Ukrainian site assessments produce valuable results for SUNRISE

01 August 2005

At a recent meeting of projects that are implementing the USAID HIV/AIDS strategy in Ukraine, Alliance Ukraine presented a summary of preliminary results from participatory site assessments (PSAs) supported by the Scaling up the National Response to HIV/AIDS through Information and Services (SUNRISE) project. SUNRISE is a USAID project to scale up and strengthen prevention work with communities most vulnerable to HIV/AIDS in Ukraine.

Results

Through participatory site assessments in 12 sites*, 13,723 people were contacted, interviewed and informed about the process and members of vulnerable populations received information on HIV, safe behaviour and services available to them. Six Ukrainian trainers were selected and prepared to train PSA teams in all regions. Over 104 members of key populations were recruited and trained in PSA methodology. Up to ten workshops were conducted in each site with representatives of the vulnerable groups to gather information relevant to establishing strategic and effective prevention programming for these communities. Overall, over 1,000 representatives of vulnerable groups were trained and interviewed during these workshops. In this way the PSAs have proven not only to be an effective way of collecting data, but also to be a valuable prevention intervention, and empowering for members of populations most vulnerable to the HIV/AIDS epidemic (key populations).

The participatory site assessments were carried out by key populations in Ukraine including sex workers, injecting drug users, men who have sex with men and people living with HIV/AIDS. The aim of the assessments was to:

  • estimate numbers of key populations;
  • assess key populations’ vulnerability factors and HIV/AIDS services;
  • set up site co-ordination groups to design and co-ordinate services to address these needs.

Key subgroups and risk behaviours

  • Female injecting drug users are more likely to be vulnerable to HIV than male. They are less mobile and more likely to have unprotected sex while taking drugs. They also report being more stigmatised and less willing to disclose their HIV status.
  • Some key population group members (sex workers in particular) mentioned difficulties in accessing sexually transmitted infection (STI) diagnosis and treatment services. Improper, often self-treatment of STIs may lead to higher vulnerability to HIV.
  • Changes in the drug scene, such as injecting drug users becoming more mobile are leading to increases in unsafe behaviour; large quantities of drugs may be bought from a shared syringe and injected on the spot, without clean equipment being available. There are also some ‘new’ site-specific misconceptions about HIV transmission, such as that a syringe used for muscular injection is ‘clean from HIV’ compared to the syringe used for intravenous injection.

    These findings will allow more focused and effective project efforts in future phases.

Geographic priorities and service gaps

Areas of high concentration of injecting drug users, sex workers and men who have sex with men were also identified in each site, which will allow service providers to define geographic priorities correctly and to concentrate prevention interventions in the most appropriate locations.

Maps of the mobility of injecting drug users and sex workers were developed. Information on mobility will help to improve the planning of activities on a geographical basis.

Gaps and constraints in services in each site were identified, and ideas for how to address them were included in a comprehensive intervention package, developed and agreed upon by the SUNRISE implementation group and PSA teams. The package of services is to be introduced in all regions of the SUNRISE operation using both funds from SUNRISE and other sources.

Estimating numbers of key populations

From the participatory site assessment (PSA), the number of injecting drug users in 12 sites was estimated to be 111,051, the number of sex workers 7,469, and the number of people who were both sex workers and injecting drug users 3,639. However, these estimates may be lower than the reality as members of key populations can operate in closed groups and be reluctant to provide information.

For this reason, the number of men who have sex with men, and male sex workers in most sites is not considered reliable. Ensuring access to these groups and reaching them with innovative prevention services and advocacy initiatives will need to be one of the objectives of further SUNRISE programme activities.

SUNRISE is implemented by the International HIV/AIDS Alliance in a consortium with the All-Ukrainian Network of People Living with HIV/AIDS and Program for Appropriate Technology in Health. In addition to prevention work, SUNRISE aims to increase care and support to those living with and affected by HIV/AIDS, to further develop voluntary counselling and testing through strengthened synergies between prevention and care services, and to strengthen the ability of local institutions to deliver vital prevention and care programmes.

*The 12 sites where the SUNRISE project is working in its first year are Simferopol, Sevastopol (Crimea); Dnipropetrovs’k, Krivy Rih, Pavlograd (Dnipropetrovs’k oblast); Odesa; Donets’k, Makiivka, Mariupol, Horlivka (Donets’k oblast); Mykolaiv; and Kyiv city.