Joanna R Busza, Olga M Balakireva,

Anja Teltschik, Tatiana V Bondar,

Yuliya V Sereda, Clea Meynell,

Olena Sakovych

PresenterDr Fredrick Stephen

PG in Community Medicine

MGMCRI

Pondicherry

• Ukraine has the highest HIV prevalence in Europe,

estimated at 1.63% of adults aged 15-49 years.

• HIV remains concentrated among most-at-risk populations,

namely injecting drug users (IDU), female sex workers

(FSW) and men who have sex with men (MSM).

• The growing numbers of adolescents living without parental

care in the region has led to increased concern for this

group’s vulnerability to HIV.

• Globally, homeless and street based adolescents are

vulnerable and experience multiple adverse health

outcomes.

• This research formed part of UNICEF’s first HIV

prevention program that explicitly defined and targeted

most-at-risk adolescents

• To measure the extent and distribution of HIV risk

behaviors among street based adolescents aged 10-19

years in four Ukrainian cities.

• To increase the availability of data on at risk adolescent

populations.

• To implement evidence based interventions and evaluate

their outcomes.

• Location Based Network and Convenience sampling

Kiev Donetsk Dnepropetrovsk Nikolaev

Cross Sectional behavioral study

(n=805)

Ukraine

• Type of study : Cross Sectional study

• Place of Study : Ukraine ( Kiev, Donetsk, Dnepropetrovsk,

Nikolaev)

• Sampling Method : Location Based convenience and

Network sampling

• Materials used: A Standardized questionnaire developed for

the UNICEF program containing core modules on drug use

sexual behavior, condom use, HIV knowledge and access to

prevention services was used.

Inclusion criteria

Adolescents aged 10 to 19 years

Subjects spending at least 50% of their time in streets

and not attending school or being engaged in

employment

Should have spent at least 3 months on the streets

Subjects who appear sober and capable of giving

consent

Exclusion Criteria

Who did not look sober

Those who didn’t spent time on the streets at least for 3

months

• Table 1 Characteristics of adolescents

Sl

no

Demographic

Background

Total

n

%

1 Sex Male 565 70.2

Female 240 29.8

2 Age, years 10-14 305 37.9

15-17 351 43.6

18-19 149 18.5

3 Living arrangement Live with adult

relatives

333 41.4

Live with friends 419 52

Ever Institutionalised 459 57

4 Educational status Never attended

school

30 3.9

Up to full elementary 154 19.4

Up to basic

secondary

585 73.8

Table 2: Drug Usage

Sl

no.

Demographi

c

Background

Total

N

%

1 Injecting drugs (Ever Use) 125 15.5

IDU injecting in the past month 65 53.3

IDU past month sharing

needles

15 44.1

2 Use of

services by

IDU

Obtaining needles from

pharmacy

69 55.2

Obtaining needles from needle

exchange or outreach

14 11.2

IDU- Injecting drug UsersMajority initiated injecting between ages 14 and 16 yrs now

inject at least weekly.

Among IDU 72.7% used sterile injecting equipment.

18.4% picked up used needles/syringes off the street.

Only 8.9% used needle exchange programme in the past

year.

Table 3 : Gender differences in vulnerability

Sl

no.

Male

N

% Femal

e

N

% P

value

1 Risk Behaviors

Ever had vaginal sex 389 69.7 196 82.4 <0.001

Ever received payment gift for sex 93 16.5 136 56.7 <0.001

Unprotected sex at last casual sex 136 54.4 48 50.5 0.520

Unprotected sex at last

commercial sex

(MSM and FSW)

12 57.1 34 35.8 0.070

Ever injected drugs 92 16.3 33 13.8 0.364

2 Service Use

Receive Condoms from outreach 7 1.2 33 13.8 <0.001

Ever had HIV test 113 20 66 27.7 0.019

FSW- Female sex worker; MSM- Men who have sex with men

• Overall , 73.5% of the sample reported having vaginal sex.

• 76.1% experienced sexual debut before the age of 15 years.

Table 4: Partner Accumulation in the past 12 months

• Majority of girls who received payments/gifts for sex did so

for the first time between 12-16 yrs.

• Among sexually active girls, 18.3% have ever been

pregnant

• 68.2% of them obtained an abortion.

Sl

no:

Rate of Partner accumulation Mean

1 Boys 4.7 partners

2 Girls 4.9 partners

Table 5: Violence on Adolescents

Sl

no.

Male

n

% Femal

e

n

% P value

1 Violence

Ever Forced to have sex 60 11.2 107 52.2 <0.001

Ever harassed by police 468 82.8 140 58.3 <0.001

50.1% of respondents have ever been incarcerated in prison

/ juvenile detention.

70.9% had been subjected to forced sex in the past 12

months.

75.5% have been stopped or harassed by the police in the

past.

• The research clearly shows that street based adolescents in

Ukraine are at a significant risk of contracting HIV.

• This group initiates risk behaviors at early ages, and does

not appear to have good access to prevention.

• Carefully designed appropriate services to increase contact

and trust of street-based youth are required to provide them

with harm reduction and child protection.

• The high rate of pregnancy among this group could serve

as an opportunity to reach out for reproductive and

maternal health services and even assist the girls in

evaluating their life choices.

• The assessment of family situation and targeted support

activities could help reduce the vulnerability of some

individuals.

• The exact period of study and duration is not mentioned.

• Females are represented less (29.8% only) hence scope for

more bias.

• Only 12.3% of the respondents knew the results of the HIV

tests undergone by them.