Olena Sakovych UNICEF Ukraine 1-2 November 2011

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

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

3. 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.

4. 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

5. 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 rewardor 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

6. Key factors enhancing risk behaviour • 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 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 UNICEF, 2009

7. 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

8. 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

9. 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

10. ‘ Pirozzi/2010 32% coverage of MARA to date (UNICEF/UISR, 2010)

11. 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

12. 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.

13. 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’.

14. Thank youwww.unicef.org.ua