Activities

Child Health and Development Programme

HIV/AIDS, Children and Youth Programme

Child Protection Programme

Advocacy, Information and Social Policy Programme

 

HIV/AIDS, Children and Youth Programme

© UNICEF/2005/UKRA/01007/Pirozzi
Denis, 20 with psychologist talking about HIV prevention in the Youth Friendly Clinic established by UNICEF in Odessa.

Ukraine has been experiencing one of the fastest growing HIV epidemics in the world [1]. It currently has one of the highest rates of HIV infection in Europe. As of January 2014, 139,543 persons were registered as living with HIV (0.31 per cent of the total population) and 29,005 living with AIDS (0.064 per cent) in the country. Estimated HIV prevalence among those aged 15 and older is 0.62 per cent, one of the highest rates in Western Europe and CEE/CIS. The HIV epidemic is still concentrated among most-at-risk populations.

As of 1 January 2014 the highest rates were recorded in Dnipropetrovsk oblast (697.8 per 100,000), Odesa oblast (687.6), Donetsk oblast (644.5) Mykolayiv oblast (621.1) population, and Sevastopol (480 per 100,000). This is because recession during the 1990s in the south and east of Ukraine heavily influenced the huge expansion of the outbreak.

Around 85-90 per cent of all new HIV infections in the late 1990s were among people injecting drugs, and injecting drug use was the main route of infection in newly diagnosed HIV cases until 2007. While heterosexual transmission during unprotected sex became the primary route in 2008, this was still driven by injecting.

The recent sharp increase in infections outside vulnerable groups and in young women in particular suggests that the coming years will be decisive for addressing the HIV/AIDS epidemic in Ukraine.

Women are more prone to the infection due to their biological and social vulnerability, which can include engaging in commercial sex work to provide funding for drugs for their male partners, as well as sexual contact with injecting-drug using partners. Women now represent 45 per cent of all adults living with HIV in Ukraine.

In 2013 HIV prevalence among pregnant women was 0.39 per cent, one of the highest in Europe. A total of 3.5 per cent of pregnant women living with HIV reported active drug use during late pregnancy. lthough, a positive trend is observed since 2008 when HIV-infected pregnant women percentage amounted to 0.55.

According to Ministry of Health statistics, 36,557 children were born to HIV-positive mothers between 1995 and 2013, of whom 26,403 are HIV-negative, 2,929 are HIV-positive, 6,899 are children under the age of 18 months awaiting confirmation of their HIV status, 829 have AIDS and 326 children have died of AIDS.

In 2013, 3,386 pregnancies were registered to women living with HIV in Ukraine, about 0.97 per cent of all births that year in the country. Ukraine has the highest coverage of Prevention of Mother-to-Child Transmission (PMTCT) services in the CIS region, including a very high rate of HIV-positive pregnant women receiving ARV prophylaxis (96.2 per cent in 2013).

The analysis of data for most at risk adolescents (MARA) aged 10 to 19, based on data of the behavioural surveillance studies among most at risk populations (IDUs, MSM and FSWs), shows that MARA represent a population group in need of special attention within the frame of the national AIDS response. Risk behaviour among this group starts very early, overlapping risk behaviours are common, while HIV/AIDS knowledge, skills and particularly access to adequate HIV prevention, treatment, care and support services is extremely low – much lower than among their adult counterparts, as this population group faces a wide range of access barriers. Many of the existing prevention and harm reduction services are not targeting MARA, e.g. the national estimate for the access of children living or working on the streets to HIV services is less than 1 per cent.

In general comprehensive knowledge about HIV prevention remains fairly low. According to Ukraine MICS 2012, only 53.8 per cent of women and 46.7 per cent of men were found to have comprehensive knowledge about HIV/AIDS. Although 90.6 per cent of women know where to get tested for HIV, only 62.9 per cent have actually done so. Despite the fact that 87.3 per cent of men know where to get tested, only 52.2 per cent of men have done so.

Research conducted in 2012-13 found that only 10 per cent of adolescents and young people have lifetime experience of HIV testing: the figure is 15 per cent for girls but only 7 per cent for boys. Only 28 per cent of respondents correctly identified the ways of HIV transmission [3].

Current trends of the HIV epidemic prove that more emphasis should be placed on prevention among most at risk adolescents and youth, information outreach to the general public to prevent discrimination of HIV-affected people, children born to HIV-positive mothers survival, care providers capacity building and increasing of quality of existing system of treatment, care and support for those who already affected by HIV/AIDS.

Action: Protecting children and women from HIV/AIDS

UNICEF is assisting the government to address the threat of a full-blown outbreak of HIV/AIDS in Ukraine while at the same time protecting the rights of those infected by:

  • Working with government partners to strengthen the national policy response to the epidemic so that the rights of the children and women living with HIV will be respected.
  • Supporting the development of youth-friendly health services throughout the country and by introducing a system that will monitor the quality and accessibility of services.
  • Helping the government and civil society to create a knowledge base of socially disadvantaged and therefore especially vulnerable adolescents, and create services that will prevent them from engaging in high-risk behaviour.
  • Providing children and youth both in and out of school with the life skills they need to protect themselves from HIV infection.
  • Preventing mother-to-child transmission of HIV by strengthening the capacity of health care facilities to provide preventive measures, including voluntary testing and counselling for pregnant women as well as antiretroviral treatment for those who are HIV-positive.
  • Advocating for the provision of antiretroviral therapy for women and children.

Impact:

The Government of Ukraine, in collaboration with civil society partners, developed a Road Map to Universal Access for HIV Prevention, Treatment and Care, with technical and advocacy support from UNICEF and its UN partners. The document emphasises children and adolescents as an especially vulnerable group and the need to provide them with special consideration in prevention, treatment, care and support.

UNICEF supported the government in developing and implementing the first National Programme Prevention of HIV Transmission from Mother to Child for 2001-2003. Today UNICEF is building the capacity of health care providers. An evaluation of the National Programme in 2007 found that it had helped to reduce transmission by two thirds, from 27 per cent in 2000 to 4 per cent in 2011.

To respond to the needs of children and families affected by HIV, UNICEF has supported community-based Day Care Centre models in Kiev, Odessa, Kherson, Mykolayiv and Krivyi Rig and Autonomous Republic of Crimea. The centres provide HIV-positive children with a place where they can communicate with other children, receive care and prepare for school. Parents receive advice in the Centres on how to care for their children, as well as psychological, legal and social support.

In light of most-at-risk adolescents being at the core of the deteriorating HIV/AIDS epidemic in Ukraine, UNICEF and the Government of Ukraine pursued a new focus vis-a-vis most-at-risk adolescents (MARA) and HIV, thereby covering a major gap in the national HIV prevention response and building a sound database and evidence-based approaches targeting MARA. Knowledge base on MARA was created; strengthened with the understanding of their behaviour, behavioural determinants and service coverage. MARA issues have been included in the 2009-2013 National Programme on HIV/AIDS and the national M&E system. UNICEF supported the HIV Education interactive programme provided in the juvenile detention facilities.

UNICEF was instrumental in ensuring that HIV-prevention is included in the Secondary School Education State Standard.

Drug education programme was developed to prevent alcohol and drug abuse among students of grades 1-12 in Ukrainian schools. The programme will be further integrated into the wider educational system through an education curriculum of class-masters.

UNICEF’s pilot project on HIV prevention among injecting drug users has been recognised as a success by the government and is being expanded across the country. 216 needle exchange programmes for injecting drug users are now operating.

UNICEF helped to integrate youth friendly services into primary level paediatric polyclinic services and the Social Services for Family, Children and Youth. Today there is a network of more than 100 Youth Friendly Clinics operating in the country Some 400 professionals are trained and are currently implementing “youth-friendly” techniques at their workplaces. The quality standards and evaluation criteria for services in youth friendly clinics (YFCs) have been drafted including certification procedure and staff excellence guidance.

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[1] UNAIDS, 2013
[2] Ministry of Health, Information Bulletin 41, 2014, at http://ucdc.gov.ua/attachments/article/586/ВІЛ-інфекція%20в%20Україні.%20Інформаційний%20бюлетень.%20№%2041.pdf
[3] O Balakireva et al, Comprehensive Study on Motivation and Accessibility of VCT on HIV for Children and Youth, 2013 at http://www.unicef.org/ukraine/ukr/3_ukr_compleksne_
doslidzheniya_motivacii.pdf  

 

 
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