By 2016, Ukraine had the second largest HIV epidemic in Eastern Europe and Central Asia with 280,358 people living with HIV. Interventions targeted for FSWs are a key component of HIV prevention programs as heterosexual contacts continue to gain higher epidemic significance – the proportion of the sexual way of HIV transmission has steadily increased and reached the value of 73,3% in 2016. However, HIV prevention programs for female sex workers generally provide services to women who self-identify as sex workers. Thus, programs aimed at female sex workers may not reach women who exchange sex for money or other resources, but who do not identify as sex workers.
The Transitions study aimed to better understand vulnerabilities to HIV, HCV, and other STBBIs among young women in Dnipro prior to, and in the very early period after entry into sex work. In order to inform HIV prevention services in Dnipro, this study examines self-reported behaviours that shape HIV vulnerability and place young women in Dnipro at increased risk for HIV infection. A multistage, stratified cluster sampling approach identified a random sample of participants between 14 and 24 years old. A team of field researchers conducted structured interviews with participants to gather information about their sexual behaviours and drug use practices using a standard quantitative tool. Authors present results from epidemiological mapping exercises and bio-behavioural surveys carried out among young women. This paper focuses on select components of the larger Transitions study, and has four aims: identifying and characterizing locations in which study group members congregate/reside in Dnipro, Ukraine; estimation the population sizes of the three study groups in Dnipro; examination how vulnerabilities to HIV and HCV overlap among study group members; and characterizing and estimate the duration of the transition period and access gap. Paper discusses the period of time between a woman’s first sex and self-identification as a sex worker as the “transition period”, and the period after formal entry into sex work, but prior to accessing health services from sex worker-specific programs, as the “access gap”. This study highlights numerous individual-level risk factors, as well as social and structural vulnerabilities for HIV faced by young women in Dnipro. Combination HIV prevention programmes that integrate behavioural, biomedical, and structural interventions are recommended to expand upon existing, local prevention efforts in Dnipro, and Ukraine more broadly.
HIV Infection in Ukraine: Information Bulletin No. 45. (2016). Kyiv: Ukrainian Centre for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the Academy of Medical Sciences of Ukraine. URL: https://phc.org.ua/uploads/documents/c21991/965cf18b2c7ecaa8c430e6965a0846cb.pdf [in Ukrainian]
HIV/AIDS Surveillance in Europe 2015. (2016). WHO Regional Office for Europe. Stockholm: European Centre for Disease Prevention and Control. URL: http://www.euro.who.int/__data/assets/pdf_file/0019/324370/HIV-AIDS-surveillance-Europe-2015.pdf
Country factsheets: Ukraine 2016: Joint United Nations Programme on HIV/AIDS. (2016). UNAIDS. URL: http://www.unaids.org/ru/regionscountries/countries/ukraine
Global Hepatitis Report, 2017. (2017). Geneva: World Health Organization. URL: https://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/
Hope, V.D., Eramova, I., Capurro, D., Donoghoe, M.C. (2014). Prevalence and estimation of hepatitis B and C infections in the WHO European Region: a review of data focusing on the countries outside the European Union and the European Free Trade Association. Epidemiol Infect, 142 (2), 270-286.
Maistat, L., Golovin, S., Deineka, O., Khan, T. (2015). Hepatitis C in Eastern Europe and Central Asia: Epidemic and Response: International HIV/AIDS Alliance in Ukraine and International Treatment Preparedness Coalition: Eastern Europe and Central Asia. URL: http://www.aidsalliance.org.ua/ru/news/pdf/28.10.2015/EECA%20HCV%20EN.pdf
Maistat, L., Kravchenko, N., Reddy, A. (2017). Hepatitis C in Eastern Europe and Central Asia: a survey of epidemiology, treatment access and civil society activity in eleven countries. Hepatology, Medicine and Policy, 2 (1), 9.
Aceijas, C, Rhodes, T. (2007). Global estimates of prevalence of HCV infection among injecting drug users. The International journal on drug policy, 18 (5), 352-358.
HIV Infection in Ukraine: Information Bulletin no. 47. (2017). Kyiv: Ukrainian Centre for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the Academy of Medical Sciences of Ukraine. URL: https://phc.org.ua/uploads/documents/c21991/8a07ad35dc72489d06682eec55d0d1d8.pdf [in Ukrainian]
Baral, S., Beyrer, C., Muessig, K., Poteat, T., Wirtz, A.L., Decker, M.R., Sherman, S.G., Kerrigan, D. (2012). Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Infectious diseases, 12 (7), 538-549.
Busza, J.R., Balakireva, O.M., Teltschik, A, Bondar, T.V., Sereda, Y.V., Meynell, C., Sakovych, O. (2011). Street-based adolescents at high risk of HIV in Ukraine. Journal of epidemiology and community health, 65 (12), 1166-1170.
Balakireva, O., Bondar, T., Nenko, O., Sazonova, I., Sakovych, O., Smyrnova, K. (2011). HIV Prevention among Most-At-Risk Adolescents: Implementation Results of the Targeted Models. Kyiv: UNICEF, UISR. URL: https://www.unicef.org/ukraine/ukr/Case_Study_EN_FINAL_block.pdf
Teltschik, A., Balakireva, O., Sereda, Y., Bondar, T., Sakovych, O. (2008). Most-at-risk-adolescents: The evidence base for strengthening the HIV response in Ukraine. Kyiv: UNICEF, Ukrainian Institute for Social Research after Oleksandr Yaremenko. URL: https://www.unicef.org/ukraine/MARA_Report_eng_web.pdf
National Targeted Social Program on HIV/AIDS Response for 2014-2018. (2014). Kyiv: Verkhovna Rada of Ukraine. URL: https://zakon.rada.gov.ua/laws/show/1708-18 [in Ukrainian]
Wilson, D., Halperin, D.T. (2008). Know your epidemic, know your response: a useful approach, if we get it right. Lancet, 372 (9637), 423-426.
Becker, M., Emmanuel, F., Isac, S., Khan, S., Lorway, R., McClarty, L., Blanchard, J., Balakireva, O., Bondar, T., Sazonova, I., Pavlova, D., Sakovych, O. (2014). Mapping of Key Populations, Services and an HIV Epidemic Appraisal in Zaporizhzhya, Ukraine: UNICEF Ukraine, Ukrainian Institute for Social Research after Olexandr Yaremenko, International Center for Infectious Diseases, Canada, The Centre for Global Public Health, Canada. URL: http://www.aidsinfoonline.org/kpatlas/document/UKR/UKR_2013_Behavioral_PSE_FSW_PWID.pdf
Emmanuel, F., Blanchard, J., Zaheer, H.A., Reza, T., Holte-McKenzie, M., HASP team. (2010). The HIV/AIDS Surveillance Project mapping approach: an innovative approach for mapping and size estimation for groups at a higher risk of HIV in Pakistan. Aids, 24 Suppl 2, 77-84. DOI: 10.1097/01.aids.0000386737.25296.c4
Integrated Behavioural and Biological Assessment (IBBA): Guidelines for surveys of populations at risk of HIV infection. (2011). New Delhi: Indian Council of Medial Research and FHI. URL: https://www.fhi360.org/sites/default/files/media/documents/Integrated%20Behavioral%20and%20Biological%20Assessment%20Guidelines%20for%20Surveys%20of%20Populations%20at%20Risk%20of%20HIV%20Infection.pdf
UNAIDS. Looking deeper into the HIV epidemic: A questionnaire for tracing sexual networks. (1998). Geneva: Joint United Nations Programme on HIV/AIDS. URL: http://www.unaids.org/sites/default/files/media_asset/jc103-lookingdeeper_en_0.pdf
IHAT. HIV/AIDS situation and response in Karnataka: Epidemiological appraisal using data triangulation. (2010). Bangalore: India Health Action Trust.
Ukraine. Multiple Indicator Cluster Survey. 2012. (2013). UNICEF Ukraine, State Statistics Service of Ukraine, Ukrainian Institute for Social Research, Statinformconsulting. URL: https://www.unicef.org/ukraine/Ukraine_MICS_FinalReport_ENG.pdf