presentation.  At one point, several young men on bicycles were verbally hostile.  Throughout the evening, whether on the street or in the pizzeria we dined in, people were pointing, staring and/or laughing.  When asked, all three brushed the responses aside as normal and something they barely notice.  They explained it is their defense mechanism to not engage at all, as clearly these acts are meant to disturb them.

Nic, Kent, Nikita, and Marian at the Life+ offices.

These three are self-actualized gay men—leaders in their community.  However, they explained that their clients are in much worse shape and clearly need the support of Life+ to get by.  Marian and Nic, who are both living with HIV, described a similar situation for themselves in the past, but they said that Life+ changed their lives – and thus motivated them to help others.

Unfortunately, the national Ukrainian government is showing no signs of challenging this homophobia.  Currently, their parliament is debating an “anti-homosexuality propaganda” bill, modeled after the one recently passed by the Russian parliament.  The bill focuses on banning the “promotion of homosexuality” within schools, but also goes much farther to challenge and possibly outlaw any work being done by NGOs that supports LGBT rights.  It would seriously affect Life+ efforts to work with GMT individuals and cost many lives.  There is a movement to advocate against the passage of such a bill, but more mainstream health authorities and other technical experts are needed to assist in these advocacy efforts. 

In the end, both Nic and Marian will continue to support their friends the best way they know—being there.  If Ukrainian policy makers are serious about addressing the HIV/AIDS epidemic, hopefully they will be there too – and defeat this bill.

Posted by Kent Klindera, June 10, 2013

 
Djordje and Isein hand out condoms and recruit people for testing in the park.

I’m just leaving Serbia after a most impressive two-day visit to our colleagues here at the Safe Pulse of Youth (SPY), an LGBT-led organization providing HIV outreach and social-support services to young LGBT individuals.  I spent the weekend being an outreach worker with their team.  Saturday night we were parked just outside the Pleasure Night Club from 11:00 p.m. to 3:30 a.m., and Sunday afternoon we worked a major public sex environment near a beautiful reservoir full of Belgradians enjoying one of the first warm sunny days of the summer season.  On both occasions, SPY teamed up with JAZAS—a mainstream AIDS organization that is supported by the Global Fund to Fights AIDS, Tuberculosis and Malaria—to offer on-the-spot HIV testing in a van.

Djordje and Isein in the park.

SPY receives minimal funding from the Ministry of Health (MOH) – Serbia’s primary recipient of Global Fund support.  The MOH/Global Fund supports SPY’s outreach program, but it also receives amfAR funding to go several steps further.  Beyond just “chasing the numbers” of HIV testing, amfAR is helping SPY build a more comprehensive program focused on the whole person.  They have a drop-in center that provides HIV tests, along with psychosocial support, including support for GMT living with HIV.  They are also part of a coordinated effort by many Serbian LGBT organizations to hold their government accountable to its promises about LGBT rights in the country.

While we were doing outreach in a major park, Isein and Djorde (staff at SPY and the cutest couple!) explained to me that public sex was more common in Serbia during the communist era, because very little property was “private”, and it was hard to find a space to be with a same sex partner because so much space was shared with others.  This is changing today.  More and more young people are becoming increasingly bold about their sexual orientation or gender identity  and are meeting each other in more visible public spaces and interacting more at home in private.  SPY is helping link the public-health community to this new generation of LGBT people.

Djordje and Isein in the park.

Interestingly enough, there was major police presence at the night club.  Outside the club, there were four uniformed officers and a vehicle, and inside two plain clothes officers roamed the bar.  Since attacks often occurred against LGBT people in years past, the police are now present every Friday and Saturday evening in these clubs to “protect.”  My colleagues at SPY explained their presence was meant to bring a sense of security. However the constant police presence also reminds everyone of the hate they suffer from in Serbia.