Street-Based Adolescents at High Risk of HIV in Ukraine

Through this study, the Centre for Population Studies of the London School of Hygiene and Tropical Medicine sought to "measure the extent and distribution of HIV risk behaviours among street-based adolescents in four Ukrainian cities as part of a regional UNICEF [United Nations Children's Fund] HIV prevention programme for most-at-risk adolescents." The Ukraine was chosen because it has the highest HIV rate in Europe and "large populations of street-based young people" for whom there was no behavioural data available on the prevalence and distribution of HIV risk.

The study is the "first study to examine patterns of high-risk activity among adolescents aged 10-19 years who spend at least 50% of their time on the street in four Ukrainian cities. The results confirm that this population is extremely vulnerable to HIV due to a range of overlapping risk behaviours including casual and transactional sex, poor condom use, and injecting drug use, as well as wider structural factors such as high rates of sexual violence, distrust of social services and other authorities, and harassment from the police, all of which restrict street-based adolescents' ability to protect themselves or access harm-reduction or treatment services. Effective HIV or health programmes targeting this group will need to address the wider risk environment that characterises life on the street."

Issues addressed by the survey were:

• Drug use;
• Sexual behaviour;
• Condom use;
• HIV knowledge and access to prevention services (non-governmental organisation (NGO), state clinics, needle exchange programmes, and outreach workers);
• Violence;
• Institutionalisation in juvenile justice or social care facilities; and
• Interaction with the police.

Information was gathered through the use of a cross-sectional behavioural survey with 805 adolescents in Kiev, Donestsk, Dnepropetrovsk, and Nikolaev. They were reached using a location-based network and convenience sampling in cities where links had been made to organisations "interested in developing follow-up interventions, and local authorities were supportive of the research."

The research was conducted through:

• The use of key informants and local NGOs to map locations where street-based adolescents congregate;
• Fieldworkers approaching individuals/groups to recruit participants;
• Peer referrals among respondents;
• Interviews on the street, in a cafe (meeting respondents where they are), or NGO office (during adverse weather); and
• Compensation with a gift pack (US$5 of personal items and snacks).

The research concludes that "street-based adolescents in Ukraine are at significant risk of contracting HIV due to involvement in injecting drug use and unprotected sex in personal and commercial exchanges…this group initiates risk behaviours at early ages and does not appear to have good access to prevention and other health services." Suggestions for follow-up include:

• Services that increase contact and trust of street-based youth;
• Further research to explore which facilities are perceived as "user-friendly" to guide future programming;
• Use of "entry points" identified by the survey such as the willingness among intravenous drug users to buy needles/syringes from pharmacies or contacting pregnant girls, who are often more open to receiving reproductive and maternal health services, which provides a window for other services;
• Services to families to reduce risk (for example, risk is reduced when adolescents sleep at home versus the street) because many adolescents retain relationships with their families, providing another avenue for intervention;
• Policy change (as indicated by a similar study in the Sudan); and
• Advocacy efforts emphasising changes to the damaging role perpetuated by authorities, whose mandate is for public protection.