HIV in Russia: the situation in vulnerable groups and NGO opportunities in response to the epidemic Maia Rusakova Russian NGO Stellit, director
Practice Examples: Map of the Studies Murmansk Pskov Archangelsk Vologda Naryan-Mar Syktyvkar Naberezhnie Chelny Orel Chelyabinsk Voronezh Samara Rostov-on-Don Novo-Troitsk Tomsk Vladivostok Barnaul Bratsk
Youth Non-institutionalized youth The most affected part of the population Have multiple risks of infection: Injection drug usage (up to 12% during the last year), Multiple sexual contacts, Extremely low level of condom usage Extremely high level of alcoholism Institutionalized youth Students of vocational schools and lyceums The level of risks is varied depending on the institution Risks connected with sexual behavior are more current than risks connected with drug usage High level of alcohol consumption Students of Universities (for example students of St. Petersburg State University) Risks connected with sexual behavior are much more current then drug usage ones Typical for all youth» Low level of involvement into testing» Lack of awareness about HIV» Intolerant attitudes to PLWHA» Low level of involvement into prevention programs
IDU Extremely high territorial specificity of drug situation and HIV-infection Presence of areas highly affected by drug addiction The number of IDUs is varied in different regions from 0,9 up to 3,9% of general population* Presence of territories highly affected by HIV among drug users HIV prevalence among IDUs is varied from less than 1% ( Arkhangelsk, Smolskaya et. al, 2004) up to 64,3% (Yekaterinburg, Stellit, 2008). Lack of IDUs involvement into prevention programs (including HIV testing) Considerable potential of epidemic generalization up to 70% of IDUs have non-idus sex partners (Omsk, Stellit, 2009) With a sufficiently high level of HIV awareness positive trends in protective behavior are expressed poorly: Sharing injecting equipment and related devises remains widespread Condom usage remains not regular * Multiple factor method
Female sex workers High territorial specificity of considerable part of basic group characteristics Level of HIV and related infections Level of drug usage Number of migrants among FSW Features of sex business organization In some territories FSW are one of the main sources of epidemics (in St. Petersburg 51,9% of street FSW are HIV-infected (Smolskaya Т.Т., Stellit, 2003), in Irkutsk -31,0 % (Stellit et. al., 2008) ) Considerable specificity of street and non-street sex-work. Street sex work is largely due to injecting drug usage However non-street FSW also have HIV Condom usage greatly varies on the type of partner. With a constant sexual partner condom usage is rare (about 50% FSW did not use condoms with a non-profit partner)
MSM The growing contribution of homosexual contacts into epidemic Official statistics data (Pokrovsky V.V. et al, 2009) Sentinel seroepidemic research data (St. Petersburg 3.8% (2006) - 5,5% (2008), Moscow, Russia 0.9% (2006) - 6,0% (2008) (North-West Aids Center, NGO Stellit, PSI) Basic risks connected with sexual behavior: Large number of sexual partners Prevalence of commercial sexual contacts Prevalence of sexual contacts in state of intoxication (alcohol and drugs) Not regular condom usage Considerable potential of bridging bisexual sex contacts - In some regions intersection of HIV and IDUs group was identified which could reinforce the spread of epidemic in this group Lack of accurate data on of MSM population size estimation Low territorial coverage of the group The major part of data refers to MSM visiting special places of leisure Territories with lack of such places or where they are hidden and the most hidden MSM groups who do not visit such places are not included into research and prevention programs
PLWHA Major part of PLWHA (up to 70%) are not aware of their HIVstatus even with high test coverage (Ekaterinburg, NGO Stellit, 2007) HIV-status awareness does not always lead to behavior change (6,5% pass their needles and syringes to other partners, 90% have sex with HIV-negative partners, 50% do not use condoms regularly) Low level of social and psychological well-being (largely due to drug-usage) Lack of awareness of ART, the presence of myths about ART
HIV epidemic response: NGO position Вleading role in the common work with vulnerable groups Reduction in funding Disunity (3 networks: National Forum of NGOs working in the field of HIV/AIDS 145 organizations, All-Russia Harm Reduction Network 26 organizations, HO Russian united PLWHA, and considerable number of organizations not included into the given group) Lack of further activities plan
Challenges in the further response Epidemic challenges to the epidemics Considerable territorial specificity (experience can not simply be extended to other areas - the need to assess the situation in the regions) Structure challenges The lack of conceptual model of the epidemic both at the state level and at the level of individual organizations. Success in changing the awareness of vulnerable groups with the absence of significant progress in changing the risky behavior The current reduction in funding and lack of certainty in the future prospects of prevention financing among vulnerable groups
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