Barriers to HIV prevention, testing and care among key populations in Russia and the role of NGOs in reducing these barriers.

Russia faces a significant HIV epidemic, primarily affecting key populations (KPs). Since 2022, international sanctions and the recognition of the LGBTQ + community as an extremist movement have complicated access to prevention, testing, and treatment for KPs. Nongovernmental organizations (NGOs) play a crucial role in reaching these populations. This article addresses barriers to HIV prevention and treatment for KPs in Russia and the role of NGOs in addressing them from 2022 to 2024. Semistructured interviews and focus groups were conducted annually with beneficiaries of services provided by nine NGOs in three cities, their staff, and KPs' activists (n = 299). Using the modified socioecological model, the study examined barriers to accessing HIV services, revealing interconnected challenges across multiple levels. NGO strategies involve helping individuals overcome documentation and transportation barriers or creating low-threshold options within or outside the state system. Stigma against KPs triggers barriers at all levels, fostering distrust and preventing KPs from seeking help. NGOs create safe, accepting environments and mediate to ensure favorable treatment for KPs. They face increasing challenges as more HIV prevention activities risk violating new legislation. Russian NGOs focus on overcoming lower-level barriers by offering specialized services or facilitating access to existing healthcare services, as legal changes hinder efforts to address higher-level systemic barriers.