Concerns over high or increasing HIV among MSM
The HIV levels among MSM remains of great concern across CEECA for both countries already experiencing the epidemic and those which record fewer HIV cases in this group. In contrast with the global tendencies, the HIV epidemic continues expanding with a greater number of new cases every year in most countries of the region, with exception of Central Europe and parts of South-East Europe. Low HIV prevalence among MSM is reported in one third of the CEECA countries, notably Albania, Armenia, Azerbaijan, Bosnia-Herzegovina, Bulgaria, Croatia, the Czech Republic, Lithuania, Kazakhstan, Tajikistan, and Uzbekistan (between 0.5-4.8% (11)). In others, Belarus, Kyrgyzstan, Latvia, Moldova, North Macedonia Poland, Serbia, Slovenia, and Ukraine, the level of HIV prevalence passed the 5%-threshold for concentrated epidemics, reaching up to 9.8%. Moreover, other five countries (Hungary, Georgia, Montenegro, Romania and Slovakia) recorded the prevalence stepping above 10%, with the major recent jump taking place over short periods of time in Georgia, Montenegro, and Romania.
There are differences on the portion of new HIV cases contributed to the homosexual transmission route in the official records of the countries. In most countries of Central and South-East Europe, majority of new HIV cases are registered among MSM (12). In the East, only 3% of new HIV cases are attributed to MSM despite a concentrated stage of the epidemic in some countries. Researchers suggest homosexual transmission is grossly underreported in the official registration of the HIV cases (13).
Optima modeling, which guides countries how to increase efficiencies and what resources are needed for reaching the UN global goals, suggests the epidemic might grow among MSM in the region in the future, if not yet, and recommends increased action among MSM for such a diverse group of countries like Belarus, Bulgaria, North Macedonia, and others (14). This recommendation is consistent with the global nature of the high levels of HIV epidemic among MSM around the world.
The level of targeted health responses among MSM remains low in CEECA. Few countries report their data to UNAIDS and European CDC. Countries, like the Baltic States, Poland, report major gaps in HIV programming among MSM (15). When it comes to reaching the 90-90-90 targets for HIV diagnosis and care, the biggest progress among the countries with the full set data reported, is in the Czech Republic where 59% of all HIV-positive MSM had their virus suppressed and lowest in Azerbaijan where this number was only 10% (16). Notably, in a study in Moscow (17), the research found this number to be only 3%. One trend seen in the limited data available is that HIV positive MSM manage to reach good treatment results if they are diagnosed and receive treatment. In Moscow, Russia, and Kazakhstan the level of suppression was lowest with 60-64%, while the Czech Republic and North Macedonia reported achieving 94%. There might be major gaps in diagnosis (e.g. only 12-14% in Azerbaijan and Moscow, Russia, while Belarus reports 100% of HIV-positive man are diagnosed) and/or with treatment (e.g. only 22% in Belarus).
HIV services in South-Eastern Europe and Eastern Europe and Central Asia, particularly specialized anonymous services provided by civil society, depend on international funding. But the Global Fund, the main donor in the HIV field, is now moving away from South-East Europe and the Russian Federation and is reducing its support for the HIV responses by 50% in the current 3-year cycle in comparison with the previous one across EECA. Moreover, there is a limited progress in securing national ownership and domestic funding of these specialized services by civil society. Positive recent exceptions are Montenegro and North Macedonia, where Ministries of Health starts funding a range of HIV prevention services among key populations including among MSM. Belarus, too, started establishing the legislative framework for social contracting and delegated allocation of funding to local authorities within its national HIV sub-program. In 2018, in Moldova the National Health Insurance Company contracted an NGO to deliver some HIV prevention services among MSM for the first time.
11. Prevalence data are used from UNAIDS database of data of 2017 available at: http://www.aidsinfoonline.org and the ECDC Dublin Declaration thematic report on MSM 2017. There was a conflicting information available for Hungary – above 10% prevalence in the ECDC publication, while in the UNAIDS database it was just 4%. The ECDC data was used in this case, as the same prevalence was found in scientific literature.
12. European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2017 – 2016 data. Stockholm: ECDC; 2017.
13. Spindler H, Salyuk T, Vitek C, Rutherford G. Underreporting of HIV transmission among men who have sex with men in the Ukraine. AIDS Res Hum Retroviruses. 2014;30(5):407-8.
14. Optima studies are available at: http://optimamodel.com/hiv/applications.html
15. ECDC. HIV and men who have sex with men. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017.
16. ECDC. Continuum of HIV care. Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2018
17. Wirtz AL et al. The HIV care continuum among men who have sex with men in Moscow, Russia: a cross-sectional study of infection awareness and engagement in care. Sex Transm Infect. 2016 March ; 92(2): 161–167