HIV Prevention in Key Populations: an Overview of Service-Delivery Projects in Russia
Author: Anastasia Petrova, Russia
According to the World Health Organization, about half of new HIV cases occur in key populations: injecting drug users, men having sex with men and sex workers. Social stigma, violation of human rights, lack of access to the necessary services create barriers to protection of health for millions of Russian citizens. That being said, providing care to people with an HIV-positive status and those who are at risk of infection is an essential measure to safeguard health of the whole nation. By implementing service-delivery projects for key groups, non-governmental organizations play an important role in preventing the spread of the HIV epidemic both in the communities and among the general population.
The bus of hope
The Blue Bus of the Humanitarian Action Foundation is the first mobile prevention unit for drug users. In 2017, the project celebrates its anniversary: 20 years ago, the Blue Bus started its first journey in St. Petersburg.
Throughout these 20 years, Humanitarian Action has been true to its principles of helping those most vulnerable to the HIV epidemic. Many clients have double or even triple diagnosis: HIV, tuberculosis, hepatitis B and C, and addiction to psychoactive substances.
People are referred to service-provision programs through street outreach, mobile units and stationary needle exchange centers. Peer counsellors provide motivational counselling, assist with hospitalization to specialized medical institutions and follow-up their clients to increase retention in treatment programs.
Bus workers distribute sterile syringes, needles, water for injections, alcohol swabs, cotton balls, bandages, vitamins, vein ointment, naloxone, etc. People who use services are not always ready to change their behavior just like that. Talking to the project staff, they get important information on how to reduce infection risks and protect their health.
For most clients, the Blue Bus is the only safe place where they are treated with respect and understanding, and the only possibility to take a rapid test, receive primary medical counselling, get access to HIV and TB testing and treatment, be referred to public institutions and learn how to protect human rights. The team of the Blue Bus proudly values these trustful relationships between project staff and clients that have been built over the years of program implementation.
Dialogue between equals
NGO Positive Dialogue is one of the oldest HIV-service organizations in St. Petersburg. Since its establishment in 1996, Positive Dialogue has gained substantial experience in working with key populations. In July 2015, the organization launched HIV prevention projects for closed population groups: men having sex with men (the Positive Dialogue project) and sex workers (the Silver Rose project). Both projects are community-driven, with the main goals to promote safer sex practices among MSM and SWs, increase access to services, including HIV/STI testing, uphold human rights, strengthen communities and counteract stigma.
The outreach team of the Positive Dialogue project conducts weekly field work in the night clubs visited by MSM and the LGBT community. The clients talk to peer counsellors and ask questions about HIV and other STIs, learn about pre- and post-exposure prophylaxis, receive condoms and lubricants.
The Silver Rose staff members provide counselling for sex workers in their office and conduct outreach work in the local saloons and street sex work areas. The project helps the girls preserve their health and human rights, protect themselves against violence, receive contraceptives, get tested for HIV and get referrals to trusted doctors. Peer counsellors also provide psychological support and involve sex workers in client management programs.
Legal components make up an important aspect of the project’s work – the so-called “street lawyers” trained by the project provide legal aid and support in cases of violations of MSM/LGBT and SWs rights. Project clients take part in educational trainings and seminars.
Particular attention is devoted to community development and mobilization, to encourage community-driven HIV responses. Project activists organize campaigns and round table discussions aimed at overcoming societal stigma.
HIV-positive women are the focus of one of the projects run by EVA Association. In October 2017, a social support center for women affected by HIV will be launched by EVA – a low-threshold service offering comprehensive individual assistance to HIV-positive women in crisis situations.
The project team unites specialists with various experiences: peer counsellors, client management officers, lawyers, psychologists. Clients will be offered counselling, rapid HIV testing with pre- and post-test counselling, and individual management of each case. Women will be able to obtain contraceptives (condoms) here and take part in self-help group sessions for women living with HIV and their family members.
Experienced specialists working in EVA will do their best to make the center as client-friendly and as responsive to clients’ needs as possible – for example, by allowing clients to bring their children, organizing distribution of clothes for women and kids, giving out hygiene kits. EVA collaborates with the municipal public services and socially oriented NGOs, which will improve activities aimed at informing women about the existing support services, providing access to various specialists and representing women in these institutions.
The center will give special attention to the prevention of violence and dependent and co-dependent behaviours. It is pilot project, unique for the region, with a focus of preventing negative social consequences of HIV among women.
Prevention projects for vulnerable groups in Russia were launched 20 years ago by our western colleagues. However, international funding for these and other social projects has been significantly reduced. Unique low-threshold HIV prevention programs are becoming as vulnerable as their clients. Some organizations manage to secure financial support from the government. Others try to change their structure. We would like to believe that projects that help thousands of people representing very closed populations to protect their health will not become extinct in Russia.