Multicity HIV seroprevalence in street youth, Ukraine.

Multicity HIV seroprevalence in street youth, Ukraine.

Robbins CL, Zapata L, Kissin DM, Shevchenko N, Yorick R, Skipalska H, Finnerty E, Ornstein T, Marchbanks PA, Jamieson DJ, Hillis SD. Int J STD AIDS. 2010;21:489-96.

The authors conducted the first systematic, community-based, multicity assessment outside the USA of HIV seroprevalence, risk factors and linkage into clinical services among 929 street youth. After city-wide mapping, they used time-location sampling and randomly selected 74 venues in Odessa, Kyiv and Donetsk, Ukraine. Rapid HIV testing with post-test counselling was offered to all eligible youths aged 15-24 years. Overall, 18.4% (95% confidence interval 16.2-20.2) were HIV positive and 85% had previously unknown status. Rates were identical by sex. Subgroups with highest rates included orphans (26%), youths with histories of exchanging sex (35%), sexually transmitted infections (37%), injecting drug use (42%) and multiperson use of injection equipment (49%). Independent predictors, similar across age groups and city, included being orphaned, time on the street, history of anal sex, sexually transmitted infections, exchanging sex, any drug use, injecting drug use and multiperson use of injection equipment. Two-thirds (68%) of HIV-positive youths were linked to services. This high-risk population has

Editors’ note: This study makes for sobering reading. The time-location sampling method used here mapped 91 locations where street youth congregate – near fast-food restaurants, recreation areas, computer clubs, and metro stops – and randomly chose 74 sites. Fully 92% of the youths approached met pre-defined eligibility criteria and of these 97% participated. Demographic and social risks such as being an orphan and living with someone who used illicit drugs or who was incarcerated were associated with a 10-fold increase in HIV prevalence compared with the Ukraine national prevalence of 1.5% for young people aged 15 to 24 years. Sexual or substance use risk factors were associated with a 20- to 30-fold increase. Given that many HIV-positive street youth will die within 5 to 10 years without treatment and that there are many political and health-care delivery system barriers to street youth accessing services, attention to this advanced epidemic among the estimated 40,000 to 300,000 street youth in the Ukraine is urgently needed.