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Introduction In Europe, young sexual and gender minority (SGM) people continue to face discrimination in the labour sector despite advances in legislation towards their acceptance and equal treatment. Non-discrimination policy strategies helping SGM individuals are not equally enforced in all contexts, making it difficult for many SGM individuals to disclose their identity, hence undermining their health and well-being. Methods Qualitative semi-structured interviews were conducted between October 2020 and February 2021 with 55 SGM youth (18–27 years) having work experience from Austria, Croatia, Serbia, Slovakia, Spain and the UK. Results From the analysis, three overarching themes were significant: (1) societal discrimination played a major role in sociocultural factors and policy considerations, (2) workplace discrimination had distinct factors and impacts on SGM individuals and (3) SGM inclusion should use strategies to ensure workplace diversity and equality. Conclusions SGM individuals from contexts of poor acceptance tended to hide their identity in the workplace, while transgender and non-binary individuals were prone to experience force-disclosure and discrimination in all aspects of employment. There is a lack of resolute reaction from policy makers in managing problems faced by SGM people in workplaces. New laws improving the status of SGM people need to be further adopted, staff training should be implemented, and managers are crucial in achieving an inclusive climate in the workplace. Policy Implications It is essential to implement policies on how to effectively handle problems faced by sexual and gender minority people in the workplace.

Structural stigma shapes men who have sex with men’s (MSM’s) mental health and sexual behaviours. The aim of this study was to examine how stigmatizing policies interact with downstream anxiety/depression and sexual behaviours to structurally pattern HIV disparities among European MSM. We conducted a secondary data analysis of the European Men-who-have-sex-with-men Internet Survey (EMIS) from 2017. We included a total of 98,600 participants living in 39 European countries. We used the Rainbow Index, a score given to countries based on their sexual and gender minority policies as the predictor of HIV diagnosis. We conducted adjusted random intercept and slope multi-level logistic regressions. In adjusted models, higher Rainbow Index scores was associated with lower predictive probabilities of diagnosed HIV, regardless of the number of condomless intercourse partners. The predictive probability of HIV diagnosis was also lower, regardless of severity of anxiety/depression, where the Rainbow Index score was better. Country-level policies interact with downstream sexual behaviours and anxiety/depression to structurally influence HIV diagnosis among MSM in Europe.

Background: Despite progress in reducing smoking prevalence in many countries, stigmatized, marginalized and socially deprived populations with low socioeconomic status still have higher smoking ra...

A correction to this paper has been published: https://doi.org/10.1007/s10461-022-03884-2

Background Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). However, there is limited data on whether changes in structural stigma, such as when a stigmatized person moves to a lower stigma context, affect mental health, and on the mechanisms underlying this association Methods The current study uses data from the 2017/18 European Men-who-have-sex-with-men Internet Survey (n = 123,428), which assessed mental health and psychosocial mediators. We linked these data to an objective indicator of structural stigma related to sexual orientation in respondents’ countries of origin (N = 178) and receiving (N = 48) countries Results Among respondents who moved from higher-to-lower structural stigma countries (n = 11,831), longer exposure to the lower structural stigma environments of their receiving countries was associated with a significantly: 1) lower risk of depression and suicidality; 2) lower odds of concealment, internalized homonegativity, and social isolation; and 3) smaller indirect effect of structural stigma on mental health through these mediators. Conclusions This study provides evidence that structural stigma is associated with the mental health of sexual minority men, both through proximal experiences and as a function of length of exposure to structurally diverse contexts, at least for those who move higher-to-lower structural stigma contexts. Findings suggest the importance of routinely assessing life-course structural influences on mental health and deploying interventions to address those influences.

Background Community-based voluntary counselling and testing contributes to early HIV diagnoses among key populations. Testing data from such decentralized services is however often not standardized nor linked to national surveillance systems. This study aimed to support the integration of community testing data into respective national surveillance and monitoring and evaluation systems for those infections. We present results from three national pilots, focused on improved data collection and transfer. Methods Within the Joint Action INTEGRATE different pilot activities were planned and implemented according to the local context. In Slovakia, standardised data collection tools were implemented in three community testing services. The data generated was used to calculate the proposed indicators. In Poland, positive test results from the community testing database were linked to the national case-based surveillance database using confirmatory test number, to improve the completeness of behavioural data in the national database. In Serbia, voluntary counselling and testing forms were improved enabling identification of community-based testing. A system to generate unique client identifiers was initiated in the National registry of HIV cases to monitor linkage to care. Results All three sites were able to estimate most of the agreed indicators. In Slovakia during the study period 675 people were tested for HIV, 410 for hepatitis C and 457 for syphilis, with reactivity rates of 0.4, 2.5 and 1.8%, respectively. For HIV, 66.7% of reactive cases were confirmed and linked to care. In Poland, 28.9% of the community testing sites’ records were linked to the national surveillance database (and accounted for 14.3% of all new diagnoses registered here during 2017–2018). Reactivity rate ranged between 1.9% and 2.1%. In Serbia, 80 persons were tested at community sites, from which two had a reactive HIV test result. By linking unique client identifiers from voluntary counselling and testing and National Registry of HIV cases databases, linkage to care within a two-month period was observed for one of two people with reactive HIV test result. Conclusions Pilot activities in the three countries demonstrate that integration of community-based testing data into surveillance systems is feasible and can help improve national surveillance data by providing key information.

As a social determinant of health, stigma is a major barrier to health care access, illness management and completing the treatment. It is attributed both to HIV as a health condition and to the populations at risk of being infected with it. In Serbia, HIV is associated with men who have sex with men (MSM), with a noticeable stigma towards them. Drawing upon a qualitative cross-sectional study, conducted in three Serbian cities, we explore the MSM's perception of HIV in the context of that social stigma. Using a respondent-driven sampling approach, 62 targeted MSM respondents participated in focus groups discussions and in-depth interviews. We found that the participants' understandings of the HIV infection, risks and prevention are shaped by stigma. Those MSM who resisted stigma relativised the HIV risk, associating it with the general population and HIV-positive MSMs, believing that HIV, perceived as a chronical illness, was unjustly related to MSM. As one of the main preventive measures, serosorting was based on alleged HIV-positive statuses of potential sexual partners. HIV-negative participants described perceiving HIV-positive MSM as the ones responsible for spreading the virus, since they were concealing their positive status. As a response to stigma, MSM tended to challenge the HIV discourse, shifting it away from MSM onto the general (male) population and HIV positive MSM. Our analysis suggests that stigma resistance may make MSM more susceptible to taking risks. HIV prevention programmes should take the social context of MSM into account and target MSM-related stigma.

Introduction The aim of this study is to explore smoking prevalence among six vulnerable population groups in Serbia from 2008 to 2013 and identify the need for smoking prevention and cessation programs for highly vulnerable populations. Material and Methods Smoking prevalence data were extracted from the databases from the (bio) behavioral surveillance surveys among populations most at risk for HIV and those living with HIV. Self-administered or interviewer administered questionnaires were used in 2008 (n=2,818), 2010 (n=2,305), 2012 (n=1,823) and 2013 (n=3,299). Different sampling methodologies are applied across the groups. Vulnerable groups included: men who have sex with men, (snow-ball sampling (SB) in 2008-2012 and respondent driven sampling (RDS) in 2013); sex workers (SB); Roma youth (RDS); children without parental care living in institutions (cluster sampling); prisoners (cluster sampling); people living with HIV (convenient sampling). Results More than 50% of respondents in all groups report smoking, with the highest percentage among sex workers (90.5% in 2013). There were not significant changes between survey waves in majority of vulnerable groups. Conclusions Smoking rates are exceptionally high among vulnerable populations in all age groups, among males and females. There is a concern that smoking prevention and cessation are not prioritized for these populations and ignoring tobacco use in these populations will worsen their already vulnerable health and social position due to the long-term health effects of smoking. Development and implementation of tailored individual and social network-level interventions are needed.

Based on qualitative research data, this article exams the meaning of condom among persons engaged in sex work. Sex-work is a specific activity, with a sex service being an object of economic transaction. In order to delineate private sexual relationship and business sexual relationship sex workers rely on a professional code. Abiding to this code is valued positively by the professional group whereas disrespecting it leads to stigmatization of the offender within the group. The basic markers separating professional and private life in a continuum of sexuality are money as a sign and condom as a symbol. Use of condom during the sex-work relation is a symbol of correct approach to work and as such marks the border between professional and unprofessional way for doing the job in addition to marking the border between work and private life. The data show that within this borderline area in real-life situations, complex interactive relationship between sex-workers and their immediate environment leads to discrepancies in the consistency of condom use. The lack of consistent condom is present when a client or type of service is perceived as safe, i.e. carries the meaning of the category "with condom", or when some ambiguous environmental circumstances are present such as influence of the police or pimps, protectors and people related to private life of sex-worker. In the field of sex-work, condom grows from an object of infection prevention into an object that symbolizes professional ethics within sex-work and, in that way, it keeps an atmosphere of a healthy and clean private life for sex-workers.

Attitudes of Serbian "returnees" of Livanjsko polje about ethnic identity of Us, Serbs, and Them, Croats, are demonstrated in this article. Croats that have political control and social-economic power, appear as "Significant Others", but also Strangers, representatives of different peaceful and humanitarian organizations. Religious belief and language appear as basic symbol of difference, Marker, between Serbs and Croats, although existing attitudes in a bigger measure rely on religious belief. Basic attitudes about identity Us and Them are led out from interrelations of these Markers and people. There are two groups of attitudes about Us-identity. The 119 first group is mostly the answer at negative external determination, by which the Serbs are determinate as nationalists and aggressors. They are steered on negation of such definition, so the Serbs are generally seen as peaceful, tolerant, nationalists - internationalists; shortly, as bearers of positive collective, but also individual relation to Others. The second group of attitudes mainly relates negative aspects of Serbian identity. There are Serbian dissension, individual interests, generally - attitudes which speak about collective, but also individual negative relation of Serbs to members of their own group. Both groups of attitudes could be explaining by interrelation of orthodox religion and people. This determination of Us, as it is limited by external definition, in that way qualifies determination of Them. So, the Croats, considering the interrelation of Catholicism and people, are seen as nationalists, with clear religion - national aim and steered to its realization - as aggressors. Though, here are both negative and positive attitudes about Croat identity. If positive or negative aspects of that identity would obtain, before all depends of the fact in which measure the Croats are steered by their church, in fact, which politics, in the certain time, the catholic church prosecutes relate to orthodox church. Therefore the Croat appears as bearers of individual-positive relation to Others (Serbs), when the church do not steer them in other way. So, until the catholic, religious politics is neutral, harmonious ethnic relations are possible, owing this positive aspect of Croat identity at individual plan and aspects of Serbian identity at both, collective and individual, plan (regardless of effect of church). On concrete terrain of Livanjsko polje, Serbs see there selves as the most representative bearers of positive aspects of Serbian identity, and neighbor’s Croats (from Livno) as people with enough distanced positive aspect of Croat identity. So, ethnic identity could be the bridge in the peaceful communication of two ethnic groups which were, lately, just because of ethnic identity, conflicted (with developed militant communication).

Background Serbia hosts some 228,000 Internally Displaced Persons (IDPs) from Kosovo, of whom more than 2,000 live in 24 collective centers. A large number of refugees and IDPs reside in substandard temporary housing or in illegal settlements lacking basic facilities. The research to assess vulnerability to HIV among young IDPs in Serbia was carried out with the support of the UN Joint AIDS Team. The goal of the research was to: assess the level and exposure to HIV risk behavior among young IDPs in two cities, Belgrade and Kragujevac, where the largest ID collective centers are placed; to inform stakeholders to tailor services to the needs of targeted population.

Respondent driven sampling (RDS) has been used in several counties to sample injecting drug users, sex workers (SWs) and men who have sex with men and as a means of collecting behavioural and biological health data. We report on the use of RDS in three separate studies conducted among SWs between 2004 and 2005 in the Russian Federation, Serbia, and Montenegro. Findings suggest that there are limitations associated with the use of RDS in SW populations in these regions. Findings highlight three main factors that merit further investigation as a means of assessing the feasibility and appropriateness of RDS in this high risk population: the network characteristics of SWs; the appropriate level of participant incentives; and lack of service contact. The highly controlled and hidden nature of SW organizations and weak SW social networks in the region can combine to undermine assumptions underpinning the feasibility of RDS approaches and potentially severely limit recruitment. We discuss the implications of these findings for recruitment and the use of monetary and non-monetary incentives in future RDS studies of SW populations in Eastern Europe.

OBJECTIVE: To explore female and transvestite sex workers' perceptions of risk in the sex work environment in Serbia. DESIGN: Qualitative interview study. SETTING: Street based locations for sex work in Belgrade and Pancevo, Serbia. PARTICIPANTS: 31 female and transvestite sex workers. RESULTS: Violence, including police violence, was reported as a primary concern in relation to risk. Violence was linked to unprotected sex and the reduced capacity for avoiding sexual risk. Participants reported that coerced sex was routinely provided to the police in exchange for freedom from detainment, arrest, or fine, and was enforced by the perceived threat of violence, sometimes realised. Accounts contained multiple instances of physical and sexual assault, presented as abuses of police authority, and described policing as a form of moral punishment. This was largely through non-physical means but was also enforced through physical violence, especially towards transvestite and Roma sex workers, whose experience of police violence was reported as relentless and brutal and connected with broader social forces of discrimination in this setting, especially towards Roma. CONCLUSION: Preventing violence towards sex workers, which can link with vulnerability to sexually transmitted infections, is a priority in Serbia. This requires monitoring perpetrators of violence, providing legal support to sex workers, and creating safer environments for sex work.

The goal of this research is to assess whether there is an increased risk of HIV infection based on gender among female partners of IDUs and to what degree is this risk present. The research has been conducted using quantitative and qualitative methodology. For the purpose of collecting the research data among the female partners of IDUs and male partners who are IDUs, a qualitative methodology was used (in-depth interviews) complemented with a quantitative methodology (survey). Within the research 50 male injecting drug users (IDUs) have been reached and 50 steady female partners of the injecting drug users, regardless of the fact whether they themselves use drugs or not. Research findings indicate the following: Gender aspect is very important in initiation into drug use. Girls and women often start with drug use practice with their partner. Out of 19 IDU males who are in a relationship with a female partner who is an IDU, eight male subjects reported that their female partners had the first contact with drugs through them. On the other hand, out of 50 male participants, only one had the first experience with drugs during a relationship with a woman IDU. Sharing of injecting equipment is still present . In most cases a male partner has priority in distribution and taking drugs. Traditional understanding and acceptance of gender roles is reflected in attempts to explain or “justify” a man’s violent behaviour with the withdrawal crises or need for drugs. Sex work is one of the frequent activities for procuring money, or sex services are offered to drug dealers in exchange for drugs. The decision on purchasing and using a condom is mostly left to a male partner, and women and girls are not enough empowered to impose the use of a condom. Men are more prone to changing partners. Women prove their devotion to a partner by agreeing to risky behaviour (for ex. intercourse without a condom) or even by willingness to get infected with HIV. They tend to remain in a relationship with a person who is HIV positive, even when that person has infected them. In conclusion, the research findings have to a great degree confirmed gender specific risks for women that have been stated in the professional literature: unequal power relations and often weaker economic position of a woman. Women are in a weaker position when they make a decision about when, with whom and under what conditions they would have a sexual intercourse. The research findings, although they are not representative due to the size and sampling method, are certainly indicative – confirm to a great degree the thesis about the specific vulnerability of women and girls, both related to situations that lead to HIV infection, and related to availability and specific content of services offered to women living with HIV.