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HIV/AIDS in Crimea: Social Perception and Authorities Actions' | 2011
1. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011
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HIV/AIDS in Crimea:
SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS 2011
Research findings
Maksym Zhumenko, GfK Ukraine Prepared for: UN Development Program
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Research goals
Analysis of epidemic dynamics data and factors, contributing to the HIV/AIDS spread, in comparison to other regions of Ukraine;
Evaluation of the level of awareness and knowledge about HIV/AIDS within general population of Crimea, perception of the importance and scale of the problem;
Analysis of the perception of People living with HIV/AIDS by general population;
Definition of the main problems within systems of medical service and social adaptation for PLWH
Preparation of recommendations for improving the situation
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Research methods
Desk research of the official statistical and open research data on the topic;
Quantitative research among general population in Crimea (1243 F2F PAPI interviews);
Qualitative research among PLWH in Crimea (10 depth interviews);
Qualitative research among experts working in NGO’s, medical institutions and authorities (15 expert interviews).
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Time to act
Epidemics
60 and 5 by *iconistas
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During last five years there’s slow growth trend in epidemic dynamics in Crimea, and in Ukraine on the whole
34.5
38.2
41.2
43.2
44.7
40.8
49.1
51.3
57.1
55.4
70.9
60.4
58.8
67.4
68.2
2006
2007
2008
2009
2010
Ukraine
Crimea
Sevastopol
New HIV/AIDS cases in Crimea and Ukraine, 2006-2010. (cases per 100 ths. people).
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Among most influenced by HIV are northern industrial districts of Crimea (Dzhankoy, Krasnoperekopsk) and Feodosia
New cases of HIV-infection to general population of the districts of Crimea, 2009
≤ 0,10% > 0,25% ≥ 0,50%
≤ 0,15% > 0,50%
≤ 0,25%
% of new cases of HIV-infection in population
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146,524
170 015; 116%
171 011;
101%
186 055;
109%
180 338;
97%
2006
2007
2008
2009
2010
804
959
1004
1111
1085
119%
105%
111%
98%
HIV-tests and positive results, 2006-2010. In comparison with the previous year, AR Crimea
Histogram shows the number of HIV-tests conducted in 2006-2010 and percentage of rise of the number of tests in comparison to the previous year.
Line graph shows the number of positive results of HIV-tests and percentage of rise of the number of positive results in comparison to the previous year. 2006 is a starting point.
Existence of the direct dependency between the number of newly diagnosed HIV-infection cases and the number of tests done allows to suggest, that the real scale of HIV spread in Crimea is still underestimated
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32,742
32 160;
98,2%
32 120;
99,9%
32 142; 100,1%
31 258;
97,2%
2006
2007
2008
2009
2010
269
229
222
255
258
85,1%
96,9%
114,9%
101,2%
HIV-tests and positive results, 2006-2010. In comparison with the previous year, AR Crimea
Histogram shows the number of HIV-tests conducted in 2006-2010 and percentage of rise of the number of tests in comparison to the previous year.
Line graph shows the number of positive results of HIV-tests and percentage of rise of the number of positive results in comparison to the previous year. . 2006 is a starting point.
Different situation is observed in Sevastopol, where the quantity of 31-32 thousands tests is probably quite enough for discovering all the new HIV-infection cases.
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Most experts agree on the evaluation of the current stage of epidemic dynamics, as an interim stage between concentrated and generalized stages, although there are polar views on the problem
“It’s still a decease of vulnerable groups only"
“… there are no vulnerable groups any more, as it’s a decease of the general population now”
«Starting to spread outside of vulnerable groups"
Experts’ views on the current stage of epidemic spread in Crimea
CONCENTRATED
GENERALIZED
INTERIM
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Social perception of the epidemic
Going for an HIV-test?
Bring friends!
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Among social and economical issues of the day, HIV/AIDS epidemic troubles minds of 17% of local population (7th rank among other problems)
1
4
6
8
10
12
17
18
24
32
38
38
59
2
3
12
7
10
16
25
16
19
32
37
42
48
Immigration from other countries
Environmental pollution / global warming
Education quality
Economical inequality
Pricy housing
Spread of drug addiction
HIV/AIDS
Pricy medical services
Corruption and bribery in governmetal institutions
Crime rates, lack of lawfulness
Lack of money
Economical recession
Inflation and rise of consumer prices
15-24 y.o. (N=205)
Total (N=1243)
Here’s the list of problems, troubling people, as many of them say. Read this list, please, and mark the problems, troubling you (%)
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12
1
3
4
5
5
5
6
17
25
29
6
2
5
5
6
8
23
24
20
Others
Road accidents
HTA
Obesity
NONE
Depression
Sexually transmitted infections, except HIV
HIV/AIDS
Cancer
Cardiac disorders
15-24 y.o. (N=205)
Total (N=1243)
Which of this factors of risk for the health worries you more than others? (%)
Among major factors of risk for the health HIV/AIDS is mentioned by 17% of crimeans, which is 3rd ranked problem
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For each statement please mark your opinion whether this is a main reason, a secondary reason, or not a reason of HIV/AIDS spread in Ukraine? (%)
18
19
22
31
31
35
36
38
44
50
68
68
68
39
37
33
35
39
38
33
28
31
27
15
16
18
26
31
34
23
20
20
21
20
15
17
10
8
8
People think, that there's a medicine which can cure HIV/AIDS
There's lack of programs for free-of-charge injectors' exchange
Condoms are pricy
Sex is a tabooed topic
Parents doesn't tell kids enough about safe sex
Lack of informational efforts in schools
People doesn't understand how HIV is spread
Low quality condoms
People think, that they're out of risk
Lack of efforts from authorities
Prostitution
Homosexuals
Drug trafficking
Main
Secondary
Not a reason
Total N=1243
In public opinion, the main reasons of HIV/AIDS in Crimea are the illegal injection drugs trade, homosexuals and prostitution
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Which categories, in your opinion, make up a significant share among people living with HIV?? (%)
71
60
55
52
26
4
73
60
54
51
34
5
Injection drug addicts
Homosexuals
Promiscuous people
Sex workers
People just like me, who were unlucky to get infected
HTA
Total (N=1243)
15-24 y.o. (N=205)
Majority of population has a general idea of the most vulnerable groups’ structure. Though, the role of sex workers is underestimated. Also, only 26% said that there could be a large number of “people just like me” among PLWH
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What do you know about HIV?!
HIV awareness
AIds Sucks by twistedscorpio
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45
50
63
65
28
25
16
18
If you don't change sexual partners often, you shouldn't worry
about HIV
If you don't inject drugs, you shouldn't worry about HIV
You can get HIV even after one unsafe sexual act
Condom usage significantly reduces the risk of HIV infection
Right answers Wrong answers
I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%)
Behavioral practices
About half of the Crimean population gave us right answers to the questions regarding the risks of HIV infection
Total N=1243
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17
24
45
67
52
11
14
HIV-infected and ill with AIDS are the same
In most cases, HIV-infection shows itself right after you get infected
You can get HIV, and you wouldn't know about it
Right answers Wrong answers
I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%)
HIV/AIDS illness stages and visible symptoms
Majority of people are aware, that you can get HIV and wouldn’t know about it. Although, only 45% know that on the initial stage the illness doesn’t show itself in any way
Total N=1243
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18
28
34
64
69
46
34
15
13
HIV infection means sure death
If pregnant woman is HIV-infected, therapy can seriously reduce
the risk of child infectioning
HIV/AIDS isn't serious problem today, as there are effective means
of treatment
For now, there's no medecine which can treat HIV/AIDS completely
Right answers Wrong answers
I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%)
Possibility of HIV/AIDS therapy and vertical transmission prevention
Majority of Crimeans know that HIV/AIDS can’t be cured completely . Though it’s not a death sentence – but only half of respondents know this last fact
Total N=1243
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19
21
28
29
44
47
33
People living with HIV now get the necessary meds and can live a
normal life
The majority of PLWH in our country have no access to the quality
treatment of the HIV/AIDS
Effective meds and therapy for HIV/AIDS are available only to those
who can pay for them
Right answers Wrong answers
I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%)
Level of availability of ARVT and possibility for the PLWH to live a normal life
Relative majority aren’t aware about the level of availability of ARVT and possibility for the PLWH to live a normal life
Total N=1243
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67
68
71
73
74
76
86
93
7
11
11
14
15
5
2
3
26
21
18
13
11
19
13
3
Oral sex without condom
Piercing, tattoo, permanent
makeup
Razors, toothbrushes
Syringes or needles
Any "blood-blood" contact
Anal sex without condom
Vaginal sex without condom
Blood transfusion
Right
Wrong
Not sure
Total N=1243
Which ways of HIV transition among following do you consider possible, and which not? True ways (%)
Only 67% know that you can get infection through oral sex, also very worrying is the fact that 14-15% consider “blood-blood” contacts, including contacts through syringes as not dangerous – this needs strong informational response
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The level of knowledge about sexual ways of HIV transmission rose among youth from 2007 till now, meanwhile level of knowledge about danger of transmission through syringes and needles fall from 94% to 75%
81
95
71
75
94
77
56
83
5
2
7
6
3
12
13
7
13
2
21
18
2
10
31
10
GfK Ukraine (2011)
KIIS (2007)
GfK Ukraine (2011)
KIIS (2007)
GfK Ukraine (2011)
KIIS (2007)
GfK Ukraine (2011)
KIIS (2007)
GfK Ukraine (2011)
KIIS (2007)
GfK Ukraine (2011)
KIIS (2007)
GfK Ukraine (2011)
KIIS (2007)
GfK Ukraine (2011)
KIIS (2007)
Which ways of HIV transition among following do you consider possible, and which not? True ways (only population 15–29 y.o., %)
GfK Ukraine sample N=310, KIIS sample N=400
95
94
83
82
75
71
70
69
1
3
8
5
14
12
12
15
3
3
10
13
11
17
18
16
Vaginal sex without condom
Blood transfusion
Anal sex without condom
From mother to child during pregnancy
Syringes or needles
Razors, toothbrushes
Oral sex without condom
Piercing , tattoo, permanent makeup
Right Wrong Not sure
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10
12
15
16
16
16
16
17
17
70
65
56
53
53
58
58
53
51
17
21
26
28
26
21
23
28
29
Touch or hug
Living in the same place with PLWH
Sharing food with PLWH
Sneeze or cough
Using the same bathroom with PLWH
Animal or insects bites
Kiss
Sharing towels or soap with PLWH
Sharing dishes or fork with PLWH
Wrong
Right
Not sure
Which ways of HIV transition among following do you consider possible, and which not? False ways (%)
The most common fallacy about HIV transmission are that you can get infection though shared dishes, forks, towels, and so on – and this mistake could lead to everyday exclusion and discrimination of HIV
Total N=1243
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During period from 2007 to 2011 the percent of youth who share false ideas about ways of HIV transmission fall, so here we can only say good about informational efforts and suggest to follow this course of action
GfK Ukraine (2011)
КМИС (2007)
GfK Ukraine (2011)
КМИС (2007)
GfK Ukraine (2011)
КМИС (2007)
GfK Ukraine (2011)
КМИС (2007)
GfK Ukraine (2011)
КМИС (2007)
GfK Ukraine (2011)
КМИС (2007)
GfK Ukraine (2011)
КМИС (2007)
GfK Ukraine (2011)
КМИС (2007)
GfK Ukraine (2011)
КМИС (2007)
Which ways of HIV transition among following do you consider possible, and which not? False ways (only population 15–29 y.o., %)
17
16
16
15
15
14
13
10
9
53
55
56
61
55
60
53
73
70
30
29
29
24
31
26
33
18
21
Wrong Right Not sure
Sharing towels or soap with PLWH
Sharing dishes or fork with PLWH
Sharing food with PLWH
Animal or insects bites
Using the same bathroom with PLWH
Kiss
Sneeze or cough
Touch or hug
Living in the same place with PLWH
33
27
17
40
30
33
14
6
22
50
50
59
37
48
48
68
87
72
15
23
23
22
21
17
17
6
15
GfK Ukraine sample N=310, KIIS sample N=400
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How real is in your opinion the risk for you to get HIV? (only population 15–29 y.o., %)
12
12
11
28
14
24
3
5
18
42
18
9
Real
Probable
50/50
Not very probable
Absolutely improbable
Hard to answer
GfK Ukraine (2011)
KIIS (2007)
In comparison with 2007 among Crimean youth the share of those who consider the risk of infection as probable (from 5% to 12%) or real (from 3% to 12%)
GfK Ukraine sample N=310, KIIS sample N=400
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Why do you think, that there’s an actual risk of getting infected? (only those, who said that the risk is real, probable or 50/50)? (%)
44
25
21
2
8
38
30
23
3
6
I know how to protect myself from HIV and I take all necessary
precautions, but anything could happen still
I know how to protect myself from HIV, but sometimes I can't take
all precautions
I don't know how to protect myself from HIV
It's all useless, you can even get an infection in hospital
Hard to answer
Total (N=354)
15-24 y.o. (N=68)
21% of respondents among those, who consider the probability to get HIV said that they don’t know how to protect themselves. This shows that there still are important gaps in informational preventative policy
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ARMED & (NOT)DANGEROUS
Behavioral practices
Sex is Dangerous 2 by timtak
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How often do you use condoms when you have sex? (all respondents excluding those who had no sex, %)
10
3
8
5
48
2
24
16
3
9
4
40
28
Always
Almost always
From time to time
Rarely
Don't use, I have sex with only one partner
Don't use, for other reasons
Refuse to answer
Total (N=1080)
15-24 y.o. (N=152)
Only 10% of people (and 16% among youth) said that they always use condoms while having sex. 13% - use condoms from time to time or rarely, so the risk group is pretty large.
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Why don’t you use the condoms at all times? (only whose, who don’t have stable partner and still don’t use condoms at all times, %)
18
17
14
10
7
7
5
3
1
1
51
17
19
13
7
7
2
2
3
54
Don't use when I trust partner
I don't like the feel
Don't have them at the time
Condoms are not relaible protection (can rip)
Condoms are too expensive
I use other means of protection
Don't think it's necessary
My partner refuse to use condoms
I feel ashamed to ask partner for this
I feel ashamed when I buy condoms
Hard to answer
Total (N=462)
15-24 y.o. (N=69)
The main reasons for not using condoms are trust to partner and decrease of pleasure level. Also they’re too expensive for 7% of respondents, so the real way to increase the condom use would be a massive info campaign with free condoms spread.
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Have you been ever tested for HIV/AIDS? If yes, why did you decide to pass this test? (%)
19
20
10
38
13
19
19
8
40
14
I do this regularly
Passed several times, but don't
do this regularly
Passed once
Hadn't passed
Refuse to answer
Total (N=1243)
15-24 y.o. (N=205)
38% of Crimeans have never been tested for HIV, 19% indicated that they do it regularly. At the same time, among those who passed the test for HIV, only 11% did that voluntarily and consciously with clear goal
85
11
4
2
86
13
3
2
It was mandatory to get
the document
For my own peace of
mind
During the special
promotion in company
with somebody
Upon the request of my
partner
Total (N=605)
15-24 y.o. (N=94)
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Why you never passed the test? (among those who hadn’t passed HIV testing, %)
65
19
6
4
3
2
1
66
18
6
2
3
I am sure that I could not possibly
get the infection
Refuse to answer
I do not know where it can be done
I do not want others to know that I
passed the test
I'm afraid of possible test results
I do not believe in the reliability of
the test
I do not want to pay for it
Total (N=477)
15-24 y.o. (N=81)
Would you like to pass a free test for HIV/AIDS if such was offered? (among those who hadn’t passed HIV testing, %)
56
25
19
48
30
22
No
Refuse to answer
Yes
Total (N=638)
15-24 y.o. (N=220)
Among those, who have never passed the test, about 65% are sure that the probability for them to get the infection is zero. The study revealed high barriers to HIV testing especially among people aged 24 and over
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The main recommendation for HIV spread prevention
Popularization of voluntary testing for HIV, testing for partners in pairs, spreading information about organizations which provide VCT and other related info
Introduction of mandatory HIV testing for various procedures / medical examinations with restrictions on results disclosure to anybody except tested person
Popularization of the basic rules of safe behavior
Promotion and distribution of high-quality condoms
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Erase The Ignorance
Life with HIV.
Attitude and adoption
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Level of social tolerance towards PLWH and groups of high risk in comparison with different ethnic and racial groups (Bogardus scale, means)
1.4
1.6
3.0
4.1
5.4
5.4
5.6
5.7
5.8
5.9
6.0
6.1
Ukrainians
Russain
Crimean Tartars
Jews
Americans
Asians
Africans
People living with HIV
Homosexuals
Chechens
Sex workers
Drug users
Socially close
Neutral
Acceptable
Xenophobic attitude
The problem in perception of people living with HIV in society is still quite significant, especially in comparative perspective with the level of "social tolerance" towards PLWH and groups of high risk
34. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011
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Are there PLWH among your acquaintances? (%)
Yes 10%
No 90%
56
42
2
79
21
I treat them as all other people
I don't show it, but I try to avoid contact
Hard to answer
Total (N=122)
15-24 y.o. (N=25)
How you feel about them? (only those who have acquaintances among PLWH, %)
At the same time, most of those who have friends among PLWH indicated that they treat them as ordinary people. Experts also believe that the mere fact of the disease does not necessarily lead to social exclusion in Crimea
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35
22
21
19
12
6
20
26
23
28
11
18
16
19
17
23
9
14
16
12
25
32
23
23
31
35
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
HTA
Total N=1243
The share of those, who thinks that PLWH have a right to preserve their status confidential, and those, who thinks, that they must warn other are almost equal in Crimea – 42% and 40% respectively
Indicate, please, for each of the following statements regarding PLWH to which measure do you agree with it, (%)
People living with HIV/AIDS have the right to keep this in secret
Rights of people living with HIV AIDS violated in Crimea
Most people with HIV AIDS are to blame for the fact that infected
People with HIV AIDS must warn others about the disease
HIV AIDS - a punishment from God
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•Quite often, after the discovery of HIV-positive status, people alienate themselves from the world, from society, even from close friends, lock themselves in the problem. This behaviour can be provoked also by the desire to protect one’s family from him/herself
Self-isolation Self stigmatization
•The physical consequences of HIV infection can be severe enough to deprive a person of the opportunity for active employment and self-realization in some professional fields. On the other hand, the opportunities for retraining and employment are quite small
Disability
•PLHIV often suffer from concurrent disorders such as drug addiction and contagious co-infections. The degree of social tolerance to such problems is significantly lower than even to HIV itself, which affects the perception of PLHIV with such problems in the first place as a drug addicts (the image of which is strongly associated with delinquent behaviour), tuberculosis-infected (TB is contagious by droplet contact). A similar mechanism applies to the CSW, whom people also often associate with delinquent behaviour.
HIV-related medical and social problems such as drug addiction, tuberculosis coinfection
Изменения в жизненном мире ЛЖВ после сообщения о статусе очень велики, и для полноценной адаптации нужна активная психологическая и социальная помощь для принятия своего положения и предупреждения самоизоляции
37. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011
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Changing attitudes toward people living with HIV status
Assistance in rehabilitation, self-realization
Overcoming negative institutional background
Improving the overall situation with perception of PLWH and HIV AIDS by the general population
Authors of photos (left to right):
Romainguy, Walt Stoneburner, Keith Allison, Julie McLeod
All photos are used under Creative Commons license conditions
Our response to epidemic should cover all stages - from the psychology and behaviour of people living with HIV to the broad understanding of problem by society. Very important step would be overcoming the negative institutional background.
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Recommendations for improving tolerance to PLHIV. To improve the tolerance towards PLHIV it’s recommended to spread in the media, as well as through the civil organizations the following information:
The epidemic has moved beyond the groups of drug users and promiscuous people – so people are often not to blame for the infection;
Life stories of adults and children living with HIV, who can (with the necessary treatment ) live a normal life (in particular, in popular programs, movies, TV series); information about human rights and violations of the rights of PLHIV. According to the research, people who have friends among PLHIV better treat them than those who doesn’t;
Intolerance towards PLHIV promotes the spread of HIV / AIDS epidemic;
Stories about healthy children which can be born to PLHIV thanks to effective treatment;
Communication with adults and children living with HIV is absolutely safe, HIV can be only transmitted through blood and sex.
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| 2011
Keep fighting
HIV-service and prevention
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All respondents are satisfied with the services for PLHIV in the AIDS centres in Simferopol and Sevastopol. Stated the following suggestions:
Increase numbers of full-time medical stuff;
Enlarge the list of available medical services – there is high demand for treatment of cardiovascular, services of dentists, gastroenterologists, neurologists, other specialized doctors;
Provide free analysis on the immune status and viral load, as well as opportunistic infections;
Provide free medicines for the treatment of opportunistic infections;
Divide the flows of patients (testing, issuing of ART for patients with opportunistic diseases, etc.);
Improve facilities (larger premises in Simferopol, separate room in Sevastopol);
(only for Sevastopol) Create own laboratory for analysis on the immune status and viral load.
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Most PLHIV are satisfied with the services provided by public organizations. Made the following suggestions regarding social services:
The main need of all respondents - to increase the volume of humanitarian aid (medicines, rations);
Expand the services in area of the care of seriously ill patients (transportation of patients to the hospital or visits by doctors at home, presence of social workers in hospitals);
Organize assistance in employment search;
Provide the services of professional lawyers;
Organize recreational programs for children;
Organize creative workshops;
Provide services like haircuts, manicures;
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The shortage of qualified doctors (especially those, specializing in infectious diseases and dentists) and the unavailability of drugs for the treatment of opportunistic infections are the main challenges in the area of medical services
Problems with medical services for PLWH
Infrastructural
Problem with access in distant areas
Lack of qualified doctors-specialists
Lack of premises, insufficiency of equipment and facilities
Availability and quality of the meds
Lack of ARVT meds, only several combinations available
Outdated drugs with negative side effects
Unavailability of drugs for opportunistic infections treatment
Availability of special services
Unavailability of artificial insemination for discordant couples
Main problems with medical services for PLWH
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Opinions PLHIV and experts agree that at present NGO’s operate more effectively than government in the fields of prevention of infection and care & support for people living with HIV
The main problems in the area of HIV / AIDS prevention and non-medical services for people living with HIV
NGO
Governmental agencies
Scope
Relatively small, mainly in big cities
Relatively large
Resources
Better equipment and resources, but lack the premises
Worse equipment and resources, enough premises
Finances
Relatively bigger project-based finance from multilateral sources
Relatively smaller budget-based
Work Organization
Project-based organization of work, more flexible, but not always successive
Planned work, relatively inert and less effective, though more permanent
Monitoring & Evaluation
Effective and established
No systematic M&E
Motivation
High
Low
PLHIV involvement
Large % of workers are PLHIV
No systematic involvement
Trust
PLHIV and people from risk groups access NGO more often. The high level of confidence is caused by the previous experience in referent groups and activity in the provision of services
Rarely apply to state non-medical organizations. Many bureaucratic procedures, delays. IDUs and CSWs often had in the past experience of the arrests and generally do not trust the state authorities
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Achievements of the HIV-service organizations in Crimea
Raising awareness about the threat of HIV / AIDS and safe behaviour practices among young people under 30 years old in 2007. At the moment, the most informed and cautious group of Crimean population are people aged 15-24, which apparently is the target audience of many prevention programs;
Advances in prevention work among IDUs, to a lesser extent – among CSW, and least of all - MSM;
Increasing the number of HIV tests performed in 2007 (16% compared to 2006) and in 2009 (9% compared to 2008) in the ARC (in Sevastopol in 2008-2009, the number of tests is stable). Overall, at the end of 2010, 47% of Crimean aged 15-29 were tested for HIV, compared with 37% in 2007 .;
Expansion of the branch network of AIDS centers and offices for ART provision
Provision of ART for the absolute majority of those in need;
Satisfaction of respondents with the work of HIV / AIDS centres and NGO’s, which is a key indicator of the effectiveness of their work.
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Priorities for the future
The relatively low level of awareness about the threat of HIV / AIDS and safe behaviour practices among the sexually active age group of 25-49 years, which receives the relevant information less often;
Lack of preventive work among CSWs and MSM;
The low popularity of regular voluntary HIV testing (of all respondents who are tested for HIV, 85% have done it because they needed a certificate for some purpose and only 11% were tested deliberately for their own peace of mind).
The low level of tolerance towards people living with HIV in the general population (40% of them wouldn’t allow PLHIV into the territory of the peninsula, 42% believe that they are to blame for their fate) and, in particular, among health care workers and employees of state organizations, including law enforcement services. In 2010 compared to 2007 tolerance to PLHIV decreased, even among young people 15-29 years old, which is the most tolerant group: in 2007, 52% claimed that their attitude towards somebody whom they know, would not change if such person will get infected, or they will try to help him, in 2010 only 37% claimed the same.