1. HIV Risk Factors and HIV Prevalence Among Street Youth in Russia, 2006-2012 Yulia Batluk, HealthRight International

2. Street Youth in 2006 1 - 5 million in Russia Homelessness Begging Alcohol and drug use, including IDU Poor health status – lice, STDs Inhalant use  poor mental health

3. HIV Prevalence Survey - 2006 Cross-sectional assessment Street youth 15-19 years old 41 locations mapped, 22 randomly selected 313 participants, 37.4% HIV-positive (Kissin, D., et. al. HIV seroprevalence in street youth, St. Petersburg, Russia. AIDS 2007, Vol 21 No 17, 2333–2340)

4. HIV Risk Factors - 2006 Double orphans Have not attended school for > 3 years Ever lived in an institution No place to live Previously diagnosed STI Needle sharing Use of stadol, heroin or inhalants

5. HIV Risk Behavior Survey Among Street Youth - 2011 Eight regions of Russia Design similar to the 2006 survey, but no HIV testing ~100 youth per region Total sample 794

6. SURVEY MAP

7. 2011 Survey Method Interviewers trained Mapping of street youth locations in each city Random selection of sites Recruit participants and assess eligibility Secure informed consent Interview participants - 60 questions on demographics, behavior and HIV knowledge Psychosocial counseling and referral

8. Survey Results

9. Didn’t use condom at last sex

10. Pregnancy

11. Previously diagnosed STI

12. No access to medical care

13. Multiple Sex Partners & No Condom Used at Last Intercourse

14. Sex Risks & Drug Use

15. Risky group characteristics VariablesHigh risk Low risk p Number of drinks last time 6.084,65,000 Number s/he get drunk last month 3,782,64,001 Never or rare use condom with street youth, % 51,721,8,000 Have been pregnant, % 35,514,4,000

16. Risky group characteristics VariablesMean 1Mean 2p Live with both parents,% 15,326,0,031 Father alive,% 42,461,7,001 Condoms – bring partner,% 35,324,2,027 Family member - alcoholic 74,456,6,002 Phys/sex abuse in the family 59,540,6,001 No medical care access 28,215,7,004

17. Lifetime Experience of Drug Use, St. Petersburg, 2006-2011

18. Current Drug Use St. Petersburg, 2006-2011

19. Experience of Institutionalization, 2006-2011

20. Sex Risks and IDU St. Petersburg, 2006-2011

21. Ever Tested for HIV, 2006-2011

22. HIV Risks, St. Petersburg, 2006-2011 Factors associated with HIV20062011p Didn’t attend school for >3 years,% 44,54,00,00 Double orphan,% 13,44,00,00 Ever lived in a shelter or an orphanage,% 35,95,10,00 No place to live (lives in attic or basement),% 23,52,00,00 Ever used injecting drugs,% 50,74,00,00 Ever used stadol,% 44,22,00,00 Ever used heroin,% 34,45,00,00 Ever used inhalants,% 55,217,80,01 Previously diagnosed STI,% 33,715,80,01

23. HIV Knowledge In 2011, more likely to know that: HIV cannot be transmitted through mosquito bite Condoms can protect against HIV Same likelihood to know that: One can be infected with HIV through syringe or needle sharing One cannot be infected through sharing a meal Less likely to know that: A healthy-looking person may be infected with HIV

24. Conclusions All HIV risk factors defined in 2006 significantly reduced by 2011 Drug use in street youth population is significantly reduced except marijuana Sexual risk level remains almost the same as well as alcohol consumption (often associated with risky sexual behavior)

25. Why? (Educated Guesses) No sexual education in schools Street youth know that HIV is related to injecting drug use Govt and NGO social service spheres are stronger preventing family breakdown