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) Voly n Rivn e Zhytomyr Kyiv Chernigiv Sum y Poltava Kharkiv Donetsk Zaporizhia Kherson AR Crimea Kirovograd Mykolaiv Odessa Vinnytsi a Lviv Ternopi l Khmel - nytski y Iv.- Frank. Zakarpatska Chernivt si 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 in Kyiv and Donetsk A Kyiv outreach team with clients, 2010

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 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 , 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 % of clients self-referred for services

Service Center Clients 89% are 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 Primary Secondary of 350 HIV+ test result of 350 Newly tested and registered at the City AIDS Center of tested HIV+ Clients who new HIV+ status before coming to the Center

Service Center Statistics (N=789) Services# clients% Pregnant clients607.61% of total number of clients HIV+ pregnant clients1016% of all pregnant clients Received PMTCT Including those who do not have documents % of all HIV+ pregnant clients Delivered babies % of pregnant clients

Challenges Engagement of partners Engagement of partners Residential services, particularly for pregnant women and women with children Residential services, particularly for pregnant women and women with children Sustainability Sustainability Violence against street-involved women Violence against street-involved women Employment Employment Referral to other cities Referral to other cities Social adaptation of recently released prisoners. Social adaptation of recently released prisoners.

Future Plans Halfway house for girls in Kyiv and one for girls and one for boys in Donetsk Halfway house for girls in Kyiv and one for girls and one for boys in Donetsk Engagement of male partners Engagement of male partners Empower women to resist violence Empower women to resist violence Disseminate STEPS throughout Ukraine Disseminate STEPS throughout Ukraine Advocate for policy changes to improve access to care. 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 Ukraine 3, Stanislavskoho St., Office 7, Kyiv, Tel.:/Fax: + 38 (044)