Estimating early HIV risk among at risk adolescent girls and young women in Dnipro, Ukraine
Authors: Becker M., Balakireva O. M., Isac S., Cheuk E., Pavlova D. M., McLarty L., Mishra S., Pickles M., Lorway R., Sandstrom P., Blanchard J., Nugent Z.
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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.