A better life for at-risk girls in Ukraine
MYKOLAYIV, Ukraine 12 February, 2012 — Anya does not talk much about her teen years in Mykolayiv, one of the most populous cities in southern Ukraine.
She desperately wants to forget the days of fighting with her grandfather, her only surviving relative after her parents died. When she finally opened up, she recounted getting thrown out of the house and being cajoled into sex work by a friend at the age of 15.
“I am ashamed of my former life. I do not want to talk about it and I don’t want to remember it,” she said.
Alcohol and drug-fuelled nights drove her to high risk sex without condom. Her story is similar to those of hundreds of most-at-risk adolescent girls from often poor and dysfunctional families. For girls who fall into sex work, their situation is dire: they routinely face arrest, exploitation and abuse. Prostitution is illegal in Ukraine.
Anya is a city girl but she knows many others from poor rural areas who migrate to cities across Ukraine to seek better paid jobs, greater independence or to flee family strife. Such girls are particularly vulnerable as they have little or no support from family and friends.
Observers note a higher demand for female sex workers in cities than in rural areas. A UNICEF-supported study across 25 cities in Ukraine found that nearly a third of girls surveyed aged 15–19 selling sex reported starting to sell sex between the ages of 12 and 15 years (Data from Desk research report – a review of the evidence on HIV/AIDS and most-at-risk adolescents and young people in Ukraine. By UNICEF, Ukrainian Institute for Social Research, 2008). National level data are lacking on how many poor rural girls come to the cities to become sex workers.
An urgent challenge is the continuing spread of the HIV epidemic, a trend that increases the vulnerability of adolescents and young people who engage in high risk behaviours. Sex workers are often prevented from accessing social or health services from the state, despite Ukraine’s alarming overall HIV infection rate of 1.1 per cent - the highest in Europe.
This HIV epidemic in Ukraine is driven by an explosive mix of injecting drug use and, more recently, sexual transmission. Children and young people constitute a group whose risk of contracting HIV is particularly high. Women now account for some 40 per cent of new cases compared to just 24 per cent under a decade ago (Data from: UNAIDS. The changing HIV/AIDS epidemic in Europe and Central Asia. Geneva, 2004, p. 5).
Mykolayiv is one of the cities in Ukraine most affected by HIV. One fifth of female sex workers here are adolescents and 98 per cent have engaged in unprotected sex during the previous year, while 16 per cent have injected drugs. Up to 11 per cent of adolescent female sex workers are infected by HIV annually (UNICEF (2009) ‘Most-at-risk adolescents: the evidence base for strengthening the HIV response in Ukraine’ – Kyiv, 2009).
To address this, UNICEF recently implemented an innovative service delivery model in Mykolayiv. With the aim of reducing risk and vulnerability, UNICEF and partner outreach workers brought girls to a drop-in centre that offered a safe space, counselling, and referrals to governmental health and social services. Working with child protection services, the police and the education sector have fostered a more supportive environment for these girls at risk, and have even empowered them to actively participate in service planning, implementation and evaluation.
“Despite having had a lot of unprotected sex, I had never visited a doctor,” Anya said. “I went to a gynaecologist. I also talked to a psychologist. I do not know what would have happened if I had not gone to them.”
She is one of the lucky ones not to have been infected with HIV. Of the 42 per cent of adolescent sex workers who accessed services at the drop-in centre, 10 per cent tested positive for HIV (Project data, UNICEF report, 2009).
Anya also managed to turn her life around.
Through these youth-friendly holistic services at the community centre, she learnt about how HIV and sexually infectious diseases are transmitted and how to engage in safer sex. She quit drinking, stopped selling sex, made up with her grandfather and returned home. She even managed to graduate from school.
Because of the results in Mykolayiv, the National AIDS Programme and the State Social Services now recognize, female adolescent sex workers as an essential constituency for services. The national AIDS law, enforced since December 2010, allows adolescents aged between 14 and 18 years to have HIV testing at local AIDS centers without parental consent. This will help rural areas too although there is a dearth of data on most-at-risk adolescents there.
UNICEF aims to have these services rolled out nationally and adequately resourced but huge challenges remain. Most legislators and other stakeholders who control the budgets for these services believe that those involved in high-risk behaviors need to be punished and not helped.
Advocacy for a less punitive legislative and policy environment for young people who inject drugs, sell sex and or live on the streets will continue. Rather than locking up the offenders, Anya, and others like her, may have another second chance in life.