UKRAINE: Strengthening families and supporting children
The social and economic upheaval following the collapse of the Soviet Union has had serious adverse effects on Ukrainian families and social structures. Thousands of Ukrainian children have been left abandoned, homeless, and institutionalized under abusive conditions. Over 145,000 adolescents are housed in state institutions, while an estimated 50,000 children live on the streets of major cities. In addition, a rapidly growing HIV epidemic has created a phenomenon of abandoned babies born to HIV-positive women lacking the support to care for their children.
Ukraine faces one of the fastest growing HIV epidemics in the world, and within the country, women represent an increasing proportion of adults diagnosed with HIV. As the overall number of HIV-infected women grows, so does the number of HIV-positive mothers. These women receive very little support to enable them to care for their children, resulting in a child abandonment rate of ten to fifteen percent. HealthRight has worked in Ukraine since 2006, when we first adapted the MAMA+ model to build access to comprehensive health and social services for HIV-positive new mothers. HealthRight has increased advocacy efforts and continues to work with the local health system to remedy gaps in services for HIV-positive women as well as women with a history of injecting drug use (IDU). Often, exclusion is caused by lack of capacity and coordination among providers and stigma against people living with HIV, especially those with a history of drug use.
While written policies grant universal access to appropriate care for HIV-positive and IDU women, there are often significant gaps in how this translates into practice. HealthRight combined qualitative research on the experiences of women accessing health care with a nationwide information and media campaign to raise awareness of the availability and effectiveness of substitution therapy in treating drug addiction. HealthRight then advocated in the health care community for non-discriminatory treatment of this population, and trained medical providers to increase clinical capacity and combat stigma within the health system.
STREET AND AT-RISK CHILDREN AND YOUTH
An estimated 100,000 children and youth are orphaned or deprived of family care in Ukraine, while over 145,000 adolescents are housed in state institutions. Without family support, young people live in extremely precarious circumstances, often facing discrimination, isolation, and physical and sexual violence, and engage in high-risk behaviors, including crime and drug abuse. With few places to turn for help, children living on the street and in institutions suffer from health problems ranging from malnutrition and HIV infection to severe depression and emotional trauma.
HealthRight is responding to this challenge by supporting the Ukrainian government’s efforts to develop a network of comprehensive care for at-risk and homeless youth. Based on the success of our programs in Russia, HealthRight established a Drop-in Center to provide youth with rights-based counseling and social services, which is now fully owned and operated by the local health system, bringing services for years to come and serving as a model for replication throughout the country.
A study published by HealthRight and the U.S. Centers for Disease Control in fall of 2010 in the International Journal of STD & AIDS found that one in five street youth in Ukraine are HIV-positive, far outpacing the rate of infections among the general population. Among the 3 cities studied, the hardest hit city, Odessa, reported infection rates among street youth higher than 26%. The study was conducted in collaboration with the Ukrainian Ministries of Health and of Family, Youth and Sports, the International HIV/AIDS Alliance and local partners. The study also found that factors such as injection drug use, unsafe sexual practices, homelessness and orphanhood were important factors connected to high risk of HIV-infection in this group. The study will provide documentation of the extent of the spread of HIV among this population, and will serve as a catalyst to make comprehensive HIV prevention, treatment and support services accessible to street children and youth in these cities and throughout Ukraine.