In Georgia, an LGBTQIA+ advocate making HIV prevention and health care accessible for all

TBILISI, Georgia – As a social worker for the LGBTQIA+ community in Georgia’s capital Tbilisi, Beka Gabadadze quickly learned how a person’s gender identity and expression can affect every part of their life. 

“It wasn’t just health care – there were housing issues, employment, a lot of violence and other things,” he told UNFPA, the United Nations sexual and reproductive health agency. 

Mr. Gabadadze began his career in 2013 with Tanadgoma, a UNFPA partner providing information and counselling on sexual and reproductive health for LGBTQIA+ people, and raising awareness about HIV testing and prevention services. 

Georgia is considered a low HIV and AIDS prevalence country, with just 0.3 per cent of the general adult population estimated to be living with the virus in 2023. But the data are different for men having sex with men, for whom prevalence rates rose from 7 per cent in 2010 to a high of over 25 per cent in 2015. For this group, Georgia in fact had one of the highest rates of HIV in the Eastern Europe and Central Asia region at the time.

Yet the data only tell part of the story, as the increase was also down to successful awareness-raising campaigns on the importance of testing and care: In Tbilisi, the number of men having sex with men who had been tested and knew their HIV status leaped from just over 15 per cent in 2010 to more than 54 per cent in 2018. 

UNFPA's longstanding partner, Tanadgoma, organizes referrals to HIV and STI clinics and hosts events to inform LGBTQIA+ people of their sexual and reproductive health and rights. And a number of community centres were set up in the country’s three largest cities – Batumi, Kutaisi and Tbilisi – as well as in smaller towns like Telavi and Zugdidi.

By 2023, HIV prevalence among men who have sex with men is reported to have dropped to just over 15 per cent – still 26 times higher than among the general population. Advocacy efforts have also led to policy advances, with the Government prioritizing prevention of new HIV infections among key populations and their sexual partners, and providing testing services free of charge for everyone. In 2017, Georgia also became the first country in the Eastern Europe and Central Asia region to roll out pre-exposure prophylaxis (PrEP) for men who have sex with men and transgender people.

Innovative responses to continuing challenges

But while these programmes have expanded, fears about openly identifying as LGBTQIA+ prevent many from attending information sessions or seeking HIV testing and treatment; even the community centres in Telavi and Zugdidi were eventually shut down due to backlash from locals and the high costs of maintaining services in those more remote locations. 

Since then, new initiatives have emerged in their place. For example, a joint project by UNFPA, the United Nations Development Programme (UNDP) and Tanadgoma offers free sexual health kits that can be ordered online – and anonymously. The packages include rapid HIV tests, condoms, and guidance about STI prevention and health services. “We are adapting our resources and new technologies to match the needs of the community,” Mr. Gabadadze said.

Recent data for Georgia suggest efforts over the years have paid off, with target groups in the largest cities showing significant improvements in HIV knowledge. In 2010, less than a fifth of the people surveyed in Tbilisi were found to have adequate information about the virus, but by 2018, that had nearly doubled to 37 per cent. 

Sexual reproductive health rights for all

In 2019, Mr. Gabadadze joined Temida, a transgender rights organization also supported by UNFPA. The stories he heard from that community shocked him: “They were kicked out by their families, which limited the possibility in many cities to even use public transport, because they might get bullied or something.”

Gender-affirming care is legal in Georgia, but equal access to adequate health care for transgender people still lags. Mr. Gabadadze explained that when he started at Temeda, there was just one endocrinologist in the whole country providing hormone therapy; the treatment was also very costly and not covered by any insurance, leaving it out of reach for most.

Those who could afford it had to deal with doctors who were unfamiliar with caring for transgender patients, so Mr. Gabadadze and his team trained health-care workers on the community’s needs, language sensitivity and fighting stigmas and prejudices. 

“At least now there are three clinics providing care,” he said. “When there was one doctor, the prices were quite high. But now that is starting to come down.”

Protecting fragile progress

Nevertheless, Mr. Gabadadze knows the work is not done – and can be undone. Homophobic and transphobic attitudes are still rife: A 2021 opinion poll found that over 60 per cent of respondents opposed same-sex marriage and the right of LGBTQIA+ people to adopt children. The Georgian parliament is also considering a draft bill that would ban non-heterosexual marriages and legal or surgical sex changes.

Mr. Gabadadze worries that if international funding or governmental support recede, LGBTQIA+ people could be forced back underground to seek health care, with untested new hormones and treatments already appearing through unofficial channels. Instead, he urged the community to lean on their experience for what may lie ahead. 

“I ask my community to stay prepared,” he said. “We will have to work differently, absolutely, but the resilience is still there.”