“The virus doesn’t care what group a person belongs to.” Interview with Denis Efremov, Sibalt Centre (Omsk)

Published by Elena Dolzhenko at 15/05/2022

Sibalt is an NGO that has been active in Omsk since the mid-1990s helping people with HIV. Legal Dialogue asked Denis Efremov of Sibalt about barriers to HIV prevention in the region, the role of peer counseling, and the organisation’s work under sanctions.

About Sibalt and how it operates with the ‘foreign agent’ label

Sibalt is a local NGO active in the Omsk region since 1996, when the first HIV case was officially reported in Omsk. Starting in the early 2000s, the HIV epidemic unfolded in the region.

Our center was created as part of a broader effort to set up a network of HIV services throughout Russia. Similar centers opened in Novosibirsk, Tomsk, Barnaul and other cities. Since 2016, Sibalt has been labelled “NGO acting as a foreign agent.”

Our priorities are to support people living with HIV and their families, and those who practice same-sex contacts.

Our primary activity is education, such as educating people with HIV about ways to live a long and fulfilling life. Back in the early 2000s, we hosted seminars in which medical specialists explained what could be done to stay healthy with HIV. Early on, our main objective was to help prolong people’s lives awaiting effective treatment for HIV to become available. More recently, we have focused on explaining the HIV treatment and why it is important.

We have operated an HIV helpline since 2003. Anyone affected by the problem can call us to learn where they can access help, whether medical, psychological or legal.

Capacity-building of PLHIV activists and volunteers

This is our most recent project supported by an international organisation at the end of 2021. While HAART in Russia is now mostly accessible and effective, many patients who know about their HIV nevertheless avoid seeking care and refuse therapy for various reasons. Therefore, the virus continues to spread in our region and elsewhere. Although the number of new cases is declining, we are concerned that HIV-positive people are dying.

The project’s objective is to bring together organisations helping the key populations in Omsk so that we may inform and educate the workers of these organisations and discuss pressing issues and concerns. In addition to education about the HIV disease, its progression and treatment, we also plan to raise broader issues such as intolerance, stigma and discrimination which often discourage people from seeking and accessing care.

The central event of the project has been the training “Motivational HIV counseling for key populations, including peer counseling.” Motivational peer counseling is done by someone who shares a similar experience with the person they counsel, such as being gay, a drug user or a person living with HIV. The peer counselor is more experienced and knowledgeable, and they share what they know with the other person in a way which is easy to understand.

How HIV is addressed in Russian law

Some training sessions focused on aspects relevant to specific key populations. This was perhaps the main highlight of the event: giving people a chance to meet and network with members of other affected groups they’d never crossed paths with before.

A separate section of the training covered the legal aspects of living with HIV. We discussed topics of particular interest to our clients which the peer counsellors are not always capable of explaining, such as liability for unauthorised disclosure of medical information and criminal sanctions for deliberately infecting someone with HIV.

Stigma and discrimination

People avoid getting tested for HIV because they believe it cannot affect them. Many assume that HIV only affects certain groups, and if they are not part of any such group, why get tested? We know, of course, that the virus does not care what group a person belongs to.

Stigma is a major obstacle for people who test positive for HIV. Stigma prevents them from seeking treatment and from asking questions about living with HIV.

Stigma makes it difficult for them to be open about their diagnosis. Therefore, it can be really challenging for us to recruit peer counsellors who are prepared to speak openly about their HIV diagnosis. This naturally limits our options for offering support and prevention services.

People living with HIV in our city often feel stigmatised by healthcare workers, such as doctors and nurses. We have been looking for ways to address this problem.

About HIV outreach under sanctions

Until recently, we regularly reached out to men practicing sex with men – our volunteers went out to bars, clubs, and other meeting places to educate patrons about HIV prevention and to offer rapid HIV tests. On average, we conducted about eight outreach visits per month. During each visit, our counsellors invited people to come over to our office and to attend educational events to learn more about various aspects of HIV and staying healthy.

But we have been forced to suspend outreach activities since April 1st; while our key donor based in Germany is committed to further cooperation with us, they are unable to finance our work, because German banks do not make transfers to Russian banks, even those which are not under sanctions.

So the project has been suspended, but we hope to find ways to receive support, including from international donors.

Another aspect related to the anti-war sanctions is a very high degree of uncertainty. It is difficult for us now to make plans for the future the way we used to do. We cannot even say with certainty what may become of our organisation a month from now. This is very demotivating. We are just holding on and trying to keep up the morale.

Recently, we have moved our office to a smaller and cheaper space. Everyone on our team is still with us and prepared to carry on.

We really wish we may continue providing support to people. Before the end of the year, we plan to conduct training on HIV and on NGO management, so that other organisations may learn how to fundraise to the extent possible under the circumstances and how to manage their activities involving peer counselors and outreach workers.