MOSCOW, Russia - HIV prevention among sex-workers is a complex issue for all organizations working with vulnerable groups at high risk of HIV infection. The Saint Petersburg initiative on HIV prevention for sex workers, combined with the joint efforts of governmental and non-governmental organizations, has proved to be effective strategy. 
With nearly 66 per cent of newly reported cases of HIV in Eastern Europe and Central Asia registered in the Russian Federation, the HIV epidemic in Russia continues to expand, though not as rapidly as in the late 1990s. The HIV epidemic in Russia is concentrated mainly among Injecting Drug Users (IDUs), sex workers, their respective sexual partners and to a lesser extent, men who have sex with men. The heterosexual mode of transmission has accelerated in recent years as two-thirds of the newly registered HIV cases in 2006 were attributed to injecting drug use and almost one-third to unprotected heterosexual intercourse. Young people aged 18-29 constitute 85 per cent of all registered HIV cases in the country and women comprised approximately 44 per cent of newly registered HIV cases in 2006.
There is substantial overlap between sex work and injecting drug use in the country as 30-39 per cent of female sex workers in the Russian Federation report injecting drugs. Studies show that almost half of Saint Petersburg’s sex workers, who are concurrently injecting drug users, said that they shared injecting equipment with others. Among the city of Samara’s sex workers, only two-thirds said that they used condoms consistently during paid sex, and only one quarter used condoms with non-paying partners. Describing how UNFPA became involved with sex workers as part of HIV prevention initiatives, Dr. Lidia Bardakova, UNFPA Assistant Representative in the Russia Federation explained, “HIV transmission in Russia is primarily among IDUs and sex workers. Effective HIV preventive measures among vulnerable groups, including sex workers in a concentrated HIV epidemic such as Russia, are crucial in order to avoid a generalized HIV epidemic.”
To assess needs of sex workers before implementing the project, research on sex workers was carried out with the support of UNFPA in ten regions of Russia. Sex workers indicated that the main reason they chose to become a sex worker was the need to support their relatives and children - or drug addiction. The study highlighted that violence and disease figured high on the list of problems of sex workers. Since 2002, UNFPA and the non-governmental organization “Humanitarian Action” of Saint Petersburg jointly developed and piloted an initiative, which included comprehensive medical, social and psychological support for sex workers.
An essential component of the project was the introduction of mobile points that provide supplies such as clean needles, syringes and condoms for sex workers and injecting drug users. Services also include medical and psychological counseling, and voluntary testing for sexually transmitted infections (STIs), including HIV, and viral hepatitis B and C.
Through this project, medical specialists and a team of “trusted doctors” were trained in carrying out effective HIV/STI prevention programmes among street sex workers, and training modules for social service providers, including medical specialists, psychologists and police officers, were developed and trainings were conducted. A network of NGOs working on HIV prevention among sex workers was established, and partnerships between NGOs and government were enhanced. One success of the project has been that more than 38 per cent of the women who were given medical referrals accessed health clinics and there has been an increase in condom use among sex workers. There have also been challenges, said Dr. Bardakova. “Since most of the sex workers in the project sites are also injecting drug users, they are generally vulnerable to HIV infection because of behavioral and biological factors. We need more harm reduction programmes combined with comprehensive services for sex workers as was carried out in a number of the project sites.” She added, “If we apply effective, early actions, it can significantly change the contours of epidemic.”
As of 2008 the project was expanded to the Siberian regions of Irkutsk and Chelyabinsk where more than 80 per cent of sex workers are IDUs. The outcomes and good practices related to this initiative will contribute towards development of a national strategy on sex workers and HIV prevention.
- Lidia Bardakova
