Assessment of strategic information on men who have sex with men and trans people in Estonia

The first HIV case in Estonia was diagnosed in 1988, and since then a total of 9,711 (as of December 31, 2017). The rate of newly diagnosed cases of HIV has decreased over the last decade (from 46.0 cases per 100,000 in 2005 to 16.6 cases in 2017), but it has been quite stable in the last few years (20,6 cases per 100,000 in 2015 and 17.4 cases in 2016). Hetero- and homosexual transmission has increased as well as the proportion of cases among people older than 34 years (1, 2).

Men who have sex with men (MSM) have been identified as the group most at risk of HIV infection in the European Union (EU) / European Economic Association (EEA). 2016 HIV surveillance data from EU/EEA countries indicates that sex between men accounted for the largest proportion of cases diagnosed in 2016 – 40%. MSM accounted for 44% of new HIV cases in Finland, 36% in Sweden, 74% in Poland (3). Increasing of HIV prevalence among MSM is commonly observed trend in Baltic states (Latvia – 7.8%; Lithuania – 5.9%)(4).

The HIV prevalence among MSM is also reported in Eastern Europe and Central Asia: Ukraine – 8.5%; Georgia – 20.7%; Moldova – 9%; Russian Federation – 7.1% (Moscow) and 22.8% (St. Petersburg) (4). In Estonia, it is estimated that HIV prevalence among MSM is 2–3% (5). High rates of regional migration (e. g. 10,470 people immigrated to Estonia and 5,440 emigrated from Estonia in 2017) (6) and regional trans-border tourism (every year, approximately three million foreign tourists with accommodation and over three 5 million one day visitors travel to Estonia) can increase numbers of HIV and STI cases in Estonia.

Although MSM are recognized as a key population (KP) in most national HIV programs in the region, including Estonia (7), national budgets allocate little to no resources to HIV interventions that target MSM (there are no recognition of trans people as a KP). In most Central and Eastern Europe and Central Asia countries (CEECA), there are only a few HIV
prevention services targeting MSM. These services are primarily available in major urban areas and are mainly funded by international donors, particularly the Global Fund to fight AIDS, TB and Malaria (GFATM) (8).

The situation with respect to trans people and HIV in all CEECA countries is even more concerning. There is virtually no data on the HIV epidemic among this group in the region. Though globally recognized as a KP in the HIV response, trans people are not included, separately or as a part of other KP, in national HIV/AIDS programs in CEECA.

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by Dr. Kristi Rüütel PhD, Dr. Sergo Chikhladze PhD, Dr. Maksym Kasianzcuk PhD
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