Blame & Banishment - Médecins du Monde

Blame and Banishment: The underground HIV epidemic affecting children in Eastern Europe and Central Asia
self-acceptance, lack of information and access to services. Given widespread homophobia,
they fear disclosing their identity and sexual orientation. Mistrust in government services is
high because of judgmental attitudes and lack of confidentiality. As expressed by a young
MSM from Moldova:
“I wish for a service that will truly keep all secret… not look at you strangely… the
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provider should be engaged in solving the patient’s problem with a kind attitude.
Unmet needs of the marginalized
HIV/AIDS programming for youth in the region has largely focused on prevention education
aimed at the general population of young people using information campaigns, school and
life skills-based curricula, and to some extent peer outreach and youth-friendly services.
Even peer-led programmes in the region tend to focus on young people in formal settings,
such as schools and youth clubs. Many of these mainstream interventions, however, fail to
adequately address the specific risk behaviours and environments of especially vulnerable
young people and tend to be insensitive to the many factors that influence their risk taking.
Too often, a ‘moralistic’ stance is assumed that ‘risk taking should not occur’, and evidence
on effective approaches to support and prevention is overlooked.
Much more needs to be done to improve the appropriateness of services for young people and
their access to them. The large majority of interventions for vulnerable or high-risk groups in
the region are oriented towards adult populations. Civil society organizations working with
at-risk populations are often reluctant to provide services to under-age populations for fear of
legal or other repercussions, such as accusations by the public of promoting risky behaviours
to minors. In some cases a ‘don’t ask, don’t tell’ approach is employed – services are provided
without asking questions – however, the problem remains hidden and underground.
At the same time, young drug users may be reluctant to access adult services because
of concerns about privacy and confidentiality, or because they feel that peer education
messages, designed for older users, are irrelevant to them. Oftentimes, they are right. For
example, very few interventions in the region specifically target recent initiates to injecting
drug use or those who inject only occasionally. A needle and syringe exchange has little
to offer young people who use drugs but do not inject. Methadone treatment may be
inappropriate for non-dependant drug injectors. As a result, rates of drug use and HIV risk
behaviour are increasing in younger populations.
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