Column by Nikolay Lunchenkov, LGBT Health Coordinator
Sometimes it feels like the conversation about HIV in Eastern Europe and Central Asia is moving in a spiral: we take one step forward, then something collapses, and we find ourselves back where we have already been. But each new cycle brings new layers — political, social, human. This is not just an epidemic; it is a mirror reflecting fear, strength, solidarity, and the rejection of illusions. And, to be honest, 2025 has become the year when it finally became clear: global partners can make mistakes, they can turn away, they can betray — but we cannot. We live here. We work here. And only we can decide what the future of the region will look like.
1. HIV incidence among MSM is rising — and this is not about personal fault, but a systemic vacuum
When I look at the numbers, the first thing I feel is anger. Not toward people, but toward the circumstances. The rise in new cases has long stopped being the result of individual behaviour; it has become the result of the absence of safe, accessible, and respectful services. It is about doctors who think it is normal to lecture people about morality. About clinics where lack of privacy turns testing into a social risk. About cities where taking an HIV test feels like a small investigation: “Who will see me?” “Who will find out?” And the most honest explanation is simple: the epidemic grows where the state prefers to turn a blind eye to human dignity.
2. PrEP is now closer, and the region is learning from itself — not from the West
PrEP is no longer an abstract concept; it has become a real practice. But access to PrEP is not really about pills and protocols — it is about how the system treats people. And here, the region has unexpectedly become its own teacher. Kazakhstan is one of the most striking examples. Despite a complex political context, it is where clinics and teams have been formed that treat a person not as an object of control, but as a human being. A simple, practical, respectful approach: doctors do not ask unnecessary questions, NGOs and the state work together, logistics are in place. This is not a perfect model — but it works, and it is ours. And for the first time in decades, we do not need to look to the United States to understand how to do effective prevention. We can look to our neighbours.
3. Chemsex has become part of urban LGBT culture, but support is still driven by people, not institutions
Chemsex is no longer a rare or hidden phenomenon. But acknowledging the reality does not automatically solve the problem. People are still facing anxiety, addiction, loss of control — and in some cases, death. And if there is anywhere in the region that shows how to work in inhumane conditions, it is Ukraine. A country where war has become everyday reality, where public services are stretched to the limit, and yet NGOs continue fearlessly supporting people: self-help groups, counselling, harm reduction services, outreach that still functions. What Ukraine is doing right now is a lesson for all of us in how to preserve humanity when everything around is falling apart.
4. Social exhaustion has become a risk — and this is where the global political “reality check” showed itself
This fact cannot be ignored: in 2025, the United States has definitively turned toward ideologically driven obscurantism. Cuts in prevention budgets, attacks on the LGBT agenda, political pressure on health programmes — all of this is destroying the model that the world relied on for decades. You can try to soften these words, but the truth is simple: America has betrayed its own principles. And perhaps for the first time, we find ourselves in a position where expecting support from it is a naïve hope for something that no longer exists.
But in that shadow, the strength of the region has become visible. Georgia, for example, demonstrates a level of surveillance and data quality that now seems out of reach for most European countries. Transparency of monitoring, timely reporting, a culture of response — all of this has been achieved not thanks to external grants, but thanks to internal professionalism. And in that moment, it becomes clear: dependence on the West was a habit, not a necessity.
5. The region’s main strength lies in the people who keep things moving, even when political cycles collapse
Every trip across the region reminds me of this: real change is made not by structures, but by people. Those who conduct testing at night in buses. Those who build chatbots for counselling so that no one is left alone with their fears. Those who create community spaces where honesty is possible. We learn from Kazakhstan how to implement PrEP. From Ukraine — how to work in the middle of a catastrophe without breaking. From Georgia — how to build a data system that creates trust. From Kyrgyzstan — how to preserve humanity in an environment where that is still dangerous.
And most importantly — we have stopped looking to Washington, Berlin, or London. We look at each other. We see our own models, our own solutions, our own resources. The region did not betray. The region did not give up. The region is still standing.
To be honest, I have not felt this much clarity in a long time. Yes, the world has become much harsher. But we have not. We have become more direct, more courageous, and we have started growing up faster. And now, as global centres are politically erasing themselves, we have a chance to build protection, resilience, and solidarity not “in someone else’s image,” but something that has grown here — among our people, in our cities, in our own conditions.
And that may be the most important fact of 2025: no one is coming to save us — and we do not need them to. We can do it ourselves.