amfAR, The Foundation for AIDS Research

GRASSROOTS: The GMT Initiative Blog

Grassroots reports on the work of amfAR-supported research teams and advocates responding to the devastating impact of HIV among gay men, other men who have sex with men, and transgender individuals (collectively, GMT).

“Outcasts” in Ukrainian Prisons

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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).

ukraine prison support group Nikoleav 
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.


Homophobia and HIV in Ukraine

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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.

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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.

Testing in Belgrade

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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.

belgrade1Djordje 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. 

SOMOSGAY Opens Paraguay’s first Men’s Health Clinic

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Posted by Ben Clapham, June 4, 2013  

It is midnight and I just returned to my hotel after spending the evening with the team from SOMOSGAY, the most important grass-roots organization led by young gay men, other men who have sex with men and trans individuals (collectively referred to as GMT) in Paraguay. SOMOSGAY has been a grantee of amfAR’s for three years. Tonight they made history in Paraguay and in the Latin American region as they inaugurated the first holistic health care center for men in Paraguay. opening 1
(from left to right) Exiting Director Simon Cazal, Dr. Ivan Fernando Allende Criscioni, and Adolfo Ruiz Ferreira inaugurating the center.

The medical center is in Asunción, Paraguay’s capital, inside the community center that SOMOSGAY recently purchased—in part using amfAR funds. The center will provide health care services for all men, regardless of their sexual orientation, gender identity, or socio-economic status

“This medical center never could have come into existence without the early support from amfAR funding rapid HIV tests,” the exiting executive director, Simon Cazal told me. “Before amfAR provided rapid HIV tests, GMT were not getting tested. The state did not provide adequate services and no one knew their status.” kuimbe
Signs outside the KUIMBA'E Men's Wellness Center.

SOMOSGAY is now testing over 200 people every month. GMT in Paraguay often face discrimination from health care providers, which not only deters them from seeking out HIV tests, but medical care in general. SOMOSGAY wanted to build on their now established reputation as a trusted rapid testing site and offer men comprehensive, non-discriminatory care.opening 2
Outside KUIMBA'E Men's Wellness Center on inauguration night.

The opening of the KUIMBA'E (Guaraní for man) Center marks an important moment. For the first time, medical services tailored to men will be offered free of charge and accessible both during and after normal business hours. Currently, people must wait in long lines at state-funded health care facilities that close at 5 p.m., meaning those who work during the day can’t get the care they need.

Simon and the incoming director, Sergio Lopez, are stars of sorts in Paraguay. Everywhere we went, whether to a restaurant or walking down the street, people recognized them and thanked them for the incredible work they are doing for Paraguay. During my visit, they spoke with a dozen media outlets to promote their services and talked about the importance of all men having equal access to health care. They have their sights set on bigger things in the future, including extending their medical services outside of the capital.

One thing is certain, the KUIMBA’E of Paraguay are set to receive free, quality services without waiting for hours in line.

Economic Empowerment in Kenya

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Economic Empowerment in Kenya

Posted by Kent Klindera, May 29, 2013 


Kisumu 003.JPGMAAYGO members hold up their banner in Kisumu, KenyaI just spent the weekend in Kisumu, Kenya – visiting with a new GMT Initiative grantee the Men Against AIDS Youth Group (MAAYGO).  Predominantly made up of young gay men, other men who have sex with men (MSM) and trans individuals (collectively referred to as “GMT”), MAAYGO focuses on reducing the HIV vulnerabilities of GMT through economic empowerment schemes.  As one member stated during a discussion in their office this past Saturday, “If you are the breadwinner, it is interesting how all of a sudden homophobia in your family goes away.”

Kisumu 005.JPGKennedy, Victor, and Simon with MAAYGO’s rentable chairsamfAR, with support from the AIDS Fonds of the Netherlands, is providing a small grant for MAAYGO to conduct a needs assessment of its members, and then roll out a “microfinance” program that offers members loans of roughly $150-$200 to start small businesses.  MAAYGO will work with members to develop formal business plans and mentor them in terms of entrepreneurship.  In addition, they will promote HIV testing and access to treatment and make referrals to testing and treatment sites MAAYGO has already trained in GMT-friendly health care.

Kisumu 008.JPGVictor with MAAYGO’s catering equipmentBeyond the project, MAAYGO takes economic empowerment seriously.  As a community-based organization, they have purchased chairs and catering equipment that they  rent out for various functions.  Thus, they can use the chairs and catering items for their own events, while also generating income for MAAYGO by renting them out.  In the year since they purchased them, they have already paid for themselves fourfold.  Sunday in Kisumu was “market day,” where local farmers and sellers come to town to sell their vegetables and meat or peddle their wares. The chairs were rented out very quickly, as MAAYGO’s office is directly across the street from a market square. 

MAAYGO believes strongly that if young GMT have choices in their life, they will make healthy ones.  Poverty is a major factor that increases HIV vulnerabilities among GMT because at times MAAYGO members rely on sex work to survive.  MAAYGO is helping these young folks in Kisumu be informed about HIV, as well as have a range of options in their life – all of which helps motivate them to be healthier and to avoid HIV infection or to remain adherent to HIV medication if they are already living with HIV.