1. Responsible and safer places where men have sex with men.… Everywhere A European Methodological Model of HIV Prevention in Men who have Sex with Men (MSM): RUBSI Dr Constantinos N Phellas Brighton, 16 th September 2009

2. RUBSI Contents 1.Background Information 2.Data Collection & Analysis: Report No 1: Period 1st April 2008 (start of the project) to June 30th (2009) Report No 2: Period 1 st July to 31 st Dec 2009 3.Conclusion 4.Future Directions/Evaluation

3. RUBSI Info (1/4) Background Information – Research Unit in Behaviour & Social Issues – NGO/Charity Registered – University of Nicosia

4. RUBSI Info (2/4) – Main Roles: The conduct of research on the psycho-social aspects of public health. The support of the relevant government departments, organizations and bodies in general, with the conduct of assigned studies and research projects for the investigation of sociological issues, health problems and political – social phenomena.

5. RUBSI Info (3/4) Public Health Programmes – Main activities: Sexual behaviour Immigrants Ageing Abortion Health issues concerning large population groups (Diabetes Mellitus, HIV/ΑIDS, Cancer, Thalassemia etc.) Organ Donation and transplants Groups of population with special needs (vision problems, mobility disabilities etc.)

6. RUBSI Reports Report No 1: Period 1 st April 2008 to 30 th June 2009: – Interviews Governmental & Non-governmental Officials MSM (four interviews) HIV MSM (four interviews) Preliminary discussions (four in total) with the business sector

7. RUBSI Data Reports Preliminary Findings: – Cyprus remains a country with a low prevalence of HIV, that is estimated to be about 0,1%. A total of 547 cases of HIV have been diagnosed from the beginning of the epidemic until 2007.

8. RUBSI Data collection The Ministry of Health of the Republic of Cyprus however has identified seven specific risk factors that may lead to an increase of the incidence of HIV in the island*: ”Difficult to reach populations, such as MSM, who have accounted for almost half of all known cases of HIV infection until now Increasing trafficking and use of drugs Recent emergence of minority groups with their own characteristics and problems Settling in Cyprus of seropositive people from countries with high prevalence

9. RUBSI Data collection Increasing proportion of resident seropositives who state Cyprus as the most likely country of infection Intensive population movements to and from Cyprus Increasing movement of population through the separation line, considered to be an important risk factor for both communities, because of the impossibility to monitor and control risky sexual behaviour and drug use.”

10. RUBSI Data collection MSM living with HIV whom we talked to shared with us the extreme difficulty they face on a daily basis, most crucially the fear of facing rejection if their HIV status were to be discovered by other people A great need for social and psychological support for People Living with HIV/AIDS

11. RUBSI Data collection In line with UNAIDS guidelines on prevention, there is an obvious need to also develop targeted campaigns that reach specific vulnerable groups, including MSM (who represent almost half of all diagnosed cases of HIV), injecting drug users, commercial sex workers, and migrants Local Cypriot NGOs, to the extent that they are able to effectively reach and to mobilize members of these vulnerable groups, clearly have a strategic role to play in implementing both targeted prevention projects as well as support projects for people living with HIV/AIDS

12. RUBSI Data collection It is one of the countries with a high proportions of cases attributable to homosexual transmission in the total reported HIV cases (estimated by the authors to be about 57%). It is one of the countries where no prevalence data of HIV among MSM is know due to lack of research. Finaly, there is only llimited information about prevention activities eventually taking place among MSM

13. RUBSI Report No 2 Period 1 st July to 30 th Dec 2009 – Qualitative Interviews MSM (eight) HIV MSM (eight) – Quantitative Preparation of a questionnaire exploring social & psychological needs of HIV MSM Distribution of the questionnaire to 50 MSM – Data Analysis – Writing up of the report Contact four to five businesses

14. RUBSI 3. Conclusion (1/3) The experts we met in Cyprus confirmed indeed that very little specific prevention and support activities in relation to HIV were taking place among men who have sex with men. This is obviously very regrettable as MSM do represent a very large proportion of positive HIV diagnoses. Targeted outreach activities have been well documented worldwide as playing an important role to reduce the number of new infections (by promoting the use of condoms and of lubricants). Such campaigns can also encourage gay men to get tested more often for HIV and other sexually transmitted infections. This enable earlier access to life-saving antiretroviral treatments which obviously has tremendous benefits.

15. RUBSI 3. Conclusion (2/3) For the majority of the respondents identity did not seem to have crystallized around their sexuality so as to render sexual identity a primary identity dimension They appeared to have accepted that constructing an all-embracing gay lifestyle might not be feasible for them without abandoning or at least challenging and unsettling their family and cultural contexts

16. RUBSI 3. Conclusion (3/3) Rather than defining themselves primarily in terms of sexual identity, they chose to see themselves in terms of other personal relationships with their families, their peers at work and with other members of their community. What came across clearly in the interviews was the men’s fear of becoming outcasts in their own cultural community Revisiting the term MSM

17. RUBSI Post-evaluation of the EVERYWHERE Project – Short-term – Long-term Future Directions – Special Groups of MSM Immigrants Prisons Elderly

18. RUBSI Thank you for your attention Contact Details phellasc@rubsi.org info@rubsi.org