Self-identity

as a factor for low coverage of MSM in social work

a short overview of research results

1 Background of the study

Donetsk oblast (the east of Ukraine) is one of the most affected by HIV [1]. Although injecting drug users remain the most
vulnerable group, the epidemic process spread to the general population (for example, since 2004 each year ever-smaller
number of new infections through parenteral way has been recorded by the state AIDS service agencies, but number of new
infections through sexual way has been growing).

Among Ukrainian men who have sex with men (MSM),
HIV prevalence is becoming more and more remarkable: ac-
cording to results of the BSS, conducted by the Institute
of Sociology of the National Academy of Sciences of Ukraine
in 2009 (the report is in print), Donetsk, Odessa and Lviv
oblasts were found to be sad leaders: while HIV prevalence
among Ukrainian MSM is on average 9%, in these 3 regions
it is 19%.
Unfortunately, the importance of the MSM-part of HIV pre-
vention is underestimated by the public health authorities [2].
Several studies, conducted in Ukraine, showed that there
is a huge gap between the estimated and actually observed
numbers of MSM. For example, according to one report [3] a
conservative limit of the number of MSM in Ukraine is approx-
imately 1% of the male population between the ages 15–49,
which makes not less than 20,000 for Donetsk oblast (accord-
ing to government population statistics). However, the total
number of socially available MSM is only 2,000 people.
The situation is worse, because only one-third of this so-
cially available MSM is covered by existing services [4, 5], and
the main part of the HIV-prophylactical projects clients took
advantage of the offered services only once.
Thus, a systemic discrepancy can be observed between the
needs of MSM and existing approaches to mobilization of the
LGBT/MSM/WSW communities. As a consequence, there
is a high risk of the HIV epidemic spreading among MSM.

The research will study what factors, including behaviour and sexual identity of MSM from non-central cities of Donetsk
oblast, interfere with effective involvment of МSМ in HIV-prevention projects.

2 Methods
The research was mainly conducted with qualitative methods.

Focused depth interviews (focus group): 8 to 12 per-
sons, selected with some criteria, speak with each other and
with the moderator, who facilitates the conversation with pre-
determined topics; results were recorded onto audio-carriers
with the subsequent decoding. During the project five fo-
cus group sessions in the cities of the oblast were conducted:
Donetsk (2 groups), Mariupol (1), Gorlivka (1), Torez (1).
Each focus group session lasted for approximately 2 hours.
Depth interviews are necessary to include people who do
not wish «to be noticed» in focus groups and for those peo-
ple who are afraid to reveal intimate details of their lives. The
format of questions and their sequence are not set rigidly,
and realised with guide. The results of the interviews were
also recorded. All interviews were conducted only if the re-
spondent gave his consent. Twenty interviews were recorded.
Every interview’s duration was approximately 1 hour.

3 Results: the reasons for low coverage of MSM in social work

Our respondents pointed to importance of some of the factors that may hinder effective involvement of MSM in HIV services
in Donetsk oblast.

Geography. HIV-prevention programs that target the MSM
of Donetsk oblast until 2010 were implemented de facto only
in the oblast center (Donetsk) owing to the presence of LGBT
and MSM-service NGOs (the Donbas-SocProject and the
Health of the Nation).
To be able to use services of these organizations, their po-
tential client should, for once, know that these services are
available, and, secondly, live either close to or have enough
free time to travel there and back.
We found that only the respondents from Donetsk have a
more or less clear idea of the spectrum of HIV-service NGOs
that carry out prevention programs for MSM. Men from Mar-
iupol know little about the Health of the Nation, and it
is only because the organization does outreach preventive
raids. The respondents during in-depth interviews remem-
bered the Donbas-SocProject. The respondents from
Gorlivka and Torez agglomerations know little.
Regional media does not disseminate information about the
services provided by NGOs and the cost of advertising the or-
ganization’s services in the media significantly exceeds NGOs’
budget capabilities.
Of course, many MSM share such information personally,
by word-of-mouth means, from person to person. This way
of information dissemination has both positive (reached iso-
lated, concealed groups of potential clients), and negative
(other people are not engaged) sides. So the information

1
about services turns into a resource, possession and redistri-
bution of which can bring economic benefits or raise one’s the
social status (network effects [6]).
Thus, the information circulates only in the midst of «close
friends», and does not reach «alien» social groups, networks,
communities because different groups may not communicate
owing to identity differencies.
Another aspect of geographical factor is time. Distances
between Donetsk and other oblast’s cities or towns vary
from 5 to 130 km and people need from 20 minutes to 2 hours
to arrive in Donetsk (where the services are) by bus or train.
Pendulum migration both during the work week and the
work day is a significant factor in Donetsk oblast (from 7
to 10% of people go to work to another city). It also compli-
cates access of the personnel of prevention projects to their
audience since during the time of the day when the former are
working, the latter, their potential clients, are also occupied
at their jobs and after the work hours return to their homes
in small towns.
Although MSM-oriented HIV service has been started in
other oblast cities, such as Gorlivka (the Life Line) and Mar-
iupol (the Istok), it is yet too early to conclude that MSM
have unimpeded access to specific public health services.
Next question: what do you know about any non-
governmental organizations in Donetsk oblast
that work in HIV prevention, AIDS or. . . —
Nothing. — other male diseases. — Nothing. —
Thus, in general, in Enakieve, there are no pub-
lic, well, activities of which you know? — I don’t
know. Don’t! (I., 28 y. o., never married, lives
with parents, railway employee. Depth interview,
Enakieve [town near city of Gorlivka], 20.02.2010)
NGO’s «bad reputation». Activities of each public organi-
zation primarily are reflected in social consciousness of their
target group.
MSM are socially and economically heterogeneous. On the
one hand, there are people who have nothing to lose; on the
other there are socially advantaged men who fear losing their
status. Among social workers and permanent clients of the
organizations there are more people with low social status
(i. e. unemployed, alcohol-dependent, etc.). So, visiting an
organization seems to be stigmatizing, causing anxiety about
confidentiality for those MSM who are not open about their
homo- or bisexuality (i. e. married, those who have children,
and/or posture themselves as heterosexuals).
According to the study conducted in 2009 by GfK
Ukraine at the request of UNDP (the report is in print),
even those services for MSM that exist in large Ukrainian
cities, are de facto inaccessible because their provision in-
volves a high risk of disclosure of the person’s confiden-
tial information (e. g. because of absence a privacy policies
in NGOs). Unfortunately, these concerns were well grounded:
I want to describe to you a case that happened
with me on the 25th of September in 2009
in Donetsk with an employee of an MSM-project
of a charitable fund NN∗ .
Previously, I regularly attended trainings at
the NN, from time to time its director O.
with her co-workers would take photos of the
training’s sessions. In May, during a training ses-
sion, a photo, where another participant of the
∗
When citing internal documents and correspondence we remove personalized information.
2
training session was sitting on my laps, was taken
without my permission. I repeatedly asked the di-
rector to remove this photo and received a reply
that it had been deleted.
After some time the project employee A. told
me that he had a compromising material and re-
minded me of the photos. After our conversation
I turned to O. again and received the answer that
the photo had long been removed.
On the 25th of September, 2009 I was walk-
ing with my loved one, when (approximately at
19.00) I met the director and her drunk staff
members. They were returning from a work
meeting, which runs on Fridays. We decided
to sit on the bench to continue the started di-
alogue. In the course of the conversation A.
began showing pictures that were in his mo-
bile phone. Among the photos was that one
that I had repeatedly asked to remove. It was
done with malice and all the details were re-
vealed to my boyfriend. . . (Au., from a com-
plaint letter to the senior management of Inter-
national HIV/AIDS Alliance in Ukraine
with a copy to the Gay-Forum of Ukraine,
28.09.2009)
The donor promptly conducted an investigation into the
incident and took necessary measures. But for our study, the
incident perfectly illustrates a very personal character of the
ties between clients and social workers in MSM-service NGOs:
on the one hand, the man complains about breach of confi-
dentiality, «drunk social workers»; on the other — he did not
see anything wrong in «to sit on the bench and continue the
started dialogue». Both clients and personnel of the projects
view mutual relations rather in terms of family than in terms
of vendor–customer.
Personal relations between NGO workers and clients lead
to the formation of a sustainable circle of people. In this com-
munity distribution of benefits (e. g., condoms, lubricants,
participation in training) functions rather through personal
connections than developed policies and procedures.
«Bad reputation» is not only incidences like that, but what
we would call a symbolic disparity field, in which an NGO op-
erates, and symbolic fields of their potential clients.
For example, people, even those MSM who live in the oblast
centre and work in HIV service, demonstrated negative re-
actions when we proposed to assess a very colorful (anime
styled) gay-booklet of the Gay Alliance of Ukraine, as
well as to imagine themselves coming-out.
I wouldn’t have taken it then and I wouldn’t
now. . . I would not put in an open place because
«how?», «what for?», «gotcha, so you’re the
same» [. . . ] everybody will see it and start ask-
ing a lot of questions. And if it were somehow
neutral — «A guide to safer sex», i. e. for all
people. . . I would put the book out like all people
do. . . like encyclopedias are there, medical liter-
ature, any. [. . . ] The word «gay» is a taboo just
like AIDS. They say it is O. K. in the society . . .
It is being discussed on television, in the printed
media. But in reality. . . (N., 28 y. o., graduated,
never married, worker. Depth interview, Gorlivka,
08.12.2009).
 Our respondents think that being gay is being womanlike,
a strumpet. This is unacceptable for ordinary men, potential
clients, because of existing a dual gender standard in the sys-
tem of hegemonic masculinity [7, 8]: a man has more rights
than a woman. So being feminine is to restrict oneself, to
become less privileged.
Even if an NGO has a confidentiality policy, «the circle of
friends» (i. e. very personal relations between the personnel
and the clients) based on similar quasi-feminine gay-identity
seems uncomfortable to many potential clients.
«Bad reputation» is of immaterial nature and harms the
effectiveness of ongoing prevention projects.
Inconsistency between the list of services provided by an
NGOs and the list of clients’ needs. Typically, there is a
standard set of services: condoms, lubricants, some brochures
and booklets, group meetings and so on. We can assume that
the majority of MSM do not need such services as, for exam-
ple, they can buy condoms.
International HIV/AIDS Alliance in Ukraine
regularly includes a block to study needs in every biennial
monitoring of MSM behaviour. So, the latest monitoring in
2009 (2 300 men from 14 regional centers in Ukraine, includ-
ing 200 men from Donetsk) showed the following hierarchy
of importance of services:
1. group meetings for LGBT (64%);
2. community centres for LGBT (58%);
3. free of charge testing for STDs (47%);
4. free of charge testing for HIV (44%);
5. psychological consultations (37%).
The joint German-Ukrainian project «Network» also stud-
ied needs of MSM clients:
1. free of charge condoms and lubricants (84%);
2. group meetings, trainings, cultural events, and educa-
tional literature for LGBT (50%);
of the LGBT community (community centers, trainings, cul-
tural events and so on), are also valuable for more than a half
of the respondents.
Do they really help there? What do you think?
What kind of help do they offer? You participate
in trainings, receive condoms. That’s good! Any-
thing else? — Information. About AIDS, also in
relations between men. Psychologists also work
there. That’s good, I think, that such organiza-
tions exist. — Do you trust them? — Of course
(M., 28 y. o., undergaduate, never married, lives
with his male partner, worker. Depth interview,
Donetsk, 13.11.2009).
Even people from small towns need these services:
The activities of such organizations, in your opin-
ion, you would say are. . . ? — Noble. They’ll
give out condoms, and lubricants, and litera-
ture, hold meetings there (Focus group, Mari-
upol, 22.11.2009).
You see, there is one single problem — lack of
info. The information on this topic is very scarce.
If such organizations, yeah? HIV, anti-AIDS cre-
ated their own blogs, extensive blogs, and put
them online, where would be detailed informa-
tion on AIDS, so that a young man or a young
woman could go there and find everything, an-
swers to absolutely all of their questions. It would
be so great! For once, such blogs could be used
by other organizations, such as the one I am work-
ing for. So that a person could just hit a key on
the keyboard and get all the information. Plus
the people who work there could provide for tests,
and condoms, and lubricants, and all. But it is
necessary to want it. When there is no desire,
nothing will be happen (S., 42 y. o., undergrad-
uate, never married, lives with parents, worker.
Depth interview, Shakhtiorsk, 13.12.2009).

3. a list of contacts of gay-friendly professionals (40%).
As one can see, free of charge condoms and lubricant
(they are from the basic package of services) are most pop-
ular. Need to be and to communicate with other members
So, there is not an inconsistency between the services list
and the list of clients needs: MSM have a great desire to
receive services and information, to receive it in a special-
ized organizations. But visiting the organization may cause
discomfort or fear.

In general, we would like to say, that there are two groups of reasons for low coverage and low effectiveness of HIV-services
for MSM:

• Economic and geographical. Services should be located close to potencial clients.

Increase in coverage of MSM with prevention services can be achieved by expanding local services and the main obstacle
is lack of local resources. However, this may be partly compensated by mobilization of local communities, increase in
numbers of active LGBT organizations and initiative groups, and by their efforts in the direction of attracting third-party
funding and lobbying the needs of the LGBT community in the local government.

• Social and psychological. Services and projects should neither be the cause of exclusion, fear, nor be perceived as
stigmatizing.
Unfortunately, the NGOs often do not realize that they face a difficult choice. On the one hand, projects and programs
should not maintain the gender system that discriminates against women and gay men. On the other hand, the conflict
with the system of hegemonic masculinity leads to exclusion a big portion of MSM from HIV prophylaxis. Thus,
HIV-NGO’s and their donors have (1) to diversify services for different groups of MSM; (2) to develop and implement
policies and procedures such as strong confidentiality, regulations to relationships between clients and the personnel
and so on.

3
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How to cite this document:

Kasianczuk, M.; Ponomaryov, S. (2010). Self-identity as a factor for low coverage of MSM in social work: a short overview of
research results. Donetsk: Donbas-SocProject.

4
 Donbas-SocProject

We unites scientists and teachers, as well as NGO workers
and volunteers, whose activities are oriented at the LGBT.
Our mission is to promote LGBT studies in the Ukrainian sci-
ence and to introduce established facts into everyday practice
of social LGBT-oriented activities of both governmental and
non-governmental organisations.
Our fundamental principles are tolerance to diversity, anti-
fascism and academic integrity.
Our activity conforms to The Code of the Sociologist’s Pro-
fessional Ethics, approved by the V Congress of Ukrainian
Sociological Association http://www.sau.kiev.ua/codex.
html
We work in Donetsk and Luhansk oblasts (the east
of Ukraine), as well as in the city of Kiev.
Our non-governmental organization was registered by
the Chief Justice’s office in Donetsk oblast, 18 May 2007,
as a non-profit and non-political institution.

Research is supported by amfAR, The Foundation for AIDS Research

Non-governmental organization «Donbas-SocProject», amfAR, The Foundation for AIDS Research,

http://donbas-socproject.blogspot.com http://www.amfar.org
+3 8099 346-00-34 +1 212 806-16-31
kasianczuk@rambler.ru msm.awards@amfar.org

Text: Max Kasianczuk, Serhiy Ponomaryov

Typographical layout: Aleck Ostapenko
Donetsk, 2010