Sex Work in Ukraine: Cancelling the Fines and Placing Condomats at Bus Stops Could Halt HIV Spread

Nataliya Isaeva is protesting and advocates for the fast decriminalization of sex work

Author: Yana Kazmirenko, Ukraine

Civil society NGO activists in Ukraine are developing a new legislation on sex work. According to them, eliminating the fines could help increasing access to medical care for women and men involved in sex work – a profession vulnerable to HIV.

“Sex workers try not to have too many condoms with them. If there is a police raid, discovering condoms and recording it in a protocol automatically means detention for sex work,” says Nataliya Isaeva, the head of the All-Ukrainian Charity Organisation “Legalife-Ukraine”, explaining the need to finally decriminalize sex work. Nataliya has been a sex worker since she was 16. Today, after being a sex worker for 15 years, she has HIV-positive status, a family, two healthy children and projects that offer support to her ex-colleagues.

Hostages and victims of violence

Even administrative charges for sex work that are still in force in Ukraine, make sex workers vulnerable to police violence. According to the Article 181-1, of the Ukraine’s Administrative Code, commercial sex is an administrative offence punishable by the fine of 15 tax-exempt minimum wages (UAH 225 or €7.5) as a maximum penalty.

“Today decriminalization is more important than legalization. Decriminalization would create an environment where sex workers could go to police to complain of violent actions against them,” Nataliya clarifies.

Preparing for the 22nd International AIDS Conference to be held in Amsterdam in 2018, “Legalife” activists have conducted a research on the types of violence against sex workers in Ukraine. They surveyed 175 women and anticipate high levels of “truthful answers”, given that the women were interviewed by activists who had been involved in sex work.

“Preliminary results show high rates of psychological violence against sex workers from police. Many have to deal with unwarranted aggression from their clients: people in passing cars throw bottles at them, and there was one case when they cut a rude word on a woman’s breast,” Nataliya is sharing.

Healthy women work longer

The Ministry of Ukraine’s Center for Public Health estimates the number of sex workers in the country at around 80,000. Some 7.3% of them have been diagnosed with HIV. Administrative liability drives sex workers underground and makes them conceal their occupation, even from doctors.

“Sex workers are usually not the ones to go and have their first HIV test on their own initiative. Decriminalization forms the prerequisite for medical screening and offering help to those in need,” Sergey Kharitonov, the head of HIV prevention and access to treatment projects for sex workers, NGO Convictus Ukraine is saying. Nataliya Isaeva, however, thinks that sex workers do try to take care of their health and contribute much less to the spread of HIV as opposed to what researchers believe.

“Women professionally involved in sex work prefer to use condoms, get tested and make sure they are in good health. The healthier they are, the longer they can work,” Nataliya explains.

Discovering status means banning from pick-up points

Experts from Convictus Ukraine have surveyed sex workers to find out what they do when they learn that they have HIV. Most of them leave work for a while, usually going back home. The story of Polina (34) from Kyiv confirms this. After she discovered her HIV-positive status in 2014, she went home to her parents for the first time in many years. Polina started using injecting drugs when she was 16. After the 9th grade, she travelled to Moscow, hoping to earn good money, and ended up in sex work through the advice from her friend. Amphetamine, heroin, dope – she could just almost write a manual on drugs. In early 2000s, she found out she had Hepatitis C, but she cannot remember when exactly she was diagnosed. After discovering her status, she applied for the opiate substitution therapy.

After learning about her HIV status, Polina switched to opioid substitution therapy

“My body gets ugly from all the injections, but my look is my income. Thus, with a doctor’s paper certifying substance use, I applied for a paid substitution therapy service. It costs UAH 1600 per month. I saved up some money, and I also want to get Hepatitis C therapy,” Polina is saying.

After she was diagnosed with HIV, Polina started to take more care about her health. “I always use a condom, do not go to saunas for groups, etc.,” she says.

According to Polina, only her mother, partner and son know about her status. Her son lives with his grandparents in Russia. Polina hopes that opiate substitution therapy will “wise her up”, help her quit drugs and find her six-year-old daughter whom she abandoned after birth.

Polina’s colleagues find it hard to establish an alternative source of income, and that is why they go back to where they were. Many of them are afraid of undergoing further testing, fearing disapproval from doctors and friends in case “God forbid, someone finds out”.

“Most sex workers suffer from self-stigma which prevents them from accepting their HIV status. If they find out one of them is HIV-positive, the colleagues try to remove this person from the pick-up point by any means,” Sergey Kharitonov says.

New law under development

Activists admit that there is little chance for changing the status of sex work in Ukraine. Back in 2015, decriminalization attempts failed. Andrey Nemirovskiy, the Deputy of the Verkhovna Rada of Ukraine (Samopomich party), submitted and, following a lot of buzz in the media, revoked the legislation regulating sex work in Ukraine. The project failed, not least because of the influence of the Orthodox church, whose vast congregation could have cut off electorate support for the party.

New legislation is developed, but, according to Nataliya Isayeva, it will only be submitted after allies are found. Currently activists are conducting advocacy work among female deputies and developing amendments to other laws.

The project manager at NGO Convictus Ukraine Yulia Tsarevskaya believes that apart from the new law, it is possible to reduce the spread of HIV among sex workers with comprehensive programming. For example, the service of condom and lubricant distribution could be replaced by placing condomats in all cities (at the bus stops and metro stations.)

Youth is Invited to Lead the Amsterdam Youth Force at AIDS 2018

Nadiia Dubchak

The Youth Force for AIDS 2018 is looking for young people and youth organisations. Nadiia Dubchak, from Kyiv, Ukraine, is the co-chair of the Youth Force of AIDS 2018 Conference, and she is representing Eastern Europe and Central Asia (EECA). Meanwhile, Nadiia is looking for active people between the ages of 15 – 26 to help found and lead the Amsterdam Youth Force (AYF). AFEW International is supporting this initiative.

The engagement of young people in the International AIDS Conference in Amsterdam next year is fundamental. Every International AIDS Conference, a group of young people and youth organisations come together to create the Youth Force. Young people are essential in creating a response to HIV and AIDS that will reach the end of the epidemic. Young people are also people living with HIV, sex workers, people who use drugs, LGBTQI and many other groups that are key in creating a future without HIV and AIDS.

“I strongly hope that, as youth activists and leaders, we will act together, on behalf of the world teen and youth community, and make a significant contribution to AIDS 2018. Indeed, I would be thankful for your support and honored to convey your ideas to the Conference Coordination Committee prior to and during the Conference. We are now building up the Youth Force working groups which would guarantee an excellent performance and efficiency of AYF in different dimensions of AIDS 2018. We kindly invite youth-focused activists and young leaders from all over the world to join us,” Nadiia Dubchak is saying.

How to join

To become a part of AYF, please like their Facebook page to stay in touch and share info about their activities online. To join a working group, please write an email to amsterdamyouthforce@gmail.com including your basic contact details and a short motivation note. Also, you can use this email to pose any questions regarding AYF and your personal involvement. For those interested in contributing to AYF, you can add Nadiia Dubchak on Facebook.

How Kyiv Fights the HIV/AIDS Epidemic

Author: Yana Kazmirenko, Ukraine

The adoption of the Fast-Track Cities strategy resulted in launching of the HIV express-testing in all outpatient clinics in Ukraine’s capital. The strategy also allowed to increase the number of people who receive antiretroviral therapy.

The struggle against HIV/AIDS epidemic in Kyiv strengthened since the mayor Vitaliy Klitschko, signed the declaration in Paris. Apart from that, Kyiv was included into the Fast-Track Cities programme in April 2016 as a measure to fight AIDS. According to this programme, 90% of the citizens in 2020 should know about the disease, 90% of the infected ones should be getting treatment, and the treatment should be effective for 90% of the patients.

In the latest United Nations agency report on HIV/AIDS (UNAIDS) and UN-Habitat as of 2015, the Ukraine’s capital entered the list of 27 most HIV/AIDS infected cities in the world. Alexander Yurchenko, the head physician at Kyiv AIDS centre, hopes that Kyiv will not be included into the newest rating. The programme has seen first success. 800 medical workers were trained, and every outpatient clinic in Kyiv received express-tests. The result of the test is available in as little as 20 minutes. There were 2,500 more individuals (compared with the previous year) who had tested their blood in a year.

A record amount of 555 people was included into the dispensary registration with the help of express-testing only over the first quarter of 2017. To compare: only 1300 people were registered in 2016, according to Yurchenko.

In his opinion, the situation in Ukraine’s capital with a population of three million people has improved. There were only around 5,000 people getting treatment in 2012, and now there are more than 7,000. It is planned to give treatment to 12,000 people by the end of the year.

Migrants and HIV

Yurchenko attributes Kyiv’s high position in the world ratings of HIV spread due to its attractiveness for migrants. 400,000 people come to work in the capital daily.

“Men who have sex with men (MSM) also tend to come to Kyiv, as it is hard for them to even live in such regional centre as Cherkassy. They attract a lot of attention in smaller cities. In the capital, they can find work, hide themselves, and find partners,” continues the interviewee.

The prevailing factor of HIV spread in Kyiv in 2012 was an injecting way of transmission. Now the predominant way has shifted to sexual transmission.

For instance, the story of the oldest patient in the capital of Ukraine. The man admitted that his wife was refusing sexual intercourse with him and he had to use the services of sex workers.

“Doctor, now I know what I will die from,” the old patient said jokingly, after he heard his diagnosis.

“According to statistics, you will die from cardiac ischemia, but we will control and monitor your HIV,” Yurchenko remembers his dialogue with the patient.

Surviving thanks to the Foundations

Kyiv’s mayor Vitaliy Klitschko stressed that one of the main responsibilities that Kyiv took within the framework of the Fast-Track Cities programme is the provision of sufficient amount of antiretroviral medicines for treatment of people diagnosed with HIV/AIDS.

There would be significant progress in the implementation of the Fast-Track strategy if the government did not delay the supplies of medicines for antiretroviral therapy. This leads to patients receiving one month course of treatment instead of six or three months’ courses.

The variety of options in treatment schemes (around 38 of them) does not yet allow to pass the dispensing of medicines to the family doctors’ level. Yurchenko promised that there will be two or three variants of treatment made, and they will be passed on to the outpatient clinics as soon as the government supplies of medicines are in full scope.

Now patients literally survive at the expense of international and private foundations. On July 11, Kyiv has become the first Eastern European city where HIV-positive patients received dolutegravir (sixth generation medicine for antiretroviral therapy) at the expense of the Elena Pinchuk ANTI AIDS Foundation. The yearly course of medications will cost $170. This allows to increase the number of people who will receive the life-saving treatment in as early as 2018 at no additional cost.

The adoption of the law on mandatory HIV testing* can also bring the capital closer to the standards implemented by Fast-Track Cities. Alexander Yurchenko says that this law might be enacted by the end of the year.

As estimated by the experts, the number of HIV/AIDS infected people in the capital is 23,000 inhabitants. This is the tenth of the estimated figures in Ukraine – 250,000. There were 304,914 officially registered new cases of HIV infection in Ukraine since 1987. Since that time, there were 42,987 deaths from AIDS. The regions most affected with HIV infection, apart from Kyiv, are Dnipropetrovsk, Kyiv, Donetsk, Mykolayiv and Odesa regions.

*AFEW International is not aware of the law on mandatory HIV testing and will advocate against such law.

Rapid HIV Testing was Discussed in Kyiv

Psychologists, social workers, medical personnel and other employees of four social bureaus in Ukraine gathered for the three-day training Conducting Voluntary Counselling and Testing on HIV with Rapid Tests that AFEW-Ukraine conducted on June 7-9.

“This training was useful because we had a closer look at the regulatory framework in the field of HIV testing, in particular in the work with minors because this procedure always caused many questions,” says Alina, the social worker from Kharkiv. “Besides, it was useful to get the information about personal and professional risks of HIV infection, what to do if such situation happens, and now everything is clear. The session of practical training in the development of pre- and post-test counselling skills has been a pleasure for me. The trainers showed what mistakes a counselor can make during counselling and how to avoid them.”

The aim of the training was to provide the participants with the knowledge and skills on the methodology of counselling related to HIV testing with rapid tests. During three days, the trainers focused on the overview of the HIV epidemic in the world and in Ukraine, aetiology, epidemiology, diagnostics, ways of HIV transmission. Stigma and discrimination, the impact of stigma on the epidemic, legal framework of HIV/AIDS, key elements of ethical and effective HIV counselling practices, pre- and post-test counselling were also discussed during the training.

The training was held within the framework of the project ‘Bridging the Gaps: Health and Rights for Key Populations’ with the financial support of Dutch Ministry of Foreign Affairs. In August, AFEW-Ukraine plans to hold a coordination meeting for regional partners to plan the next ‘Bridging the Gaps’ project year.

Compass Centre in Kharkiv, Ukraine: when Policeman Becomes an Uncle

img_0039“I come here often,” Senior Inspector of the Juvenile Prevention Department of National Police of Kharkiv region, Ukraine, Andrii Stadnik is sitting by the table in the centre Compass of Kharkiv City Charitable Foundation Blago. He is smiling and pointing at the table. “Look, here I even have my own cup to drink from…”

Andrii Stadnik started to work in police in 1998. He says he is very happy with his job now. In Compass he meets many children who are grateful for not being send to prison, and he likes to be able to help them. The regulars of the centre even call him uncle Andrii, and this shows very good relations between people in the Ukrainian culture.

18 years old Oleksandr (Sasha) is sitting in front of Andrii, at the same table. Sasha is one of the main characters in the film that was made about the centre Compass a few years ago. Once he was detained by Andrii Stadnik and stayed under police control for some time. Now, after the client management program at Compass, Olexandr is doing much better. He even found a job as a security guard. “Now I somehow feel as Andrii’s colleague,” Sasha smiles.

“The criminal juvenile cases decreased tremendously last years, due to the approach when juvenile police is collaborating with a youth centre that offers client management. These alternative supporting ways are more constructive and more effective,” Senior Inspector of the Juvenile Prevention Department is telling us. “Previously there were 2000 cases per year, and now it is 362. The formulas of substances that circulate on the streets change so fast that young people can often not be prosecuted, but by giving youth an option and an alternative for other options, young people have less problems and also cause less problems for the society they live in.”

img_0036There are 492.000 children in the region in total. 897 families are under juvenile department control in Kharkiv region in Ukraine. The Juvenile Police checks these families, sees how they are doing, and if there are cases of child abuse, financial problems, and so on. Kharkiv Juvenile police is also inviting colleagues from other smaller cities or villages, and teaches them how to work with the Centre Compass. Through this cooperation they found out that young people from the region have difficulties with coming to the Centre since Kharkiv is too far for them. That is why now once a week a social worker of the Centre travels to the villages to counsel young people in need there.

Kharkiv City Charitable Foundation Blago has a long history of working with key populations, including people who use drugs, sex workers, men having sex with men and street children. The organisation started to work with adolescents using drugs since 2012 within the framework of “Bridging the Gaps: Health and Rights of Key Populations” project, through ICF “AIDS Foundation East-West” (AFEW-Ukraine.) Bridging the Gaps project supported the opening of the centre Compass that specifically serves vulnerable adolescents and young people, focusing on youth using drugs. The centre offers psychological counseling services, medical help, testing for HIV, hepatitis B and C. It is a daycare facility with social workers, psychologists and medical workers. The centre is providing case management services to youth using drugs, and also works with youth in prisons, and vocational schools.

Access and Quality of Youth-Friendly Health Services in Ukraine Presented During Youth Week in Amsterdam

dsc00091AFEW-Ukraine’s Project Manager, Iryna Nerubaieva, will take part in the Share-Net Youth Week which is held in the Netherlands from 26th-30th September. Iryna will speak about increasing access and quality of youth-friendly health services for young key populations: people who use drugs in Ukraine.

The Youth Week, organized by Share-Net and its members, will link comprehensive sexuality education and youth friendly health services to broader discussions on gender, gender based violence and sustainable development. The Youth Week will take place in two Dutch cities: The Hague and Amsterdam. The whole program of the Youth Week is available here.

Iryna Nerubaieva from AFEW-Ukraine will be giving her speech on Tuesday, September 27, in De Balie, Amsterdam, during the workshop “Service Delivery and Quality Assurance”, starting at 2pm.

Iryna Nerubaieva coordinates innovative and pilot projects, such as the Immediate Intervention Programme for HIV-positive women and is also responsible for M&E and human rights components of the Bridging the Gaps programme in AFEW-Ukraine. Iryna has 10 years of experience in the sphere of HIV/AIDS prevention, which started from volunteering. Prior to her work in AFEW, Iryna worked for the Alliance for Public Health in Ukraine within Harm Reduction projects among populations most vulnerable to HIV (IDUs, MSM, SW, prisoners) and for Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) as a Consultant within the primary prevention project for children and youth “The Join in Circuit on AIDS, Love & Sexuality.”

Please, join us on Tuesday, September 27 at 2pm for the workshop!

“Kyianka+” has got additional funding

5_Interview-of-Vera-Varyga-for-pressSelf-help group for HIV-positive women in Kyiv, Ukraine “Kyianka+” (transl. as “Kyiv city woman”) has got additional funding from Gilead Sciences Europe Ltd and continues its active work under the project “Expanding immediate intervention model to ensure adherence to HIV and hepatitis C (“HCV”) treatment and improve quality of life for HIV positive women in Kyiv” to the full extent.

Starting from June 2016, the telephone hotline and on-line support via secretive Facebook group has been supplemented with additional self-help group activities. Thus, HIV-positive women of Kyiv city once again will be able to participate in the workshops and trainings on the different important aspects of living with HIV, including prevention of opportunistic infections and aging issues, study at the vocational courses for further employment, visit psychologist and simply spend their leisure time nicely and usefully in the company of like-minded women.

Let us remind you that self-help group “Kyianka+” was created in September 2014 as a result of collaboration between AFEW-Ukraine, Kyiv city branch of All-Ukrainian Network of People Living with HIV/AIDS and Positive Women of the World (PWW) in order to support and empower HIV-positive women in the Kyiv city.

Telephone hotline to support HIV+ women in Kyiv, Ukraine: +38 (067) 239 69 36