 Hello, my name is Peter Szaroszy, I'm the Director of the Rights Reporter Foundation and the editor of the Drug Reporter website and we are sitting here at the Global Village of the International AIDS Conference in Amsterdam and today I have two guest speakers, Ferenc Bajinsky, who is from the 8th Action Europe and Tomasz Berecki, who is from Eupati, PM Patients Academy for Therapeutic Innovation. Therapeutic innovations, both of them have been working in LGBT and HIV activism for quite a while, so today we will be discussing what are the gaps in HIV awareness in the LGBT movement and how to bridge these gaps. First of all, I would like to ask you, Fery, about your presentation you delivered yesterday here at the conference about low prevalence countries, so-called low prevalence countries in the eastern, central and southern part of Europe, where HIV rates are traditionally lower than in other parts of Europe, but yesterday you were speaking about the change in the situation, that this situation is now rapidly changing. Can you tell us about that? Yes, so in the central European and south-east European countries we see the total numbers are really low, that's why it's low prevalence, everyone is happy, everyone thinks it's a lucky situation and they are doing nothing about it, but at the same time what we see that in the last 10 years there has been a 300% increase in new infections among gay men and other MSM and we have no real data about sex workers, we don't have real data about transgender people, IDUs, et cetera, et cetera, so it's an alarming situation and yesterday I had a chance to speak at the panel which was, the health commissioner was there from the European Union, some ministries of health or deputy ministers and it was kind of celebrating that Europe is going in the right direction, we are reaching the 1990-90 targets and if you look at the European Union data, it is actually very close to the 90s, in the high 80s or even over 90, but if you break it down to individual countries then you will see that in Hungary, for instance we have very bad data, the ministry reported almost 90% of people being tested and then 45% being on antiretroviral, at the same time the country has a test and treat policy, so what is happening in between? The data is bad, the presentation of the data is even worse because it's clearly leaving some regions behind, so I almost said yesterday that Central Europe is the Eastern Europe of the European Union because it's just nobody cares, there is no funding, national governments, you know more about that, that they have spent zero on prevention and services for key populations in Hungary for years now, international donors are not there because they think that the European Union is doing their job, giving money to civil society and building capacities, but the truth is that just to apply for a grant from the European Union, you either have to be promoted by your national government, which is not happening in most of the countries, because governments like to work with easy civil society, we're not advocating for rights of people, or even if you can apply for a project, you don't have the capacity for the administration etc, it's a nightmare to administer a European Union project, so the last man standing was actually the OSF, the Soros Foundation, but you know we don't have to talk much about what kind of attack is and demonizing of the Soros Foundation, not just in Hungary, but also in Macedonia and other countries, so that was the feedback was that it was really a timely call and we need to do something, make sure that not only the big countries and some luckier countries like Slovenia, Slovenia is very active, they have most of the projects in place or starting, even local governments are supporting people living with HIV with projects, yeah it was a timely call that we really have to look into it and make sure that even in those countries where the government is inactive or actively blocking HIV related work, that we can make sure that civil society and communities can be involved in these projects and learn via networking from each other. Can you talk more about this, that you said that the data we have are not reliable, so is it because the governments are like playing or manipulating this data, making some cosmetics of the data, or is it because of the data collection system doesn't work well? I'm not sure about the data collection system, is there a national epidemiology center any longer or not? So it's, you know, the national epidemiology center I think was one of the technical institutions who sometimes made statements that were not in favor of the government, so they basically shut them down, integrated them under the ministry so they don't have the freedom to speak about things. What I think about the data is that there is this doubly monitoring going on which is organized by the ECDC and national governments are required to report, I think, annually or by annually. In the past, it was a requirement that national governments included civil society in the reporting. Now it's a recommendation, so what is happening in some of the countries, including Hungary, civil society is not part of the report, it is done by the ministry and I think they have no idea what they are doing. For instance, it's from 2015 to 2016, there has been a change in the reporting and they are reporting that Hungary is providing free of charge antiretrovirals for undocumented migrants. I think they didn't understand the question, that's the problem. So, and there is no control. You can talk to ECDC and they will say that, sorry, this is the data we have to work with because that's what your national government is reporting. So there is real need for shadow reporting via other channels because otherwise this data is just useless and really making a forced picture of the countries. So, from the existing data we have, we can conclude that this epidemic is largely driven, at least in these countries, by infections among men who have sex with men. So, is this issue addressed within the LGBT movement in these countries? Do they speak openly about this issue? Do they do something to respond to this epidemic? No. And to some extent, yes. So, there's also, I think that there has been some change happening now in the recent, literally in the recent weeks or months. But traditionally, Hungarian LGBT organizations, and I will not include the queue very consciously because I don't think that these organizations are queer. I think that they are LGBT organizations or even more just LG organizations and bisexual and trans communities and intersex people are completely invisible, not just in Hungary in our region. This is a traditional problem. So, they do not engage so much in HIV related or even comorbidities related work. And this is, actually this is a historical tradition which dates back to the debates that happened in this community many years ago, also in the West. You know that there is this association of stigma and discrimination with HIV and with being MSM or being gay or lesbian for that matter, but let's concentrate on gay people now. So, one argument says that you should not associate HIV with being gay or with a gay identity because that will reinforce stigma. While we say, especially we people living with HIV that in a region where 80% of people living with HIV are MSM, are men having sex with other men, it is the issue of the gay community. It is a problem that the gay community must deal with because HIV decimates our community. So, if I say that HIV is not part of the gay community, then that is what reinforces stigma. That is, I mean, it's exactly the other way around in our opinion, because this sends the message that I, as a gay man living with HIV, I am not part of the gay community. I'm also excluded by my own people. So, I think this is where I feel excluded by my own people. So, I think that this is a misguided strategy. But I also have the impression now that there is some change, some fresh air coming into this. And you know, let's face it, as Ferent says, this is also a funding issue. So, and unfortunately, which goes together with the whole crisis of civil society in our region, also gay organizations or LGBT organizations will go in the direction where the money flows. So, if there's no money in HIV prevention, they will not do HIV prevention, often which is said. So, it's not like I support this practice. So, I think that you should first choose your priorities and then find funding for that instead of finding funding and then do whatever there's funding for. So, but still, I can see some rudimental change starting or emerging in this field. Like, for example, the largest LGBT organization in Hungary, Hatir, is starting their PREP project now, which I think is tremendously good and very timely, even a bit late. But it's I mean, it's good that it's happening. Can you explain what PREP is? Oh, yes, sure. I mean, PREP is pre-exposure prophylaxis, which is a pill that currently one pill. And there are also clinical trials going on about other compounds. But it's one particular pill that you take on a regular basis and that prevents that you get infected by HIV. Now, this is tremendously important and valuable because this means that on the one hand, if I as a person living with HIV, if I take my treatment, we know now, since yesterday, when the latest results of the Partner 2 study came out, that it's practically absolutely certain that if I take my medicine, I do not infect other people. So I can have unprotected condomless sex, and I will not transmit the virus. Now, on the other hand, if a person not living with HIV takes PREP, takes prevention, the prevention pill, then he or she cannot contract HIV. So this means that we have every tool and we have the right scientific evidence to stop the epidemic. Now it's only the political will and the cooperation of all stakeholders that is necessary to really stop the epidemic. So it's not the science is done. Does that answer your question? Good. So what would you answer to those people who say that, you know, this is now not maybe not the most priority issue. We have other things to spend money on. It's too expensive to pay for PREP for people. So what would you say to that? What do you say? PREP is not expensive. You can buy generic PREP, which is as effective as the as the original one, the branded one. I think it's also very important to say that if you're having sex by using a condom or you are on treatment, which is virus suppress treatment, or you're taking PREP, this is all free, it's protected sex. So we should move out the, you know, if you take up the condom, there's this concept that it's unprotective. No, it's protective because you are on treatment. It's because you are on PREP, etc. I don't have a good answer for why should we spend money here and not there. I think that we should all, regardless of we are working on HIV issues or LGBT issues or drug user issues, or other social issues, we should join together and together demand more funding for these issues because, you know, if you just fund here, but not there, then it's not going to get there where we want to go. You know, you can, you can address women issues and then leave everyone else behind or you can address gay issues and then leave other people behind. It's not the solution. We all together, I think it is really high time that people who are working on social issues and advocating for the rights of people and communities is to sit down together, have our conversation, and then, you know, come up with a joint advocacy and joint plan on, we are doing our job, but, but we are not, you know, seeing each other as a competition, that would be important. I think that there's, I have two points to make here. One is, look around, look around here. I mean, if you look around here, if you look at this incredible buzz that's going on, which is actually typical for every AIDS conference, but this is also this time, somehow it's, I mean, it's very impressive to see how many people, how many different communities are represented. And what binds us together here is accidentally HIV. But in fact, it's, because many of us actually live with HIV, but in fact, it is, it's by accident. And it just shows that there's much more than that, that what we have in common. So yes, we hear, we often hear this criticism about identity politics and, you know, the of the over emphasis of human rights and what about class and, you know, class issues and whatever. But if you look around here and also because HIV is biological, it's something that I carry in my body. I live together with another entity. So it's absolutely biological and it defines, it does define my position in society. So why not use this opportunity, as Ferri says, for working together, for finding those common avenues where we can reduce or through which we can reduce inequalities in health, but also in society in general. And the other point I want to make about this is why do we accept this, this notion that health care is a zero sum game? So that if I finance prep, then you will not be able to finance oncology. Or if you finance cancer cure or cancer treatment, then there's no more money left for multiple sclerosis. Why? That's, I mean, that's absolute nonsense. And also, why do we accept it for granted that HIV treatment and HIV prevention should be from the same pot? Why? I mean, it's not even, it's not even treatment. If you don't live with HIV or not, I mean, you're not infected with HIV, and you want to prevent that you're infected with HIV. Why is that HIV treatment? It's not. It's a different thing. So let's start, let's, you know, let's handle these things separately. And, and thereby, we can also take a completely new approach to prevention and health care concerning HIV. It is one other issue which is widely discussed now in the harm reduction community. I wanted to ask you about that. It's, and it's cam sex. And we don't really have much data about it as far as I know. But do you have like any information about how widely spread this phenomenon is in our countries, in our region, in Central Eastern Europe, and how much it contributes to this large increase in the rates of HIV among men who have sex with men? It's only partly true that we don't have data because data are coming out now from the, from the EMIS and the ECHOs studies, which was conducted over the last one and a half years. And the first results were presented the day before yesterday here at this conference. Now the first data will be published. EMIS is actually a major internet based survey of the health of men having sex with men across Europe, everywhere in all countries of Europe, which was conducted in 30 languages over a period of, I think, eight months so that data collection was really massive. 140,000 people completed the questionnaire, and it's a massive effort to analyze these data. And a large chunk of the questionnaire was concerned with substance use and sex and the, and the confluence of substance use and sex or cam sex as you, as you, as you rightly call it. So these data will come out and then we will see what the extent of this, of this is. But let me tell you this. I think that, and I say this also as a former substance user and I've been involved in the cam sex scene for a long time, I was involved in the cam sex scene for a long time. I think we're still do not acknowledge the importance of this. We still do as if this wasn't an, an, an issue while it is an issue, especially in our region where drugs have become very cheap, very easy to access and gay sex has always been there. So it's, you know, and, and we know that sex is good, drugs can be fun. Sex and drugs can also be fun to a certain point and then it destroys you. So I think that, so it's partly true. Yes, we don't have data, but data are coming, coming now. And I think that we underestimate the importance of this issue. Yeah. And just to add to this, the, I think that we don't have so much data from Hungary on cam sex compared to the Netherlands or even Germany is because drugs are illegal. Drug use is criminalized. This is also make it difficult to have any harm reduction programs because, you know, if something is happening and they in a cam sex scene, who do you call? Do you call the ambulance and, you know, or, and then there is this threat of being criminalized and when put into prison or whatever, paying a fine. I think that we really have to, when it comes to cam sex, that the LGBT, HIV and drug user movement has to work on it together because drug user movement have been advocating for the decriminalization of drug use. And if you decriminalize something, it immediately reduces the vulnerabilities of the people who are in that action. Because I think that we are not vulnerable. We are not vulnerable as gay men or sex workers and some of the most fierce people are sex workers who are around here. What, what creates vulnerabilities is the legal systems and the discriminating policies. And this is the thing that I was talking about working together and, you know, instead of doing our things in silos, we should, we should join forces and, and work together on creating safe, legal environments where harms can be reduced just by, just by having the right policies and having all these harm reduction services and, and tools that we were talking about, prep, treatment espionage, needle and syringe exchange programs, available and legal. Can I, can I, can I add one more thing to this, which is, again, typical for the whole region and not just Hungary. Maybe not so much in Slovenia and, and you're right, they have been doing some excellent work. But, you know, I had, I had several meetings with harm reductionists in, in Hungary. People working in traditional harm reduction. And I was lecturing about chem sex and what it means for, for the individual, what it means for the, for the gay community, also for the lesbian communities, by the way. And, and what I found was that these organizations are so stretched. They are in such a difficult situation right now that they don't even know what to do with traditional substance use. So it's just that they lack the capacity to understand and work properly in something as new and, and unconventional as chem sex would be. So we need to do a lot of groundwork also with harm reduction organizations to, to make them understand what the patterns are, what chem sex actually entails. So what it, what it means, because it's a completely different pattern of substance use from what they, what they usually work with and what interventions make sense. And then only then can we start thinking about how you organize those interventions. That's, that's, that's the next step. So we are even behind that first step that, that, that ferry was talking about. So before finishing our conversation, do you have any other highlights from this conference about gaps and how to bridge them or any message you will take back home from this conference? Why are there so many, so, so, so few people, sorry, from our region? You know, this is, this is, this is really painful. Like, I know that one doctor from Hungary is here because I've, I heard that he's here, but I haven't met him. And it's just why are there so, why it's, it's, it's really time that we, that we, that we start taking this seriously as also very pointed out. The numbers are terrible and, and the, and the attention is not, is not there. So that's, I mean, one of the biggest highlights for me is that we came here, we were waiting for this conference to happen in Europe for so many years. It's happening in Europe and I don't see the benefit for our region. That's, that's my biggest pain and also my biggest point. For me, one of the highlights was that I attended the Beyond Blame conference. It was a before the, before the actual IAS conference. It was addressing the issue of HIV criminalization, criminalization of HIV exposure. So if you expose someone to HIV in some countries, you end up in prison. You don't disclose your status. And although you are taking all the, that we were talking about, you are on treatment and not infectious, or you're using a condom and still you can be charged with, with, with penalty. That was, that was a very interesting and very energizing conference. We heard personal stories of people who have been incarcerated and they are still wearing the homosexual offender on their driving license because in the U.S. they put it on their driving license so the police can see already that you have been, and what happened to him, he was having a monogamous relationship with someone and because of exposure, he ended up in prison. Also the outcome of this, of this meeting was that we really have to stop working in silos. And even when, and of course what Tamash was saying is completely right. Most of the organizations because of the shrinking space, we are moving where the funding is coming from. So we are writing our applications according to the call instead of writing an application according to what we want to do. But even in this application writing, we can be more creative and put in more intersectional things so that, that fits the call, but we are still doing what we want to do. Thank you so much, Tamash Berezki and Ferens Balinski for being with us today. And thank you for those who are watching us from home. I hope we gave you a lot of food for thought. And please stay with us. This week we will have more live stream interviews from here, from Amsterdam. Thanks. Bye.