In 2008, Ukraine had the fastest growing rate of new HIV infections of any country in Europe. According to a WHO HIV/AIDS report released that year, the prevalence of HIV among adults in Ukraine rose from 0 percent to 1.6 percent between 1990 and 2007. In Odessa, HIV prevalence among adults has been...

Closing a Gap to Protect the Young and Vulnerable

In 2008, Ukraine had the fastest growing rate of new HIV infections of any country in Europe. According to a WHO HIV/AIDS report released that year, the prevalence of HIV among adults in Ukraine rose from 0 percent to 1.6 percent between 1990 and 2007. In Odessa, HIV prevalence among adults has been three to four times higher.

Historically, HIV/AIDS funding in this region has targeted high-risk groups. While still supporting harm reduction interventions, this strategic initiative was launched to cover interventions that have suffered from a gap in funding: HIV prevention for the general population, primarily focussing on the "Abstain, Be Faithful, Use Condoms" approach (ABC), and the improvement of and increased access to voluntary counselling and training (VCT) services.


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Strategic Initiative

SECTOR

Health

TOTAL INVESTMENT

US$ 1,330,473

LOCATION

Ukraine

LIVES CHANGED

118,247

SOCIAL IMPACT INDEX

57.4 (out of 100)

AVERAGE COST PER LIFE

US$ 11.25

Expand All

SI Breakdown:

Key Achievements

  • Over 100,000 people reached through awareness-raising efforts – Local organisations provided HIV prevention education to 111,930 people.
  • High quality VCT provided – A total of 14,918 people from the general population underwent high-quality voluntary counselling and testing and were referred to appropriate medical or HIV servicing organisations.
    Successful outreach to HIV-positive women in Odessa – Every HIV-positive pregnant woman in Odessa has been counselled and provided with psychological support and medical assistance due to this SI. The total number of women reached was 1,159.
  • Peer educators and VCT providers trained – 468 peer educators and 1,468 VCT providers and other professionals were trained to improve the way they address HIV.

The Problem

In 2008, Ukraine had the fastest growing rate of new HIV infections of any country in Europe. According to a WHO HIV/AIDS report released that year, the prevalence of HIV among adults in Ukraine rose from zero to 1.6 percent between 1990 and 2007. In Odessa, HIV prevalence among adults has been three to four times higher. In 2006, Odessa had the second highest rate of HIV prevalence in Ukraine. Primary research revealed several problems specific to this region that are contributing to the increase in HIV-positive rates. First, there is a lack of HIV prevention education for the general population as distinct from high-risk groups, which have been the focus of prevention education. Second, there is a lack of voluntary counselling and testing sites and low quality of testing and counselling services. Third, there is an unusually high number of IV drug users, especially among street children and commercial sex workers.

Solution

The US$ 1,330,473 Ukraine HIV/AIDS Strategic Initiative was launched during one of the most severe HIV epidemics in Eastern Europe in one of the most affected regions: Odessa, Ukraine. Historically, HIV/AIDS funding in this region has targeted high-risk groups. While still supporting harm reduction interventions, this strategic initiative was launched to cover interventions that have suffered from a gap in funding: HIV prevention for the general population, primarily focussing on the "Abstain, Be Faithful, Use Condoms" approach (ABC), and the improvement of and increased access to voluntary counselling and training (VCT) services. The Initiative also sought to provide medical services to treat sexually transmitted infections (STIs), improve care for those who are sick, and decrease stigma and discrimination against groups living with HIV or who are vulnerable to it. Investing over US$ 1.3 million in six local organisations to provide a variety of essential services, the initiative was expected to reach approximately 105,000 people.

Critical Analysis

At the end of three years, the Ukraine HIV/AIDS SI has achieved its primary goals. In some areas, implementing partners have exceeded our expectations and developed model programmes that can be replicated in the entire country. We have observed a significant improvement in VCT services due to the outstanding work of Future Without AIDS (FWA). Alternativa served every HIV-positive pregnant woman in Odessa Oblast, contributing to reduced mother-to-child transmission (MTCT) rates. Expertise and services developed by our implementing partners have been recognised at the national level. Peer-driven interventions introduced by The Way Home and the Sophia Girls’ Shelter by Faith Hope Love have become models to replicate in other regions of Ukraine. Future Without AIDS has actively participated in the development of national law that regulates VCT procedures.

While each individual implementer has reached the goals set before them, some strategic goals for the SI remained unreached. The community of practice that we were trying to facilitate did not become a reality. Even though some implementers cooperated more than others, overall, the organisations conducted their work separately. We believe that by creating a community, the overall impact of the SI would have been greater. Over the course of three years, we motivated our implementing partners to think about the impact of their programmes in terms of creating behavioural change rather than just raising awareness. Not all implementers, however, were able to evidence actual behaviour change.

Despite unreached goals, progress, has been made. A recent report by the Ukrainian Centre for the Prevention and Fight against AIDS (2007–2009) indicated an improved outlook for Odessa, as the number of new cases of HIV in this region has steadily decreased. In 2010 Odessa’s HIV prevalence rates fell to fourth place in Ukraine. In this context, the Ukraine HIV/AIDS Initiative has had a marked impact by providing essential services to Odessa’s high-risk groups and general population, teaching thousands to protect themselves from contracting the virus and contributing directly to stemming the spread of HIV. With new funding promised for the future, we hope these excellent organisations can secure sustainable programme funds, as we believe the SI has provided a solid foundation for this region to continue its fight against HIV.

Lessons Learned

Successes:

Flexibility is a key to success – When Future Without AIDS (FWA) developed its VCT manual and held its first training for VCT providers, they realised that many questions were raised about legal issues related to VCT. In order to respond to this need, they invited a legal expert from Kiev to raise their knowledge in this sector. As a result, they held two trainings on the legal aspects of providing VCT. Having realised the need to train the mid-level medical staff in VCT, FWA asked us to redirect part of the third year funds for the development of a new training module and running four pilot trainings. At the present time, FWA is working on this training module.

Using lessons learned and reflection to create visible improvements in programmes – The Way Home worked with street children in Odessa, providing them with food, hygiene kits and easily understandable prevention information. Even though they were achieving their goals, in Year 2, they changed their approach to prevention activities in order to reach even more vulnerable youth. Using a peer-driven intervention approach, they were able to engage street children in prevention activities and train 200 youth to provide awareness to their peers. The Way Home is now working on creating low-threshold centres that provide access to social and preventive assistance for street children.

The creation of tools and materials that have a sustainable long-term impact on the sector – Some information, education and communication (IEC) materials developed within the framework of projects in this SI will be used in the future and will help those providing essential services in the sector. These include a high quality VCT manual, which will be used in other parts of the Ukraine and is now part of curriculum for medical students, and the development of a methodology to assist runaway girls, supported and recommended by UNICEF.

Facilitating behavioural change by creating opportunity – As part of the project activities, The Way Home runs an open-type shelter for street children. Their remedial education programmes allow children to catch up with current curriculums and reintegrate into schools. By making a secondary school education a requirement for shelter dwellers, children were able to continue their education levels even after school. In addition to attending numerous vocational courses, one beneficiary was able to successfully enrol in a university programme, 18 people entered technical schools, 16 people found employment and 37 presently study at school.

Increased societal influence – As project activities were successful, implementing partners started receiving recognition from local authorities, as well as national experts. FWA’s trainings were backed by the head of the regional health department. The organisation’s leaders were invited to participate in the development of a new law regarding VCT. In January 2011, Sveta Olikh, ACET project manager, was recognised as among the 20 most influential young people of Odessa by Odessa’s mayor.

Challenges:

Currency fluctuations – Global financial turmoil had an impact on project finances in 2008 and 2009. The Ukrainian Hryvnia was constantly depreciating, especially against the dollar. Depending on when funds were exchanged into local currency, some organisations lost part of their funds, while others saved money. As a result, some implementers struggled with low budgets, while others had under-spent funds.

Political change – A change of government in 2010 resulted in shifting structures at national and local levels as new government officials took office. In 2010, all of our implementing partners had to re-establish relationships with new authorities.

Drug-addicted children – HIV-positive, drug-addicted street children are extremely challenging to work with, with the majority of these youth suffering from deep psychophysical trauma, low self-esteem, and limited motivation to undertake behavioural change. In the majority of cases, these kids continue to live on the streets and can potentially contribute to ongoing infection.

Flu outbreak – Several schools and educational institutions in Odessa were quarantined in November and December of 2009. As all public events and gatherings were cancelled, projects could not conduct scheduled prevention lectures or youth clubs. Since November and December are the most productive months for ACET prevention programmes, this organisation struggled to reach its intended beneficiaries. By the end of the third year, they were able to reach 81 percent of the planned number of students.

Ukraine HIV/AIDS: Featured Projects

SII ScoreProject NameGrantLives ChangedCost Per LifeSector
72.00 The Way Home$238,9401,420$168.27
68.40 Faith, Hope, Love$322,9618,203$39.37
53.20 Life Time Plus$154,1793,335$46.23
52.00 Future Without AIDS (FWA)$230,856518$445.67
49.40 ACET$300,796103,355$2.91
49.40 Alternativa$82,7411,416$58.43
Note: The Social Impact Index Score reflects the relative social impact of a given development project. The lowest possible score is 20; the highest possible score is 100.

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