final program.qxd - Parallels Plesk Panel

Given the high HIV prevalence in IDU populations, with high rates of sex with non-IDU
partners and sub-optimal condom use rates, the risk of "firs-wave" transmission through
non-commercial sex might be high. Commercial sex acts are also likely to be important in
terms of generating significant heterosexual transmission in non-IDU populations, since
here there is the potential for multiply unprotected sexual contacts with large numbers of
different non-IDU clients.
Evidence suggests that the number of female sex workers (FSW) in countries of Eastern
Europe has increased exponentially following the collapse of the Soviet Union. There also
appears to be a high degree of overlap between injection drug use and commercial sex.
Estimates of the proportion of female sex workers who inject drugs vary between 25% and
80%. In Mykolaiv 32% of sex workers were HIV positive, while in Donetsk, Lutsk, Poltava,
and Odesa the corresponding figure ranged from 25% to 29% in 2005. Data from the
recent nationwide study showed that 58% of the female sex workers in Ukraine had from
5 to 25 clients per week, consistent use of condoms was relatively low (54% during the
month prior to the interview), 45% of the FSW had IDUs and 25% had bisexual or
homosexual men among their clients. Thus, FSW might be considered to be an HIV
bridge between IDUs and general population in Ukraine. Moreover, this group might serve
as a bridging population between IDUs and another vulnerable population of special
importance - men who have sex with men.
A limited number of recent studies among men who have sex with men indicate high levels
of risk taking and a high frequency of bisexuality, which has implications for HIV diffusion
into the heterosexual population. In a study in gay venues in 7 cities (886 men), 40%
reported unprotected anal sex, 54% of sexually active persons did not have a permanent
sexual partner, around a third had had both male and female sex partners in the past 6
months, and around 22% had recently exchanged sex for money. About 14% reported a
sexually transmitted infection in the past 6 months. At the same time, injecting drug use
was not appeared to be widespread in this group. Only 6% of the respondents declared
ever injecting drug using.
Although Ukraine decriminalised consensual sex between adult men in 1991, men who
have sex with men are still largely inaccessible to sentinel research due to stigmatization.
Yet, there are signs that prevalence in this population group could be very high. In the
sentinel surveillance conducted in 2005 among men who have sex with men, five of
26 men in Odessa were found to be HIV-positive, as were two of the 23 men tested in
Mykolaiv. Knowledge and awareness of AIDS among this population is also poor, and risky
behaviour appears widespread. In a study in seven Ukrainian cities, only 55% of men said
they had used a condom the last time they had sex with a man.
Numbers of newly reported AIDS cases in Ukraine began to rise dramatically in the
mid-1990s, from 45 in 1995 to 4,222 in 2005 (120% increase compared to 2003). Likewise
for AIDS deaths: from 20 in 1995 to 2,185 in 2005 (70% increase compared to 2003).
At the same time, not all those who died of tuberculosis and other diseases secondary to
AIDS were tested for HIV in their lifetimes, so these numbers do not show the whole
picture.
“ Focusing FIRST on PEOPLE “ 56 w w w . i s h e i d . c o m