Street Youth in Ukraine: Focus on Girls and HIV Prevention

XIX International AIDS Conference in Washington D.C., USA Satellite Session “Two Steps Forward, One Step Back: the HIV Crisis

among Street Youth”July 22, 2012

Halyna Skipalska, Country Director in Ukraine

30 to 100 thousand youth live on the streets

in Ukraine

Donetsk, 2010

Street Youth and HIV High HIV prevalence among street youth

(18.4% on average according to 2008 HealthRight and CDC study)

Volyn Rivn

e Zhytomyr

Kyiv

Chernigiv

Sumy

PoltavaKharkiv

Donetsk

Zaporizhia

Kherson

AR Crimea

Kirovograd

MykolaivOdessa

Vinnytsia

LvivTernopil Khmel

-nytski

y

Iv.-Frank.Zakarpatska

Chernivtsi

Cherkasy

Dnipropetrovsk

Luhansk

Donetsk:9.8% 30/307)

Kyiv: 18.6% (58/311)

Odesa:26.7% (83/311)

HIV prevalence rate in three cities 18.4%

Street Youth

Among 929 youth survey participants (according to HealthRight/CDC study):

28.7% had six or more sexual partners during last year

47.3% did not use a condom at last sexual intercourse

73.2% have at least one experience of drug use 25.4% did not know that condoms protect from

HIV 19.2% did not know that a healthy-looking person

may be HIV-positive

Street Girls

Street girls and young women are a small (24%), but highly vulnerable sub-group of the larger street youth population

Main Survey Recommendations Bring HIV prevention, testing and follow up to

street youth through outreach Introduce new interactive programs for reducing

risk behavior Introduce additional services for street-involved

women and girls Implement a continuum of care model and case

management for street Coordinate government and NGO services, ensure

access of street youth to state services.

HealthRight’s Response

Street Outreach

Mapping of sites Psychosocial counseling Client referral Voluntary HIV counseling

and testing STI testing 1,315 street youth received

outreach services in 2010-2011 in Kyiv and Donetsk

A Kyiv outreach team with clients, 2010

Drop-in Centers

Drop-in Centers Low-threshold services:

– Shower/laundry – Psychosocial support– Leisure activities– Group trainings on HIV prevention– HIV, STI counseling and testing

921 clients served in 2 drop-in centers in Donetsk during 2010-2011

245 clients improved their lives

Referral networks of partner organizations in Kyiv (63) and Donetsk (70) to enhance access to services

Involved main Ministries and state services Introduced case management

Referral Network

A round table in Kyiv, 2012

STEPS training program for street youth In 2010-2011, trained 77 trainers on STEPS from 35

NGO and state organizations 2,335 at-risk children and youth were trained in

outreach and 146 in Drop-in Centers in Kyiv and Donetsk

Behavior Change Communication Intervention

STEPS trainings in Kyiv, 2011

HealthRight’s Service Center for Girls and Women

Opened: April 2010 Partner: Kyiv City Center for

Social Services Funders: Elton John AIDS

Foundation and Olena Pinchuk ANTIAIDS Foundation

Staff: Center Manager, Social Workers/Outreach, Psychologist, Lawyer

789 girls and women served since May 2010

37% of clients self-referred for services

Service Center Clients 89% are 17-24 years old 36.54% live on the street 10.76% double orphans 39% have children 25.6% have HIV 5.7% use injecting drugs 8.1% abuse alcohol 9.1% sexually abused

Low-threshold services Case management Specialized services

Services

HIV-related: VCT, escorting for confirmatory testing, registration with AIDS Center, referrals to HIV service organizations, PMTCT and ART adherence

For clients with children: birth certificate, government allowances, medical referrals and psychosocial support

For IDUs: supported referrals to detox and harm reduction services, substance abuse counseling, counseling about substitution therapy.

Specialized Services

Service Center Statistics (N=789)Services # clients %

Tested for HIV By rapid test at the Service Center At AIDS Center

PrimarySecondary

35031040

31063

44.3588.57 of 350

HIV+ test result 53 17.09of 350

Newly tested and registered at the City AIDS Center

48 90.56 of tested HIV+

Clients who new HIV+ status before coming to the Center

149 18.88

Service Center Statistics (N=789)Services # clients %

Pregnant clients 60 7.61% of total number of clients

HIV+ pregnant clients 10 16% of all pregnant clients

Received PMTCT

Including those who do not have documents

10

3

100% of all HIV+ pregnant clients

Delivered babies 34 56.67% of pregnant clients

Challenges Engagement of partners Residential services, particularly for pregnant women

and women with children Sustainability Violence against street-involved women Employment Referral to other cities Social adaptation of recently released prisoners.

Future Plans Halfway house for girls in Kyiv and one for girls

and one for boys in Donetsk Engagement of male partners Empower women to resist violence Disseminate STEPS throughout Ukraine Advocate for policy changes to improve access

to care.

Thanks to Our Donors:

Elton John AIDS Foundation Olena Pinchuk ANTIAIDS Foundation World Childhood Foundation Johnson & Johnson U.S. Agency for International Development (USAID) Open Society Foundations International HIV/AIDS Alliance in Ukraine

Thank you!HealthRight International

Representative Office in Ukraine3, Stanislavskoho St., Office 7, Kyiv, 01001

Tel.:/Fax: + 38 (044) 278 2358Halyna.Skipalska@healthright.org

www.healthright.orgwww.healthright.org.ua