2002 UKR: Evaluation of Project HIV Prevention Among Young IDUs (10 regions of Ukraine) Plus KAP Results
According to the statistics concerning HIV/AIDS for 1987-June 1, 2001, there were 39,752 officially-registered, HIV-infected citizens in Ukraine. 28,875 of them were people using drugs intravenously. The prevention of HIV-infection among injection drug users is complicated by the fact that this target group is closed, hardly accessible, but at the same time, it desperately needs intervention. Until 2000, preventive work using harm-reduction strategy was done mainly by non-governmental organisations that were financed by donor organisations. Now, there are Social Services for Youth Centres headed by the State Social Services for Youth Centre (SSSYC) working along with these NGOs. The joint project of the SSSYC and UNICEF, HIV/AIDS Prevention among Young People Using Injection Drugs, involved the creation of Trust counselling stations that work directly with the target group. They provide counselling (psychological, medical, social, legal etc.), syringe exchange, condom distribution, disinfecting solutions, informational educational materials and outreach work.
Purpose / Objective
- To evaluate the results reached by the project (2001-2002) against its objective: to build the capacities of social services for youth in the field of HIV prevention among young IDUs
- To analyse and describe the monitoring and evaluation system developed and established for the purposes of the project, for its further scaling up
The final evaluation was done September 17-23, 2002 in 14 cities of Ukraine - Sevastopol, Novovolyns'k (Volynska region), Makijivka (Donetsk region), Melitopol (Zaporizhja region), Chervonohrad (Lviv region), Mykolajiv, Biljajivka (Odesa region), Kharkiv, Chernihiv, Yalta, Dnipropetrovs'k, Nikopol, Kryvyj Rih, and Dniprodzerdshyns'k (Dnipropetrovs'k region). Anonymous one-on-one structured interviews were conducted by 52 interviewers from the State Institute of Family and Youth Affairs, who are constantly working as part of the existing network of interviewers. 1,997 injection drug users, 14 years old and older, were interviewed.
623 of the interviewed injection drug users used the services of the Trust counselling stations in 9 cities: Sevastopol, Novovolyns'k (Volynska region), Makijivka (Donetsk region), Melitopol (Zaporizhja region), Chervonohrad (Lviv region), Mykolajiv, Biljajivka (Odesa region), Kharkiv and Chernihiv. A certain portion of questions coincided with the questions that were asked during the initial evaluation. At the same time, the questionnaire included new questions about knowledge, attitude and practice of injection drug users.
Key Findings and Conclusions
Regarding the implementation of HIV/AIDS Prevention among Young People Using Injection Drugs Project, project activities fit the urgent needs of the target group representatives. Individual kinds of work under the project are inter-related and correspond to the general mission of the project - that is, the amplification of the opportunities of the SSYC in terms of preventive work among injection drug users through Trust counselling stations. The attitude of the target group representatives to the work of the project is, in general, positive. However, there is a problem of negative public opinion towards injection drug users and the work of such projects.
The evaluation of the effectiveness of the work of Trust counselling stations showed that certain positive changes took place at all levels of project influence -- individual, social environment and political levels.
The following positive shifts were registered at the individual level:
- the proportion of those who always use only a sterile new syringe for each injection; those who, after injection, disinfect their syringe with a special disinfecting solution; as well as those who never use drugs with other people using the same shared syringe, has increased
- most of the interviewed young people using injection drugs are in monogamous relationships with sexual partners
- the proportion of injection drug users who always use condoms also increased
- a significant part of the users of the services of the stations are aware of the risks related to using drugs with a syringe
- a large percentage of the users of the services of Trust counselling stations started applying the following measures of prevention: using only sterile syringes and needles; treating instruments used for injections; and using condoms
At the level of social environment:
- in specified cities, fruitful work was done in order to lower social tension, improve psychological macro climate and decrease negative public opinion, at least in the social environment that exists around injection drug users
- a team of like-minded individuals was formed who, through common effort, are solving the problem of counteracting the HIV/AIDS epidemic in the environment of injection drug users at the city level
- working relationships with local mass media was established involving co-operation in preventive work, creating a positive image of the SSYC counselling stations and coverage of their work
- constructive contracts have been signed with target group representatives and their co-dependents; ways of reaching them through support groups and volunteer movement are planned
- volunteer movement experienced great expansion; now it involves not only injection drug users, but also youth that does not use drugs, parents, and specialists of different fields
- SSYC volunteers' selection and training is done on a regular basis
- State Social Services for Youth Centre is constantly providing methodical support for the work of the project, with 2 methodical manuals published
- Working relationships with other state and non-governmental organisations have been established involving joint preventive work
At the political level, we can outline the following positive tendencies:
- a positive image of Trust counselling stations was created at the level of local authorities
- support for the expansion of the network of Trust counselling stations as one of the priorities of the SSYC
- constant increase of financial support of the SSYC Trust counselling stations from the local budget
- ways of financing the work of the stations from the local budget are always sought
- in some cities, work to create new and expand the activities of the existing SSYC Trust counselling stations was taken to the regional level (Donets'k, Kharkiv and Odesa regions)
- some programmes of activities in the area of HIV/AIDS prevention among injection drug users developed by project implementing agencies became the basis for regional programmes for contracting HIV-infection epidemic (Donets'k region)
- constant informational flow to local authorities has been set up on the implementation of preventive programmes and the work of the project
The effectiveness of the HIV/AIDS Prevention among Young People Using Injection Drugs Project and the work of the SSYC Trust counselling stations in all the designated for research cities, in particular, can be evaluated as high. Despite the fact that project implementing agencies faced numerous difficulties and obstacles, they managed to gain rich experience, make certain steps ahead by way of the creation of a network of counselling stations for young people using injection drugs, and create a foundation for continuing this work.
Continue to develop and expand this important work, taking into account project implementation experience and knowledge. It is extremely important to preserve and develop established relationships with other preventive programmes, different organisations and institutions. Continual financing by the government is required for successful project implementation.
In order to continue the work of creating a positive environment for injection drug users, deliberate, informational educational work needs to be done broadly in order to shape tolerant public opinion toward drug addicts and Trust counselling stations that provide them help. For this purpose, it is expedient to use a larger variety of mass media.
Informational, educational work also needs to focus on the representatives of the social environment of young people using injection drugs - meaning co-dependents, their parents and other relatives. For this purpose, they need to be more involved in volunteer activities and participate in self-support groups.
Legal statutory support of the work for better co-ordination and harmonisation of actions with law enforcement offices and medical institutions is necessary.
In order to help specialists to work in the area of HIV-infection prevention among injection drug users, with the specifics of working at Trust counselling stations, it is vital and timely to create a system of continuous, scientific support.
In order to involve volunteers from among youth and experts from different fields, a system needs to be developed that would motivate, encourage and support them.
In order to reach the latent part of injection drug users, constant attention needs to be paid to "street work" through the creation of field stations for counselling work, employing peer educators, as well as new technologies and methods of involving injection drug users in HIV/AIDS prevention.
For the professional development of recruited specialists, it is expedient to continue to systematically exchange experience and teach new methods and technologies through organising seminars, training courses, round table discussions and conferences.
Accumulated experience needs to be disseminated and spread to other regions and cities of Ukraine. For this purpose, additional funds to finance this activity are needed.
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