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General information about HIV epidemics in Armenia
The registration of HIV cases in Armenia started in 1988. Overall, as of 31 July, 2019 3,583 HIV cases had been registered in the country among citizens of Armenia with 429 new cases of HIV infection registered in 2018.

Males constitute a major part (69%) in the total number of HIV cases. Of all the people living with HIV, slightly more than half (51%) was in the age group of 25–39 at the time of HIV diagnosis. The main modes of HIV transmission are through heterosexual contacts (72%) and injecting drug use (20%), followed by male-to-male sex, accounting for 4.4% of all registered cases.

Globally, gay men and other men who have sex with men (MSM) accounted for 19% of new infections in 2017.

In the Eastern Europe and Central Asia region gay men and other MSM accounted for about 20% of new infections in 2017.

MSM remain one of the KP groups most at risk for HIV in East Europe and Central Asia (EECA) region, where HIV prevalence among MSM is high (Ukraine — 7.5%, Georgia (Tbilisi) — 21.5%, Moldova (Chisinau) — 9%, Russian Federation — 7.1% for Moscow and 22.8% for Saint Petersburg).

HIV Prevention among MSM and trans people in Armenia
The most recent MSM and trans population size estimation exercise for the country states that there are 16,100 MSM and 150 trans people in Armenia.

The latest IBBS (2018), conducted in 3 major cities of the country (Yerevan, Gyumri and Vanadzor) came up with aggregated HIV prevalence among MSM of 1.9% (2.7% in capital city of Yerevan), which is lower than HIV prevalence among MSM in other countries of the region. Moreover, while HIV prevalence among MSM has steadily increased in all countries of EECA, it has been relatively stable among MSM in Armenia (2.5% in 2012 to 2.7% in 2016). HIV prevalence among trans people in Armenia was at 2%.



Risky sexual behavior is frequent among MSM in Armenia. According to the IBBS 2018 condom use was inconsistent, with 25% in Gyumri (2nd largest city in Armenia) and 71% in Yerevan, reporting using a condom during their last anal penetrative sex with a male. Overall, MSM had moderate (48%) knowledge of HIV/AIDS, roughly half of MSM were not aware of the risks associated with HIV infection. Overall, 97% of trans people, participating in the study, reported using a condom during their last anal penetrative sex with a male.

More than half of MSM knew where to get an HIV test and had been tested for HIV at some point in life. About 90% of MSM in Yerevan reported having an HIV test within the last 12 months and knowing their status, whereas in other cities of the survey this number is significantly lower (40% and 57%). High stigma and discrimination existing among general population and health care workers may prevent MSM from accessing testing services (Ibid). According to the results of the study on the attitude to LGBT people among key social service providers in five countries of Central and Eastern Europe and Central Asia, the degree of alienation towards LGBT people in Armenia is below average social workers and above average among health care providers. Only 48% of health care providers and 67% of social workers surveyed in this study in Armenia believed that homosexuality was acceptable in the society.

Since 2003 the GFATM is the major donor of HIV prevention work in Armenia. In the frames of the current grant (2019-2021) HIV prevention interventions for MSM are conducted in three project sites: Yerevan, Gyumri and Vanadzor cities. The minimum package of provided preventive services includes peer education, condom distribution, HIV testing and counseling. Additionally (expanded package of services), information materials/booklets, lubricants and information on availability of PrEP and PEP at National Center for AIDS Prevention are being distributed, as well as STI testing and treatment is offered to project beneficiaries. Legal counseling services are also made available on the basis of NGO. Similar minimal and expanded package of services are being provided to trans people, recognized as key population to work within the current grant. In addition, services of endocrinologist are mentioned in the expanded package of services for trans people, to be provided with the funds of the implementing NGO.

The coverage of MSM with HIV prevention services remains low (39%) in Armenia. Most MSM respondents in IBBS of 2018 reported not being reached by HIV prevention activities. This finding highlights the need to prioritize the development and implementation of effective interventions tailored to meet the needs of MSM5. According to a study of internal homophobia in EECA countries, low willingness of MSM to use HIV services is associated with a high level of internal homophobia. Greater acceptance of homosexuality is associated with more regular HIV testing and greater coverage by all prevention services. Thus, the package of services should include the work of community centers, work with mental health, overcoming internal homophobia and associated depression and the use of psychoactive substances.

Strategic Information
Strategic information is the basis of better planning and tailoring effective HIV prevention interventions. Solid evidence and reliable data are of key importance for strategic planning and budgeting of national response to HIV among MSM in the country. IBBS is conducted in Armenia on biennial basis. The most recent IBBS among KPs in Yerevan, Gyumri and Vanadzor, Armenia was conducted in 2018. For the first time, it also included transgender population. The latest PSE of MSM and transgender population was also carried out in 2018. To address some of the issues of previous IBBS, such as difficulties reaching hidden MSM groups, inadequate involvement of LGBT community in the process of survey planning and implementation, community –based NGOs were invited to conduct the field work. Consensus between state institutions and CSOs with regards to accepting and approving the survey results was reached. The quality of strategic information has improved significantly, mainly due to the fact that IBBS and size estimation study was first conducted among trans people in Armenia.

Major reports on a number of studies conducted, including IBBS and HIV surveillance reports are available both in Armenian and in English on the website of the National Center for AIDS Prevention.

The Role of Communities in HIV response
Community-based and -led organizations are the driving force of the global HIV response. They have led the development of effective HIV prevention programs and design and implementation of innovative approaches in programs for MSM and trans populations worldwide. Scale-up of service coverage, better retention in care, quality monitoring, human rights advocacy, and fighting stigma and discrimination, require united community voice and meaningful community engagement.

In general, the country has seen an increase in the participation of LGBT people in decision-making processes regarding HIV infection. A number of MSM-led organizations in Armenia are actively engaged in national HIV response. One grassroots MSM NGO currently provides HIV prevention services to MSM in Armenia in the frames of the GFATM grant. Several community-based MSM organizations are involved in advocacy and human rights protection issues. Advocacy activities are implemented within the framework of different projects funded by international donors. Community members recognize the need of strengthening their advocacy skills for better advocacy for the needs of MSM in the country. Transgender community is also represented by a number of NGOs, working in the field. All organizations need regular organizational capacity building and development. LGBT communities in Armenia are getting increasingly involved in the process of survey planning, implementation, analysis and interpretation due to improved communication with state institutions. Yet, continuous strengthening of analytical and research capacity is needed for the communities to be able to meaningfully engage at all stages of HIV strategic research.

MSM and trans communities in Armenia are not included in Country Coordination Mechanism of the country, as the main coordination body for the HIV/AIDS work carried out in Armenia. Recently, thanks to the joint community initiative of MSM, other KPs and CSOs in the country and with the technical assistance from GFATM Community, Rights and Gender Department, a Meaningful Community Engagement Plan was developed by country stakeholders with roles/responsibilities and timelines outlined. The implementation of the Plan with the community participation in HIV decision-making processes is key to successful and smooth transition of the country from external to domestic funding.