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In Ukraine, providing holistic health care to sexually exploited adolescents and other at-risk youth

© UNICEF Ukraine/2010/Pirozzi
Two girls forced into sex work stand in Mykolayiv, Ukraine.

By Veronika Vaschenko

UNICEF’s flagship report, ‘The State of the World’s Children 2012: Children in an Urban World’, will launch tomorrow, 28 February, focusing attention on children in urban areas. One billion children live in urban areas, a number that is growing rapidly. Yet disparities within cities reveal that many lack access to schools, health care and sanitation, despite living alongside these services. This story is part of a series highlighting the needs of these children.

MYKOLAYIV, Ukraine,  27 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, who was her only surviving relative after her parents died, and what happened after she was thrown out of the house.

When she finally opened up, she recounted being forced into sex work at age 15. She found herself having unprotected sex and abusing drugs and alcohol.

“I do not want to talk about it, and I don’t want to remember it,” she said.

Anya’s story is one familiar to thousands of adolescent girls in Ukraine, most of them from poor or abusive families. Anya comes from the city, but she knows many girls from rural areas who migrated to cities across the country to seek better paying jobs or to flee family strife. Such girls are particularly vulnerable, as they have little or no support from family and friends.

Facing high HIV risks

There are an estimated 15,000 adolescent girls exploited by sex work in Ukraine. A UNICEF-supported study of adolescents living and working on the streets of major cities like Kyiv and Mykolaiv found that almost 60 per cent of the girls started to sell sex before age 15. 

These girls are particularly vulnerable to HIV. Ukraine’s adult HIV prevalence is 1.1 per cent – the highest in Europe and Central Asia, and  annual diagnoses of HIV have more than doubled since 2001. HIV prevalence is also higher in Ukraine’s cities, where populations are denser. In 2007, 78 per cent of HIV cases were registered in urban areas.

The HIV epidemic in Ukraine has also been fuelled by injecting drug use, an activity that girls exploited in sex work are vulnerable to. According to a 2008 study, 19 per cent of adolescent female sex workers reported using injecting drugs, essentially doubling their risk of HIV infection.

© UNICEF Ukraine/2010/Pirozzi
A girl talks to a counsellor at a UNICEF-supported community center that provides services to sexually exploited adolescents. The centre offers medical consultations, social support and information on HIV/AIDS prevention.

Despite these vulnerabilities, adolescent sex workers are often excluded from the services that should protect them. Stigma and discrimination are barriers to critical social and health services, as are girls’ fears of being reported to the police or institutionalized.  
Reaching girls most at risk

To address this, UNICEF recently implemented an innovative service delivery model in Mykolayiv, with the aim of reducing adolescent girls' 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 began fostering a more supportive environment for at-risk girls, even empowering 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. With help from the drop-in centre, she was finally able to access health care. “I went to a gynecologist. I also talked to a psychologist,” she said. “I do not know what would have happened if I had not gone to them.”

Anya is one of the lucky ones. She was not 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. 

Advocating for less punitive policies

Because of the results in Mykolayiv, the National AIDS Programme and State Social Services now recognize girls exploited in sex work as an essential constituency for services. A law, enforced since December 2010, allows adolescents between ages 14 and 18 to obtain HIV tests without parental consent.

UNICEF aims to make these services available around the country and to keep them adequately resourced, but challenges remain. Most legislators and other officials who control the budgets for these services believe that those involved in high-risk behaviors – including young people who inject drugs, sell sex and or live on the streets – should be punished rather than helped.

Anya, meanwhile, managed to turn her life around. Through the holistic services at the drop-in centre, she learned how to protect herself from HIV and other sexually transmitted diseases. She quit drinking, left sex work, and reconciled with her grandfather. After returning home, she went back to school. She has since graduated.

*Name changed to protect identity



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