Blame & Banishment - Médecins du Monde

Blame and Banishment: The underground HIV epidemic affecting children in Eastern Europe and Central Asia
Fortunately, some innovative efforts, not only to prevent HIV and reduce harm of drug
injecting but also to reduce initiation into injecting among youth, are beginning to emerge. In
Albania, for example, UNICEF and NGO partners are piloting an HIV prevention programme
to ‘break the cycle’ of initiation into drug injecting. Most young people are introduced to
injecting drugs not by dealers but by peers and siblings, who often then regret their role
in perpetuating the vicious cycle of addiction and risk. The ‘Break the Cycle’ programme
recruits IDUs through methadone substitution treatment services and mobile outreach
teams, with the aim of promoting non-injection messages and behaviours and dissuading
established IDUs from initiating others into injecting.
Adolescents selling sex: Service provision and empowerment
An innovative service delivery model has been developed in Mykolayv, one of the cities in Ukraine most affected by HIV, where one fifth
of female sex workers are adolescents – 98 per cent of whom have engaged in unprotected sex during the previous year, while 16 per cent
have injected drugs. 25
With the aim of reducing risk and vulnerability, non-governmental organization (NGO) outreach workers bring girls to a drop-in centre
that offers a safe space, counselling, and referral to governmental health and social services. Work with child protection services, the
police and the education sector is undertaken to foster a more supportive environment for these girls at risk, and they are empowered to
actively participate in service planning, implementation and evaluation.
Mobile phones are used to facilitate contact – to invite them to project events, remind them about appointments with health-care and
social workers, enable emergency calls (in case of detention, abuse, conflicts) and to provide phone-based counselling. These phones,
an everyday feature of the youth subculture, have proved to be a very efficient communication tool, allowing girls to openly discuss their
risk behaviour and seek advice as needed. In Mykolayv, 90 per cent of adolescents selling sex now have mobile phones and regularly
communicate with staff and each other. Demand for the services has far exceeded expectations. The involvement and support of the
Mykolayv municipal authorities have been critical to the centre’s success, and will ensure sustainability in the future.
Young MSM: Hidden and underserved
Throughout the region men who have sex with men (MSM) constitute one of the most hidden
segments of society. HIV infections among MSM are systematically under-reported. 28 Little
is known about their risk behaviour including the extent of their involvement in commercial
sex. Assessments conducted with MSM in several countries of the region indicate that
same sex relationships start at a young age. In a study among 500 MSM in Serbia, close to
half reported first male-to-male sex before the age of 18, and 22 per cent of the respondents
in Belgrade before the age of 15. 29 Young MSM in the region report having problems with
22