Blame & Banishment - Médecins du Monde

Blame and Banishment: The underground HIV epidemic affecting children in Eastern Europe and Central Asia
Behaviours that put adolescents and young people most at risk of HIV include engaging in
multiple unprotected sexual partnerships and injecting drugs with non-sterile equipment. A
host of factors, situations and circumstances influence risk taking. Peer pressure, curiosity,
and thrill seeking sometimes lead to experimentation with drugs, alcohol and sexuality.
Similarly, family problems may trigger or accelerate risk taking among youth, with many
at-risk youths in Eastern Europe and Central Asia reporting poor relationships with parents
and other family members. Deeper structural issues such as unemployment, poverty, crime,
trauma, illegal status, conflict, and marginalization also drive risk taking, with substantial
numbers of young people turning to drugs and sex work as a means of coping or escape.
Who is at risk?
Assessing the size of the population of adolescents and young people at greatest risk of
HIV and their contribution to the AIDS epidemic is complex. The issue can be addressed in
two different ways. One is by estimating what is the proportion of most-at-risk populations
(MARPs) who are minors. For example, what proportion of IDUs are adolescents or what
proportion of females selling sex are minors? The other is by looking at what proportion
of broader adolescent populations engage in behaviours that put them at high risk of HIV
infection. For example, what proportion of Roma adolescents sell sex or what proportion
of institutionalized young people inject drugs? Both approaches capture ‘most-at-risk
adolescents’ (MARA). While their risk profiles may differ, the imperative for prevention,
treatment and support is equally urgent.
The situation among MARA is particularly bleak. In Ukraine, adolescent girls aged 10–19
who sell sex comprise an estimated 20 per cent of the female sex-worker population.
Moreover, in 2006, HIV prevalence among females aged 15–19 selling sex exceeded
19 per cent compared to 1.4 per cent in the general adult population. 21 Many of these
adolescents and young women do not seek the help of services as they fear police harassment
or being sent to state institutions. Worrisome evidence across the region suggests that risk
behaviours are increasing among younger cohorts. In Tajikistan, for example, recent initiates
to injecting drug use are twice as likely to be HIV-infected as those with longer injecting
histories, implying riskier HIV behaviours and potentially less use of harm reduction services
than older, more established users. 22
Risk is exacerbated by the overlapping vulnerabilities that young people experience. Figuring
among the most-at-risk are adolescents and youth from disadvantaged or troubled families,
those who have dropped out of school or are unemployed, juvenile offenders engaging in
petty crime, or those ‘graduating’ from institutions unprepared and without support to face
life on their own. They are young people whose rights to care and protection have been
violated, and who suffer indignity, social injustice and exclusion on a daily basis.
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