AN INNOVATIVE MODEL OF HIV PREVENTION. A project to support protective and inclusive HIV services for the most at-risk female youth in Ukraine

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1 UNICEF Canada and ICID Funding Proposal JULY 2012 AN INNOVATIVE MODEL OF HIV PREVENTION A project to support protective and inclusive HIV services for the most at-risk female youth in Ukraine UNICEF/NYHQ /Pirozzi

2 PROJECT NEED UNICEF/NYHQ /Pirozzi The HIV and AIDS epidemic in Ukraine is one of the fastest growing in the world, but stigma and discrimination against people living with and affected by HIV, including children, are hampering further progress in prevention, care and support. The HIV epidemic in the region is driven by an explosive mix of injecting drug use and, more recently, sexual transmission. Children and young people, including those living on the streets, constitute a group whose risk of contracting HIV is particularly high. Today, one third of new HIV infections in the region are among the age group and more than 80 percent of people living with HIV are under 30 years old. The recent sharp increase in infections in young women in particular means that the coming years will be critical in stopping the spread of HIV and AIDS in Ukraine. Effective HIV treatment and prevention programs in Ukraine were primarily designed for adults and have largely failed to reach those who are most vulnerable, in particular young people. The insidious consequence of this has been a hidden epidemic which disproportionately strikes children and youth. Children and youth suffer from the negative impact of Ukraine s years of political instability, economic hardship, rising unemployment, and crumbling social safety nets. Many families find themselves unable to cope. The use of drugs and alcohol is pervasive, divorce rates are high, and reports of domestic violence and abuse are widespread. In reaction, some youth start to engage in risky behaviour as a coping mechanism leaving them especially vulnerable to HIV infection. For some children from troubled families, the streets become their home or source of livelihood, and risk behaviours become a part of their daily lives. Who are the most at-risk children and youth? Children and youth aged 10 to 19 are at an increased risk of contracting HIV once they become engaged in risky behaviours such as living and working on the streets, injection drug use, or participating in commercial sex work. These are generally youth who have faced multiple and overlapping vulnerabilities in their lives, such as being orphaned, living in poverty, belonging to an ethnic minority, or experiencing domestic violence. Young girls are especially vulnerable to infection due to widespread gender inequality in Ukraine resulting in a lack of education and employment opportunities. Consequently, girls often resort to selling sex as a means of livelihood, putting them at increased risk of contracting HIV. The number of most atrisk adolescents in Ukraine is difficult to estimate given that the government has only recently begun tracking these population groups, but data suggests the number is large enough to warrant special attention and targeted programming. The central challenge of responding to HIV in Ukraine is the need to come to terms with an epidemic that mostly affects people deemed by society to be delinquent. Every day, children and young people engage in behaviours that put them at risk of HIV infection. In some cases, peer pressure, curiosity or just the natural recklessness of their age leads them to experiment with drugs or sexuality without thinking of the consequences. Many have been driven to the edge by social, economic and family problems. Whatever the reasons, effective solutions cannot rest on social condemnation and exclusion. Children and young people are among the most vulnerable in society, but at the same time represent its greatest hopes for a better future. They need to be nurtured, supported and protected. The proposed project aims to create youth-friendly, protective and inclusive HIV services for the most at-risk youth in Ukraine to stop the spreading epidemic of HIV and AIDS. UNICEF Canada and ICID are seeking a total of USD $1,083,942 to support program and staff costs for this project over a four-year period. 1

3 WHY PARTNER WITH UNICEF AND ICID? UNICEF has saved more children s lives than any other humanitarian organization. We work tirelessly to help children and their families, doing whatever it takes to ensure children survive. We provide children with health care and immunization, clean water, nutrition and food security, education, emergency relief, and more. UNICEF is supported entirely by voluntary donations and helps children, regardless of race, religion or politics. As part of the UN, we are active in over 190 countries more than any other organization. Our determination and our reach are unparalleled. Because nowhere is too far to go to help a child survive. In order to create a program that effectively integrates HIV prevention, care and support for the most at-risk children and youth in Ukraine, UNICEF Ukraine has partnered with the International Centre for Infectious Disease (ICID). ICID will provide technical support and expertise to the project, as well as fundraise for its implementation. ICID is a Canadian not-for-profit organization partnering to reduce the impact of infectious diseases by bringing people and resources together to catalyze solutions. ICID s expertise in HIV prevention programs will add to UNICEF s recent research on HIV prevention among the most-at-risk youth and UNICEF s strong relationships with the Government of Ukraine and local community-based organizations. PROJECT DESCRIPTION The purpose of this pilot project is to develop a youth-friendly, innovative and integrated model of HIV prevention, care and support services for the most at-risk female youth in Ukraine. This model will then be used to create similar programs across Ukraine and in other countries in the region. With prevention programs tailored to the needs and behaviours of at-risk youth based on understanding, support and inclusion rather than blame, banishment and exclusion, we can help to reverse the spread of HIV in Ukraine. LOCATION AND KEY BENEFICIARIES The project focuses geographically on the Zaporizhzhya district in south-east Ukraine. The population of the district is about 2 million and there are a significant number of vulnerable and at-risk children and youth. Although prevention programs and services exist in the area, they are not widely available and services are somewhat fragmented. The project will focus on female youth 14 and older who are at high risk of contracting HIV. The age range was chosen to reflect the fact that only a small number of children younger than 14 engage in most-at-risk behaviour and because Ukraine s new legislative norms allow children 14 and older to access medical services without parental consent. This is important because of the stigma and discrimination associated with HIV, as well as for children and youth who may not be living with their parents. UNICEF/2010/UKRAINE/Pirozzi 2

4 PROJECT DESCRIPTION (cont.) Outreach and community mobilization Using innovative peer-to-peer outreach, UNICEF will encourage at-risk female youth to reach out to their peers to build confidence in the program, spread knowledge and awareness of HIV, and mobilize individuals and groups to access health and support services. A key challenge is to build relationships of trust, so youth will feel safe in contacting and using services without fear of stigma or discrimination. UNICEF/NYHQ /Pirozzi KEY PROJECT COMPONENTS Assessment Phase In order to design effective HIV programs and services, ICID and UNICEF will complete an initial assessment phase to fill crucial knowledge gaps. ICID will be taking the lead in designing and conducting a social mapping study of the most at-risk female youth, including where they can be found, and a review of what influences their attitudes, behaviours and interactions with the wider community. This will build knowledge about the context and drivers of HIV-related risk and vulnerability for these girls. ICID and partners will also conduct a mapping of existing programs and services available, and what may be preventing youth from using them. Finally, there will be an assessment of the existing capacity within program and service delivery organizations and institutions, and a capacity building plan will be developed. Program Implementation Phase The knowledge gained in the assessment phase will be used to design an integrated program model with a strong outreach component. Elements of the model will include: Risk and vulnerability reduction A set of activities that specifically address the risks and vulnerabilities of the most at-risk female youth will be developed. These include education, counselling, and skills development, as well as prevention messaging around drug use, sex work and other risky behaviours. UNICEF will also partner with the appropriate social service delivery organizations to ensure that female youth can access social support, such as vocational education opportunities, housing schemes, legal aid, and crisis response services. Monitoring and Evaluation Phase The program will have an overall monitoring and evaluation framework to assess the outputs and outcomes of key program elements, such as service delivery, outreach, risk and harm reduction, and community response to the program. ICID will be taking the lead in designing the framework and developing monitoring tools. The evaluation will be used to both fine-tune the program s design and activities, and to disseminate lessons learned to policy makers, program planners and implementers in other parts of Ukraine before national roll-out of effective program components. Health services capacity development Reproductive health services and HIV care, treatment and support will be integrated with community outreach to provide a continuum from prevention to care for at-risk youth. There will be a specific focus on building the capacity of existing health services to make sure they are youth-friendly and inclusive. UNICEF/NYHQ /Pirozzi 3

5 BUDGET UNICEF and ICID require USD $1,083,942 to implement the pilot program that will model effective youth-friendly, protective and inclusive HIV services for the most at-risk youth in Ukraine. Description of activities Cost in USD Assessment Phase Social mapping study of most-at-risk female youth Mapping of services available Capacity assessment of program and service delivery institutions Program Implementation Phase Health services capacity development Outreach and community mobilization Risk and vulnerability reduction activities Program supplies and equipment Monitoring and Evaluation Phase Monitoring and evaluation Operational research Key learning dissemination for national roll-out Project Support, Technical Expertise and Management Costs Total project budget $95,285 $802,400 $25,075 $161,182 $1,083,942 UNICEF/NYHQ /Pirozzi UNICEF/2010/UKRAINE/Pirozzi CONCLUSION Children and youth in Ukraine are vulnerable to a growing HIV and AIDS epidemic, but with your support we can make a difference in their lives and reverse the spread of this terrible disease. UNICEF and ICID are committed to increasing access to HIV counselling and testing, as well as inclusive health care and social services for the most at-risk children and youth in Ukraine. Through community outreach, ensuring access to youth-friendly services, and introducing behaviour change practices, this pilot project will encourage at-risk female youth to adopt safe behaviours to minimize their vulnerability to HIV while ensuring support and treatment for children and youth already living with the disease. Once modelled effectively, UNICEF will help the government to scale up this program across the country to benefit all children and youth at risk of contracting HIV and AIDS and to ensure they receive the HIV prevention, care and treatment they deserve. Thank you for considering a gift to transform the lives of children and youth in Ukraine. Please read on to learn how your gift could make a world of difference for children who face tremendous adversity every day. 4

6 Providing integrated health care to at-risk youth in Ukraine Anya (name has been changed) does not talk much about her teen years in Mykolayiv, one of the most populous cities in southern Ukraine. She desperately wants to forget the days of fighting with her grandfather, who was her only surviving relative after her parents died, and what happened after she was thrown out of the house. When she finally opened up, she recounted being forced into sex work at age 15. She found herself having unprotected sex and abusing drugs and alcohol. I do not want to talk about it, and I don t want to remember it, she said. Anya s story is one familiar to thousands of adolescent girls in Ukraine, most of them from poor or abusive families. Such girls are particularly vulnerable to HIV, yet are often excluded from the services that should protect them. Stigma and discrimination are barriers to critical social and health services, as are girls fears of being reported to the police or institutionalized. To address this, UNICEF recently implemented an innovative service delivery model in Mykolayiv, with the aim of reducing the risk and vulnerability of adolescent female sex workers. UNICEF and partner outreach workers brought girls to a drop-in centre that offered a safe space, counselling, and referrals to governmental health and social services. Working with child protection services, the police and the education sector began fostering a more supportive environment for at-risk girls, even empowering them to actively participate in service planning, implementation and evaluation. Despite having had a lot of unprotected sex, I had never visited a doctor, Anya said. With help from the drop-in centre, she was finally able to access health care. I went to a gynecologist. I also talked to a psychologist, she said. I do not know what would have happened if I had not gone to them. Anya is one of the lucky ones. She was not infected with HIV. Of the adolescent sex workers who accessed services at the drop-in centre, 10 percent tested positive for HIV. Because of the results in Mykolayiv, the National AIDS Program and State Social Services now recognize girls exploited in sex work as an essential constituency for services. A law was also passed that allows youth between ages 14 and 18 to obtain HIV tests without parental consent. UNICEF aims to make these services available across the country and to keep them adequately resourced, but challenges remain. Most legislators and other officials who control the budgets for these services believe that those involved in highrisk behaviors including young people who inject drugs, sell sex and or live on the streets should be punished rather than helped. Partnering with ICID, UNICEF plans to start a similar pilot project in Zaporizhzhya where we trust that bringing these critical services to at-risk female youth will result in more success stories like Anya s. Anya, meanwhile, managed to turn her life around. Through the integrated services at the drop-in centre, she learned how to protect herself from HIV and other sexually transmitted diseases. She quit drinking, left sex work, and reconciled with her grandfather. After returning home, she went back to school and has since graduated. UNICEF/NYHQ /Pirozzi For more information about ICID: call or info@icid.com Charitable Registration No RR0001 For more information about UNICEF Canada: call or info@unicef.ca Charitable Registration No RR0001 icid.com unicef.ca 5