- Outreach in meeting places of MSM.
- Counselling and rapid HIV and hepatitis C infection testing.
- Support groups for MSM living with HIV.
- Seminars and training for MSM and specialists working with MSM.
- Epidemiological and behavioural studies among MSM.
- E-publications, discussion forums and other information activities on the Internet.
- Development, publication and distribution of information and educational materials.
Why is LaSky unique? Perhaps because we can be trusted. We have support groups. /…/. If someone does not like the group work, they can always get individual peer counseling. According to the AIDS Center data, 90% of our clients living with HIV are registered and are receiving ART.
V. Zhukova, Head of the Department of Epidemiology and Prevention of the State Healthcare Institution “Moscow Regional Centre for the Prevention and Control of AIDS and Infectious Diseases”
Moscow Regional AIDS Centre cooperates with the project since 2015. The long-term cooperation experience allowed us to reach clients who need help. Thanks to f low threshold services, clients have the opportunity to receive the help of friendly specialists and peer consultants in a convenient place at a convenient time. The innovative component of the project on pre- and post-test counselling and rapid HIV testing, organised outside of a medical centre, but at the community-focused NGOs, with the confirmatory blood test at the AIDS Center, contributes to the timely detection of HIV infection among MSM and provides for the early start of treatment.
The support of peer consultants working at the project promotes an increased level of adherence to the treatment of HIV infection and other comorbidities. Working with the representatives of the MSM group, like any other group, requires respect towards the principles of ethics and deontology.Taking into consideration the closed nature of the MSM community, it is very valuable that, through the work of peer counsellors, the patients begin to trust the doctor, and this allows them to seek medical help without delays.
The number of MSM seeking medical attention from the AIDS Center has increased by almost 30% during the past two years. Over 90% of people with confirmed HIV infections are under clinical supervision, which assures good adherence to treatment with a high degree of trust towards the medical institution. The implementation of this unique project of HIV/STI prevention among MSM is now making a significant contribution to the development of joint programs involving public healthcare and socially oriented NGOs. Such systemic work will contribute to the reduction of the prevalence of HIV infection both within the MSM group and among the general population.
M. Angeltvedt, head of “Gay & Lesbian Health Norway” organization
We did not have much experience in international projects. Speaking about the Eastern European countries, we had cooperation only with organisations from Latvia and Slovenia. The Norwegian-Russian collaboration began in 2011 when we decided to publish a Russian language brochure on safer sex for men who have sex with men. We were looking for an NGO that could translate the text and adapt it to the Russian context. It was not easy. As a result, we released the brochure only in 2016, thanks to the cooperation with LaSky. This project immediately proved to be a reliable partner with all the facilities to make quality products.
The more we cooperate with LaSky, the more we learn about their needs, about their struggle and about what they are capable of, if they receive support. In Norway, many people think that outreach work is impossible in Russia. Well, LaSky in practice demonstrates that this is not true, that it is possible to work effectively in Russia on the prevention of HIV infection among MSM.
However, the exchange of experience is necessary. It is essential for us to show how we work in our country, in Norway. LaSky learns about our expertise, borrows something for its activities, selects some approaches, but realises everything in its style. For us, the most vital thing is that everything should be functional, all the mechanisms work. For example, if a person tests positive for HIV, they need to receive treatment. And LaSky are great at it. Just like in cooperation: doing their own extremely important work, while relying on the experience and support of partners.
At present LaSky is one of the largest HIV prevention projects for MSM in Russia. The project is implemented by employees and volunteers, public health and medical specialists, representatives of the community of people living with HIV.
From the “Comments Book”
Thank you very much for such a wonderful project! Thank you for the people who can convey valuable information adequately and understandably. Thank you for the attention and kindness. Usually this is in such short supply. Special thanks to the guys who are doing this work, who are contributing their time, who are experienced workers, qualified specialists, and simply good people.
LaSky clients are people aged 18 to 65. The largest age group is 31 to 40. LaSky works with gay men, bisexuals and other men who have sex with men, transgender people and sex workers. The project pays particular attention to MSM living with HIV who can be present in each of the above categories.
- Gay men – men whose sexual partners are only men – account for 70-80% of the project clients. The easiest way to establish contact with this group is through work in gay clubs and gay saunas.
- Bisexuals and men who have sex with men make up about 1/3 of the project’s clients.
- Recently 97 transgender clients contacted the project.
- 10% of all LaSky’s clients provided sexual services for a money over the past year. Men who provide paid sexual services are one of the most challenging groups to work with. These clients do not only have a high risk of HIV infection due to a large number of their partners; they are also more likely to experience violence and stigmatising attitudes from the general public. All of this negatively affects their ability to protect themselves from HIV infection or, in the case of a confirmed diagnosis, to start treatment in time.
The clients learn about LaSky mainly through outreach workers or through their own partners. Recently, however, more and more clients find out about the project through our website and our social networking accounts as well as through contextual advertising.
How are they coming to us? First of all, through outreach: our people are working, and this work is not only to distribute condoms and counsel, they also invite to join the project, to visit us at Krasniye Vorota, to do tests. Clubs, saunas… let’s call them places of concentration of the target audience, this is where many people come from. Second, – any search engines. Search words “HIV”, “MSM” provide links to LaSky in the first place: to our site, Instagram, Facebook.
The project team provides prevention services for more than eight thousand people per year. The first contact with the client occurs most often through an outreach worker. LaSky outreach workers are representatives of the MSM community; many of them live with HIV. The task of the outreach worker is to establish contact, provide condoms and lubricants, make client interested in taking tests for HIV, STI and Hepatitis and learning more afterwards. Many people whom the project team met during outreach work in clubs come to us after a while to get counselling regarding HIV infection and for support in connection with psychological and social problems.
Everyone comes with some difficult situation … And they, in fact, need to be adequately propped and supported all the time … because what people lack basically, is real support. Many others turn away from them, and they cannot discuss their problem with anyone. All this is also strongly stigmatised. And here they feel they can safely talk about their orientation, about the status, they can discuss anything – and no one will judge them.
Community-based rapid testing
Anonymous and free testing for HIV infection is one of the most popular services among LaSky’s clients. By the latest international WHO recommendations, the project officer provides the client with a set of self-tests and explains in detail how to do the tests and how to interpret the results. An essential advantage of such a test is that the client learns the result within a few minutes. In case of a positive result, he is provided with all the necessary information about what should be done afterwards, how and where the confirmatory test is passed, how to get treatment, etc.
For most people, a positive HIV test result is an immense stress. LaSky’s testing staff have had specialised training to support and assist the clients in accepting the diagnosis.
If the result is positive, we shall tell you where and to whom to turn next, how to get there, what they will be doing there, what tests must be done and why. We discuss all the necessary steps for a person with a preliminary status. We make sure to provide information about the support group for HIV positive guys: when are the mettings held, in what format, what is a “support group”. We make sure to tell everything about all our services, about the fact that a person is always free to contact us, with any issue they can always come or call us. Anytime.
We always make it clear in the conversation that we are here to stay, that we will render any support that … not just a stupid test and “bye-bye, go, do what you want” … we will fully support as long as it needed. And no money. The main thing is: come, and we’ll stand by you, through thick and thin. It is crucial to give hope to a person, that someone loves him. Because when people get the preliminary status, they do not understand who to tell and what to tell or not; they think: “everyone will turn away from me, I will have no friends”… We position ourselves as peer consultants with whom one can safely talk about the status and to whom one may ask any questions and discuss everything with; from whom one can get both information and psychological support.
Another valuable service is consulting about the issues of disclosure of your status to a partner. Discordant couples are provided with counselling services and a possibility of regular HIV status monitoring for the negative partner.
The most difficult moment … this seems to me to be one of the most challenging moments of HIV infection: when you have already received the status, your situation has changed, your life has changed… but if you infect someone else, then for you this moment will be psychologically even more traumatic than the moment you learned about your own status. It’s tough to realise that you are the cause of someone’s infection. And to make sure this does not happen, it is necessary to undergo therapy to achieve undetectable viral load … Here we perform a kind of NLP on the client: all of that is required to cure yourself and, at the same time, not to infect anyone else.
Support for MSM living with HIV
HIV treatment is a medical service provided in specialized medical institutions. However, without peer counseling provided on the basis of NGOs, it is impossible to ensure the necessary treatment coverage and high adherence to antiretroviral therapy.
Accepting the status [infected with HIV] is a challenging period when you do not understand what you need to do, whether you need to do something at all, and how it should be done. There are times when guys lose the meaning of life. And they call us at two or three in the morning and say that they want to commit suicide because their life is over. Therefore, regardless of whether it is your day-off or not, whether you are resting with your friends or sleeping, you need to step aside, to wake up – and you begin to respond and support this person.
Many of LaSky clients are not registered in Moscow: this could be other Russian regions, sometimes even the CIS countries. They need help to get ARV therapy in Moscow or even to pass a confirmatory test; they need explanation where they can go to, who to contact, what to do now and later, when they return home.
We want to develop this direction now: we want to be able to do the viral load, CD-4 and biochemistry for free and to try and provide them with the first treatment scheme, at least for the period when the person is collecting money for their journey home. Tajik citizens often travel back home, they have families there, and we try to find out whether they have contacts there and recent newborn children, we explain what measures have to be taken: going home and examining the family – and only after that you can return here, with medication. Many of them later come to us and tell us that everything worked out.
Myths about HIV are one of the problems that LaSky’s peer consultants face. For example, some people do not believe in the existence of HIV, nor they do believe that they have contracted an HIV infection; therefore, they do not recognise the need to get treatment. It is sometimes necessary to provide repeated consultations and comprehensive psychological support to convince such people to start treatment.
A 19-year-old guy had been diagnosed with HIV but did not believe in HIV. He was saying: “HIV does not exist. It’s all corruption to make money. ” I say: “What money? They will give you free tablets. ” He responds: “It’s still all a lie …”. In short, he held off until he recently came to me in such a terrible state, with a high temperature … He says: “You can now register me … I still do not believe in it, but I’d rather take the meds.” Now he will start taking pills and we’ll see what happens next.
In addition to participation in assessments on HIV prevalence , risky practices and access to the services, LaSky is also performs routine monitoring. This real-time control provids an opportunity to measure the results through the increase in the numbers of new clients, HIV tests, condoms and information materials distributed, etc.
Since 2008, LaSky project has served as the base for five major studies, their results are being used today by leading Russian and international experts.