Journal club presentation

1. Joanna R Busza, Olga M Balakireva,
Anja Teltschik, Tatiana V Bondar,
Yuliya V Sereda, Clea Meynell,
Olena Sakovych
Presenter
Dr Fredrick Stephen
PG in Community Medicine
MGMCRI
Pondicherry

2. • Ukraine has the highest HIV prevalence in Europe,
estimated at 1.63% of adults aged 15-49 years.
• HIV remains concentrated among most-at-risk populations,
namely injecting drug users (IDU), female sex workers
(FSW) and men who have sex with men (MSM).
• The growing numbers of adolescents living without parental
care in the region has led to increased concern for this
group’s vulnerability to HIV.

3. • Globally, homeless and street based adolescents are
vulnerable and experience multiple adverse health
outcomes.
• This research formed part of UNICEF’s first HIV
prevention program that explicitly defined and targeted
most-at-risk adolescents

4. • To measure the extent and distribution of HIV risk
behaviors among street based adolescents aged 10-19
years in four Ukrainian cities.
• To increase the availability of data on at risk adolescent
populations.
• To implement evidence based interventions and evaluate
their outcomes.

5. Cross Sectional behavioral study
(n=805)
Ukraine
• Location Based Network and Convenience sampling
Kiev Donetsk Dnepropetrovsk Nikolaev

6. • Type of study : Cross Sectional study
• Place of Study : Ukraine ( Kiev, Donetsk, Dnepropetrovsk,
Nikolaev)
• Sampling Method : Location Based convenience and
Network sampling
• Materials used: A Standardized questionnaire developed for
the UNICEF program containing core modules on drug use
sexual behavior, condom use, HIV knowledge and access to
prevention services was used.

7. Inclusion criteria
Adolescents aged 10 to 19 years
Subjects spending at least 50% of their time in streets
and not attending school or being engaged in
employment
Should have spent at least 3 months on the streets
Subjects who appear sober and capable of giving
consent
Exclusion Criteria
Who did not look sober
Those who didn’t spent time on the streets at least for 3
months

8. • Table 1 Characteristics of adolescents
Sl
no
Demographic
Background
Total
n
%
1 Sex Male 565 70.2
Female 240 29.8
2 Age, years 10-14 305 37.9
15-17 351 43.6
18-19 149 18.5
3 Living arrangement Live with adult
relatives
333 41.4
Live with friends 419 52
Ever Institutionalised 459 57
4 Educational status Never attended
school
30 3.9
Up to full elementary 154 19.4
Up to basic
secondary
585 73.8

9. Table 2: Drug Usage
Sl
no.
Demographi
c
Background
Total
N
%
1 Injecting drugs (Ever Use) 125 15.5
IDU injecting in the past month 65 53.3
IDU past month sharing
15 44.1
needles
2 Use of
services by
IDU
Obtaining needles from
pharmacy
69 55.2
Obtaining needles from needle
exchange or outreach
14 11.2
MIaDjUo-rIintyje cintinitgia dtreugd U insejerscting between ages 14 and 16 yrs now
inject at least weekly.
Among IDU 72.7% used sterile injecting equipment.
18.4% picked up used needles/syringes off the street.
Only 8.9% used needle exchange programme in the past
year.

10. Table 3 : Gender differences in vulnerability
Sl
no.
Male
N
% Femal
e
N
% P
value
1 Risk Behaviors
Ever had vaginal sex 389 69.7 196 82.4 <0.001
Ever received payment gift for sex 93 16.5 136 56.7 <0.001
Unprotected sex at last casual sex 136 54.4 48 50.5 0.520
Unprotected sex at last
12 57.1 34 35.8 0.070
commercial sex
(MSM and FSW)
Ever injected drugs 92 16.3 33 13.8 0.364
2 Service Use
Receive Condoms from outreach 7 1.2 33 13.8 <0.001
Ever had HIV test 113 20 66 27.7 0.019
FSW- Female sex worker; MSM- Men who have sex with men

11. • Overall , 73.5% of the sample reported having vaginal sex.
• 76.1% experienced sexual debut before the age of 15 years.
Table 4: Partner Accumulation in the past 12 months
Sl
no:
Rate of Partner accumulation Mean
1 Boys 4.7 partners
2 Girls 4.9 partners
• Majority of girls who received payments/gifts for sex did so
for the first time between 12-16 yrs.
• Among sexually active girls, 18.3% have ever been
pregnant
• 68.2% of them obtained an abortion.

12. Table 5: Violence on Adolescents
Sl
no.
Male
n
% Femal
e
n
% P value
1 Violence
Ever Forced to have sex 60 11.2 107 52.2 <0.001
Ever harassed by police 468 82.8 140 58.3 <0.001
50.1% of respondents have ever been incarcerated in prison
/ juvenile detention.
70.9% had been subjected to forced sex in the past 12
months.
75.5% have been stopped or harassed by the police in the
past.

13. • The research clearly shows that street based adolescents in
Ukraine are at a significant risk of contracting HIV.
• This group initiates risk behaviors at early ages, and does
not appear to have good access to prevention.
• Carefully designed appropriate services to increase contact
and trust of street-based youth are required to provide them
with harm reduction and child protection.

14. • The high rate of pregnancy among this group could serve
as an opportunity to reach out for reproductive and
maternal health services and even assist the girls in
evaluating their life choices.
• The assessment of family situation and targeted support
activities could help reduce the vulnerability of some
individuals.

15. • The exact period of study and duration is not mentioned.
• Females are represented less (29.8% only) hence scope for
more bias.
• Only 12.3% of the respondents knew the results of the HIV
tests undergone by them.