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Following the collapse of the Soviet Union and other communist regimes in Eastern Europe, political liberalisation resulted in the emergence of free market economies, freedom of speech, travel opportunities and the public appearance of previously hidden communities throughout the region, including most post-Soviet states. The political trends, however, were not uniform across countries, nor were the HIV epidemics that unfolded. Men who have sex with men (MSM) gained an opportunity to ‘come out of closet’ and become more visible through meeting venues and community-based organisations (CBOs), participate in gay-oriented events and enhance their presence in public spaces. However, effective and sustained HIV prevention programmes and services for MSM were absent in much of the region, while stigma and homophobia were widespread. In the past two decades, HIV rates significantly increased in the former Soviet Union and other parts of Eastern Europe, much later than in the West. (Countries included in this commentary are those categorised by European Centre for Disease Prevention and Control/WHO as belonging to Central and Eastern Europe.1)
HIV incidence among MSM in Eastern Europe was generally low until 2010.1 However, an overall 57% increase in HIV incidence occurred in the region between just 2010 and 2015, with Russia accounting for over 80% of the region's infections recorded in 2015 alone.2 A large body of research indicates that high-risk sexual practices among MSM are common.3 Large proportions of MSM in the region exchange sex for money or valuables and use alcohol and other substances.4 Although overall HIV incidence rates vary across the region, there have been sharp increases in the number of MSM among recorded HIV cases diagnosed in many counties including Bulgaria, Czech Republic, Hungary, Poland, Romania, Slovakia and Slovenia as well as the post-Soviet republics of Belarus, Georgia, Azerbaijan, Kazakhstan …
Funding The preparation of this manuscript was supported by the US National Institutes of Health grants R01-HD085833, R01-MH098729 and 2P30-MH052776.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.