Transcript Olena Sakovych, UNICEF- Ukraine

HIV/AIDS and drug use in the streets
From evidence to action:
experience from Ukraine
Olena Sakovych
UNICEF Ukraine
1-2 November 2011
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
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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
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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
‘
32% coverage of MARA to
date (UNICEF/UISR, 2010)
Pirozzi/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 demotivating – 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
www.unicef.org.ua