Olena Sakovych UNICEF Ukraine 1-2 November 2011 HIV/AIDS and drug use in the streets From evidence to action: experience from Ukraine

Outline Background –Ukrainian context –Key factors enhancing risk behaviour UNICEF Ukraine experience –Strategic information –Policy development –Modelling interventions Some conclusions and challenges

CRC Concluding Observations, 2011 on children in street situations high number of children in street situations which the State party acknowledges as “acute”. their vulnerability to health-related risks, including in relation to substance and drug abuse, HIV/AIDS, sexual exploitation, forced labour and police violence. limited availability and accessibility with respect to social services for the protection and social reintegration.., health care and education, and at information that no full-fledged network of rehabilitation centres for children abusing drugs exists. highly insufficient holding capacity of shelters for children in street situations. general lack of cooperation with NGOs.

Ukrainian context HIV Prevalence exceeds*:19% among A-FSWs 29% among A-IDUs 18% among street youth** Adolescents comprise*:26% of FSWs 24% of IDUs 32% of MSM Generalized PSE on MARA*:1,602 out of 100,000 A lower knowledge of HIV/AIDS and lower use of prevention services than among adults at risk * UNICEF, 2010; **Robbins et al., 2010

Ukrainian context: children in street situations* 15,5% have experience of injecting drug use, some 2/3 informed that have used a common needle during the last month. Some 57% of girls have provided sexual services on reward or for food, clothes, protection, etc. Some 10% combine the risks of the injecting drug use and commercial sex. Every tenth boy has practiced anal sex with male, some half of them stated that received some reward like money, clothes, drugs, etc. Only some 9% are well informed about HIV/AIDS. * UNICEF, 2009

Key factors enhancing risk behaviour Societal and cultural factors rising economic disparities youth unemployment growing gender inequality stigma and discrimination misguided and underfunded social sector high levels of corruption law enforcement that fails to protect the most vulnerable political instability growth of organised crime, drug and human trafficking and the sex trade Individual factors parental problematic drug and alcohol misuse growing numbers of dysfunctional families family conflict academic failure and low commitment to school social networks small and service experience of peers of critical influence health is of low value low knowledge, skills and confidence levels low coverage with prevention services service-seeking behaviour and knowledge about services is low police harassment common, fear of being sent to state child care institutions high UNICEF, 2009

Creating a knowledge base Understand risks and vulnerabilities Identify the patterns of deprivations to be addressed Respect ethical and legal considerations when conducting a research among MARA Formulate evidence-based argument to decision-makers and stakeholders

Political Buy-In Provide decision-makers and stakeholders with understanding how the actual policy and legislation frameworks impact the MARA and HIV situation Combine advocacy with skills-building and training of service providers and policy makers Build partnerships with the big HIV players Integrate into wider strategic planning processes implemented by the Government

Interventions Targeted outreach: reaching out MARA with information and services Drop-in centres to provide social support, education and HIV counselling Making STI clinics & AIDS centres MARA-friendly for health care support and VCT Strengthening referral systems for MARA to facilitate access to social and health services Rehabilitation to break a cycle of addictions Safe house to provide shelter and rehabilitation

‘ Pirozzi/ % coverage of MARA to date (UNICEF/UISR, 2010)

Way Forward for Systemic Inclusion Integration of interventions into the system of existing services Scaling up and strengthening inter-sectoral linkages Intensification through ‘equity lens’ Finding practical solutions to problems inherent in systems & sectors Maintaining political commitment and increasing accountability

Conclusions and Challenges Daily battle with governmental systems that can be de- motivating – linked to the limitations that NGOs are facing in providing services to minors. Reaching the most hidden – is it possible? Providing education, information, condoms and syringes are not enough. Many MARA require on-going psychological counselling, protection and social support.

Conclusions and Challenges Working with families of MARA, most of which are dysfunctional and difficult to reach. Sustaining service coverage levels of MARA interventions over time in light of limited capacities and funding. Linking upstream policy and community-based activity. Introducing effective ways to reach the most marginalised and close the ‘equity gap’.

Thank you