FOCUS GROUP DISCUSSIONS WITH YOUNG KEY POPULATIONS COUNTRY REPORT UKRAINE
Country Context Ukraine is one of the most affected by HIV infection countries in Eastern Europe and Central Asia. As of September 2015, a total of 275,754 cases of HIV infection were officially registered, including 81,577 cases of AIDS and 37,543 deaths from AIDS-related diseases. The HIV prevalence rate among 18 y.o and older is 0.62%, which is one of the highest among Western, Central, and Eastern Europe. Among those on ART, youth and adults (18 and older) constitute 95.5% (64,360): 52.8% men (32,477) and 46.2% women (28,995). Currently, Ukraine has a concentrated HIV epidemic (among key populations). In late 90 th around 8590% of all new cases of HIV infection were due to injecting drug use and this mode of transmission was prevailing up until 2007. Starting from 2008, the main way of transmission shirted to sexual: in 2015 it reached 72% of all new HIV-infections. Today, women constitute 45% of all population in Ukraine. Women are more susceptible towards HIV infection than men due to their biological and social (gender inequality and discrimination) vulnerabilities. In particular, a certain number of women are involved in sex work in order to be able to buy drugs for themselves and their partners, practice unprotected sex with their clients, a lot of times in poor hygienic conditions, and are victims of physical violence (which is also a risk factor for HIV/STI infection). Young people are particularly vulnerable towards HIV infection and STIs, especially young key populations. Vulnerability of young SWs and MSM is due to a number of risk factors: early start of sexual life, irresponsible and risky sexual behaviour, absence of knowledge about HIV/STI prevention and sexual and reproductive health (especially during sex work and MSM-MSM contact), limited access to health, social and legal services. Ukraine has adopted a National Programme on HIV prevention for 2014-2018. The Programme includes components on HIV prevention among key populations (SWs, MSM, and PWUD) however, young key populations are not separately highlighted. Ukraine also has a network of youth-friendly clinics (around 130 nationwide) that quite successfully address issues of SRH and HIV prevention among adolescents and youth. However, key populations, and especially young key populations, most of the times, either do not know about their existence or do not want to visit them fearing stigma and discrimination on behalf of medical personnel. A number of donor organisations (such as AFEW) and UN agencies (UNFPA, UNICEF, UNDP) are implementing projects on HIV prevention among key populations. However, the main donor in the country that funds HIV prevention and treatment programmes is the Global Fund that implements its projects through 3 primary recipients: International HIV/AIDS Alliance in Ukraine, Network of PLWHA, and State Centre for Control of Socially Dangerous Diseases (UCDC). At the same time only the Alliance has activities on HIV prevention among key populations, and this year the GF dramatically cut funding for prevention activities. As for the State budget, within the framework of the National HIV prevention Programme, funds for prevention are not allocated. Most of the State-allocated funds go towards procurement of ART for people who live with HIV and AIDS. The situation with the armed conflict in the east of Ukraine significantly increased vulnerability of key populations towards HIV/STI as a result of displacement, hard economic situation, and, a lot of times, absence of social protection and access to quality health services.
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Mobility and migration Young SWs – is a mobile community (no restrictions of movement internally and abroad). SWs migrate a lot within the country: seasonal migration and migration from the armed conflict areas. Also, during the last year, migration abroad has increased: SWs are migrating to Russia and other countries where they work illegally and are subjects to additional risks such as human trafficking, violence from local pimps, and sexual slavery. Methodology of small focus group discussions: In total, 7 focus-group discussions (FGDs) were conducted in 4 regions of Ukraine among 80 representatives of young key populations (SWs and MSM). As a result, 34 SWs and 46 MSM were surveyed in the following cities: Rivne – 12 SWs, Kiev – 2 discussions with 20 MSM, Zhytomyr – 14 SWs, Novograd-Volynsky – 10 SWs, Dnipropetrovsk – 12 MSM, Dneprodzerzhynsk – 12 SWs. FGDs were conducted by a hired facilitator (representative of local NGO LigaLife) and UNFPA HIV Programme Officer. FDGs were conducted during September 2015.
1.
Other circumstances, additional information about the country situation
On 18 September 2015, one of the Members of Ukrainian Parliament Mr. A, Nemyrovsky has introduced to the Parliament a draft law #3139 on “Regulating prostitution and brothels” that envisaged legalization of sex work in Ukraine. However, this draft law was never discussed with any of the representatives of sex work community. Later on, this draft law was called off by the same Member of Parliament without any explanation.
2.
Key findings
COMPONENT 1 Social and cultural aspects of young key populations
Key findings: MSM: typically is citizen of Ukraine, between 22 and 24 years old, single, has no children, lives with his family (parents), has technical or vocational education (college), in big cities – higher education (university), a lot of times is a SW, likes active leisure, travels a lot, likes to spend time outdoors. Main problems: discrimination, self-identification, personal space, coming out. Only in one city – Zhytomyr, all participants of the FGD noted that they communicate with friends from childhood. In in the rest of the cities no more than 10% of respondents keep in touch with friends from childhood. Most of MSM (90%) have problems with lack of money, however, after becoming SWs, they usually meet wealthy client that supports them. MSM practically do not use drugs. Rare cases of drug use (10%) were reported only in early adolescence (before 20 y.o.) – mostly stimulants and opiates. In those few cases that MSM use drugs at the moment – it is mostly marijuana. Situation in Kiev differs: MSM showed quite high level of drug use – 40%. Only 12% out of this 40% tried using injecting drugs and those cases were more than 3 years ago. Also, absence of targeted information for MSM who use drugs was noted (including IEC materials), no trainings, and no reliable statistics. No one is working with this category of people in the area of harm reduction. As a result – during the last couple of years, no one from this 12% received any harm reduction services. Also, by the end of discussions, MSM confessed that there is a problem of hidden alcohol abuse in their community. By the end of each FGD most of MSM confessed that they practice sex work. Most of MSM reside in the same place as were born, except in Kiev, where there is a big percentage of MSM that moved from smaller cities and towns (80%). All MSM reported not being part of any network or self-organized group and know very little about such networks.
Regional specifics showed some very interesting trends: in Kiev, where MSM showed high level of knowledge and information in different thematic areas, including HIV prevention, and integration into the society – MSM are hiding their status and are not ready to disclose it, only to very close friends. In Dnipropetrovsk, which is also a big city with MSM well integrated into the society, very week work of local NGOs was observed – some MSM did not even know what lubricant is and how to use it. At the same time in Dnipropetrovsk half of the surveyed MSM do not conceal their status of MSM and SW. The other half of MSM in Dnipropetrovsk that preferred not to disclose their status turned out to be TGs. During the last 5 years most of the respondents did not notice worsening of quality of medical services – this is mainly because most of the young MSM prefer to use private clinics. Only a small percentage of MSM (10%) use local NGOs to undergo necessary screenings, testing and receive other medical services. All young MSM agreed that currently it will be very difficult to change attitude of the society towards MSM – based on their personal experience of double stigmatisation (MSM, and in particular TG, and SW). It is important to notice that young MSM in all cities, except Kiev, in comparison with the surveyed young SWs, were more opened, showed bigger potential and higher level of knowledge. Also, right from the start of discussions, young MSM acted more openly, were more interested in the topic and showed willingness to receive new information. At the same time, very little expressed willingness to work in initiative groups, as activists.
SWs: All surveyed SWs were citizens of Ukraine, most of them reside in the same place as where they were born (80%). It should be noted that FGDs among SWs did not cover Kiev, where this trend is opposite.
Very few of the respondents have their own apartments. Most of the times it is rented. Some live with their boyfriends / partners or with parents. 70% of SWs share rented apartments between themselves. The age of the surveyed SWs was from 20 to 24 years old. The majority of SWs in big cities have higher (university) education. One third of SWs have additional income, apart from sex work. In small cities SWs mostly have highschool or technical vocational school (college) education. The majority of SWs were never officially married and live with their partners in civil marriage (or are being in free relations). Almost 70% of SWs have children. One third of them – more than 1 child. In 90% of the cases children live with their mothers. SWs usually spend their leisure time with their friends or family. Around 30% of respondents noted that they prefer to spend their free time “at workplace”- in cafes, saunas, restaurants, and night clubs. A lot of them have personal hobbies and home pets. Almost all of young SWs hide their status as sex worker or HIV-positive when visiting state institutions and places where they get medical, social or legal support. Almost all of young SWs noted their inability to organize sex work as business, noted lack of skills and experience with spending money that they earn and personal budget planning. Only 10% of SWs keep contacts with friends from their childhood. Page 3 of 16
90% of surveyed SWs are clients of HIV-service NGOs. Only 5% are involved in the work of self-organized communities and networks. All SWs noted that 5 years ago they experienced a lot of illegal arrests, sexual and psychological violence by police. Now the situation is a little bit better, however, illegal arrests, blackmailing, physical and economic violence are still present. Almost all of young SWs abuse alcohol. 25% of those who drink alcohol usually give discount to a client who pays for their drinks. Drugs are used by a very little number of young SWs СР (up to 5%). COMPONENT 2 Access to and accessibility of SRH and HIV services
Key findings: MSM: In case of health problems, 25% of MSM from Kiev will go to a public clinic, 25% to private clinic or NGO, 25% will ask friends for help, and 25% will look for treatment information on thematic internet forums and online resources.
MSM from Dnipropetrovsk noted that they ask for help from their relatives (90%), look for information on thematic internet forums (6%) and avoid private clinics (only 4% of respondents go to private clinics). Work of NGOs with young MSM needs to be improved – young MSM have very little information on the available medical services (including on HIV and STI prevention and treatment. Only a small percentage of surveyed MSM (up to 10%) noted that they receive information from local NGOs, however, this happens very rarely. MSM in Zhytomyr usually seek help from local NGOs, and in case they need specific medical help, they prefer to go to private clinics. As for the state facilities, only 10% of respondents reported going there due to “constant need for bribes and lack of confidentiality”. Because there were no PWUDs among surveyed MSM, no one had any information about the existing harm reduction programmes. MSM have a very limited knowledge about TB and only go for testing if required by employer or during mandatory medical check-ups. MSM reported that they never received any information about TB and its prevention and treatment from local NGOs. Zhytomyr oblast is among those with high level of TB. Prevention programmes that are adopted on oblast level require fluorography before attending any other physician. TB clinics experience shortage of medications, such as “Tuberculin” and there are a lot of cases of TB among PLWHA. In other regions, MSM reported doing fluorography only when it is required by employers (90%). Although fluorography is accessible, 100% of MSM noted that they were required to pay for expendables (fluorography film). MSM in all regions reported lack of specialized medical doctors (proctologists, urologists, sexopathologist). In Zhytomyr MSM also reported absence of tests for gonorrhoea and other STIs that are specific to MSM in local NGOs and local clinics. Local NGOs pay very little attention to the work with young MSM – this leads to the lack of information and knowledge of MSM about existing medical facilities and services, including on SRH and HIV prevention. Low motivation among MSM themselves is also a barrier for accessing prevention and treatment services. MSM also reported lack of access to HIV rapid tests, VCT and other effective diagnostics. In case of TB, because of a lack of information and diagnostics, MSM start TB treatment very late, if at all.
SWs: In case of health problems 80% of SWs turn for an advice to their friends and local NGOs, 15% talk to their parents, and only 5% go to public medical clinics (usually
because of the need to pay for services and treatment). Around 80% of SWs go to local NGOs for testing and contraception (including condoms), lubricants and counselling (in Ukraine, NGOs usually distribute condoms procured by the Global Fund project). During the last 2 years SWs noted some shortages with condoms in local NGOs. In 80% of cases SWs use condoms, however, there are times when condoms are not used: if client pays extra money, if client insists (with violence), if husband or boyfriend insists, if condom is of a wrong size or bad quality, smells bad, costs too much to buy, or is not available, especially at night time. SWs themselves lack communication skills to insist on using a condom with their clients and partners (90%). SWs do not know what “safe abortion” means and are not aware of post-abortion care. Medical doctors have a negative opinion towards abortions in general and they prefer not to council SWs but to talk them out of doing an abortion, justifying this by future complications with health and infertility. As a result, some pregnant SWs decide to give birth and some – do abortion (in Ukraine, “criminal abortions” practically do not exist). In case SW decides to do an abortion, she goes to a medical clinic. If in the clinic the doctor tries to talk her out of doing an abortion, she just finds another clinic with more “loyal” doctor. 90% of SWs learned about condoms from their friends. 10% - at school or from parents. All 100% of SWs expressed their interest in receiving information (trainings, webinars, leaflets, posters, etc.) on barrier and other types of contraception and ways of HIV/STI prevention. Young SWs, apart from condoms, use other methods of contraception. Most of the times they use IUDs (it is still recommended by most public clinics and contraception method for those who had an abortion). Practically no one is using hormonal or chemical contraceptives, although everyone has heard about them. The reasons for not using these types of contraceptives are very different: from inability to mix with other medications that SWs take, to lack of access due to their high price. More than 50% of SWs received information about other types of contraceptives from their friends, including those from women’s internet forums and chats. Around 30% from local NGOs, including from medical doctors to whom they were referred by NGOs. 80% of surveyed SWs are satisfied with access to services provided by local NGOs because there they see friendly and non-judgemental attitude and can receive services anonymously and free of charge. This is exactly what is missing in public clinics (according to SWs) and is a barrier for receiving necessary services. All SWs have noted that it is important for them to receive non-bias treat and that medical doctors should be familiar with peculiarities of SWs (it would be good to have special trainings for medical doctors with involvement of SWs as co-facilitators). 80% of SWs reported that they are ready to pay for medical services if they are of a good quality and anonymous. Often SWs conceal they status fearing stigma, and this can be an obstacle for a doctor to prescribe a correct treatment. Those young SWs who go to private clinics (90% of them) report revealing their status to the doctor without fear of being exposed. All 100% of SWs noted inability to receive all services needed in one place. Different services are located in different places, sometimes very far away from each other – this leads to a “drop out” of SWs when going from one place to another. SWs noted that it would be good to have a “drop-in” centres for women in all cities (for all women, without specifying SW). Mandatory registration of the place of living has been abolished in Ukraine for a long time now, and is not needed for accessing public medical institutions and local NGOs. However, public medical institutions require passport if a person moved from one city/region to the other and wants to receive services in that new region/city. As for Page 5 of 16
NGOs, no identification documents are required, everything is free and anonymous. In private clinics all services and anonymous, attitude is non-judgemental and friendly but the price of the services is expensive and only 15% of young SWs can afford them. A lot of SWs have noted lack of the following highly-needed services for them: counselling of gynaecologist and endocrinologist, testing for TB and viral hepatitis, including VCT by VCT specialist, not by social worker as it is currently being practiced. Services that SWs receive in local NGOs (those on STIs, HIV, and SRH) are quite adequate, however, still require improvement. The following obstacles for receiving effective and good quality services in NGOs were identified by SWs: • Absence of specialized services; • Referral to medical clinics that are located very far from each other (sometimes in other city); • Absence of medical specialists (gynaecologist, endocrinologist, urologist, dermatovenerologist); • Absence of peer counsellors in a lot of local NGOs. The issue with absence of medical specialists in NGOs became topical in the recent year when the Global Fund dramatically decreased its funding for prevention among SWs. As for the public clinics, access of SWs to the services is hampered by some additional factors such as lack of confidentiality - SWs are afraid that medical staff will inform law enforcement about them, will disclose their HIV status that will hurt them and their children (in kindergarten, school). Also SWs-IDPs (internally displaced persons) who are running from the military conflict zone in the east of Ukraine, very often do not have any identification documents that makes it impossible for them to receive services in public medical institutions. Information for this group of SWs on how to access services is practically absent. COMPONENT 3 Legal aspects, discrimination and violence
Key findings: SWs: Violence inside of the community: Around 40% of young SWs experienced violence, discrimination and stigma inside of their own communities. These manifest as unhealthy competitiveness and psychological pressure when older SW starts to blackmail young SW by threatening to disclose her status. There are also conflicts between those SW who use drugs and those ones who do not: in 5% of such cases they end up in physical violence. There is also discrimination of SWs if, for some reason, their HIV-positive status was disclosed. Such SW can be abounded by her peers, humiliated, and forced not to work in the same place with other SWs. Such SWs become most vulnerable. The reason for most of the cases of violence inside the communities is internal competition and jealousy (for higher pays, more attention from the clients, wellness, beauty, being young, etc.). The reason for stigma and discrimination towards HIVpositive SWs is primarily low knowledge and information about HIV, its ways of transmission and prevention. Low self-esteem and lack of knowledge that in Ukraine there is a quite strong community of SWs, activists, peers who are ready to support and help other SWs, often leads to a situation when young SW becomes a victim, a person that does not trust anyone and is angry at the whole world. Violence from outside: In 90% of the cases it is law enforcement representatives (police) who are perpetrators – they blackmail, demand and take away money from SWs, apply physical violence, force to sex without pay, restrict personal freedom (detain SWs). In those cases when the perpetrator is a client, pimp, or any other person, the police almost always tends to “close their eyes” and not to act thus, depriving SWs of their right to justice and protection. The police may not want to record testimony of a SW who was a victim of violence or rape, or even present perpetrator as a victim himself.
70% of SWs will go to police in case they experience physical violence, but only if their status as SW will not be disclosed. It is the fear of being disclosed that prevents 90% of SWs to go to police in case of rape. Also, one of the barriers for SWs to seek justice is high cost of professional lawyers. In Kiev, 30% of SWs tried to defend their rights in courts. One of the SWs told that her legal hearing is currently underway: she was raped by a stranger, robbed and beaten up, but when she went to police, they did not even want to open a case because of her SW status. It was only due to public pressure from other SWs-activists and members of the community that her case started to be investigated. All SWs noted stigma and discrimination in their everyday life (from relatives, partners, neighbours), in the communities (40%), from the clients (75%), as well as in medical facilities. SWs also reported an increased number of cases of violence from soldiers who come back from the military conflict zone – 25% (reported in all regions except Kiev). Most of the SWs conceal their status from relatives and friends. Almost all SWs who have children of school age fear that their status will be disclosed in school where their children study. There was only one case reported by a SW who took part in the FGDs when a medical doctor, when learned about the SW status, refused to provide her medical services and disclosed this information to other people. 70% of SWs know about existing NGOs in their cities, however, 80% were not sure if these NGOs provide legal counselling and support. 40% of SWs reported that earlier NGOs had layers working with them, however, during the last year NGOs are not able to pay for their services (due to decrease in funding for SWs from the Global Fund). The same situation is seen with medical doctors. All young SWs want abolishment of administrative and any other prosecution of sex work and are ready to discuss the necessity of legalizing sex work in Ukraine. All SWs noted that in order to increase access to SRH and HIV services in public institutions it is important to create drop-in centres for SWs (with involvement of SWs themselves into their work) and women’s centres (clinics) that would provide a whole range of necessary medical services anonymously. All doctors and other medical personnel of such centres would have to be trained on working with marginalized groups of women, in particular with SWs. MSM: Violence inside of the community: Inside of the MSM community the same types of violence and their reasons were noted as among SWs. Violence from the outside: Law enforcement (police) very rarely appear in places where MSM and TG (including MSMSWs and TG-SWs) sell sex or simply hang out. Most of MSM (70%) will go to police in case they experience violence (regardless of the fact who the perpetrator is). Two MSM from Kiev had experience of dealing with police after they experienced physical violence. The police is reluctant to investigate such cases when they learn about MSM status of the victim. In the past there were also a lot of provocations from the police side, however, during the last year their number significantly decreased. MSM told about violence that is very common in prisons form cellmates, as well as from Page 7 of 16
representatives of penitentiary system. One of the MSM told a story that happened with one of his friends: he was raped by police and then committed a suicide. Nobody was brought to justice. The aggression from police and other law enforcement side usually comes after MSM receives preliminary conviction (then starts blackmailing and threats). The MSM community does not have an open access to justice due to the fear of being exposed and aggression from police. Therefore, only 7.6% of MSM decide to go to court. All MSM also noted the problem of homophobia among a lot of lawyers, as well as overall homophobic attitude of Ukrainian society in general. Also, problem of violence between the partners was revealed, however, MSM decided not to talk about it. MSM also noted a pressure from the colleagues at work when they learn about their status. Stigmatisation of MSM is widespread in the families, among friends and at work (95% of respondents reported being subject of stigmatisation). MSM are forced to always stay alert, silently listen to insults and constantly experience humiliation. They live in constant fear, receive psychological traumas with which, in most of the cases, they have to deal by themselves. Situation with discrimination also worsens due to russian homophobic propaganda. Also, some radical political groups and parties in Ukraine pose a threat for MSM community. A lot of MSM experienced physical violence from members of these parties and groups. There were also raids to some night clubs where LGBT community usually hangout. COMPONENT 4 Participation and rights
Key findings: SWs SWs should participate in decision making, discussions of laws and other normative documents targeting them, as only they fully know and understand their own needs. SWs also should be involved in development of informational campaigns that would form public opinion and prepare society for changing legislation and decriminalizing sex work. The society has to be ready for decriminalization and legalization of sex work. Only appropriate legal norms can put SWs in equal position with other members of the society. Stigma and discrimination (including by HIV status) is prohibited in Ukraine. Nevertheless, it is important to understand that many official documents have declarative nature and their implementation heavily depends upon foreign donor aid. This humpers continuity of interventions. MSM MSM, just as SWs, should participate in decision making, discussions of laws and other normative documents targeting them, as only they fully know and understand their own needs. MSM-SWs and TG-SWs are usually the most closed groups and are not aware of the existing programmes and prevention activities. Although not popular among the general society, this group needs to be included into prevention activities, otherwise it will continue to stay “in shadow” and be invisible. Human rights of TG-SWs group should also be addressed. This is a very specific group that, in most of the cases, became SWs to earn money for future sex-change surgery. MSM usually are not well integrated into the society – this makes them feel vulnerable and forced to live in their own world. Absence of safe places for MSM, lack of information with regard to services – all this makes them even more vulnerable. MSM have a very low motivation for participation and involvement in advocacy work
because they are afraid and do not believe that they can change the situation.
Quotations COMPONENT 1
Quotations and problems: MSM KIEV "I send my leisure time in company of gays, they all know about my work. We drink, socialize, laugh ... " "In the clubs I hang out and sometimes I also find clients there. Or just go for love ... " "I'm single, it is enough for me to go out just once a week. I have to work a lot, my mother in Donetsk is alone... " "The integration makes it possible to have a family and relationships” "I am included into society. My friends know who I am, what I do for living, and they are willing to help me when I get into troubles" " When I am a woman – it is who I really am, not that strange man that I sometimes can see in the mirror " "Because I cannot integrate I drink and use drugs. This is the only way I can forget that no one needs me " "If you do not accept yourself, then why the society should accept you? We should start from ourselves " DNIPROPETROVSK «It is quite common – to drink after a working day» ZHYTOMYR «I want to work without discrimination...» «If someone uses drugs, they do it discreetly, without telling anyone...» «We do not have drug addicts among us, most of us if using drugs, they are not injectable, just marijuana. This is just to relax…» «When I go to nightclubs I use energetics or stimulants – I do not think it is something bad. Abuse of alcohol – this is a real problem, as drunk people usually do not use condoms »
SWs: КIEV «I usually spend my free time with my family, children…. I do not have any friends really…» «We usually go outdoors on picnics» «It is very hard to keep friends and work – hate to lie that I work as a waitress or a dancer…» «I like bike, do sports…» «I usually go to “dacha” with my kids…» «I do not need specific services – just quality and attitude» «I always do all tests and analysis, even if I have to pay for them» «I would never go to clinic that is specifically for SWs. I would rather go to a general clinic for women…» DNIPROPETROVSK «Only 20% of my time is devoted to home…» «I usually go to night clubs» «I try to spend my free time with my kids» «During the last 5 years quality of services went down in public clinics, and if you say that you are a SW……. » Page 9 of 16
«Clients stopped to follow personal hygiene. Sometimes you just have to force them to go and take a shower…» Integration and social inclusion «Integration gives an opportunity to obtain family, job, have relations…» «People who are integrated into the society have better access to the services» «18-25 years old SWs seem to be out of this world, they are disoriented somehow…» «Young SWs think less about their future, they do not care about their health, including personal hygiene. They usually do not know how to organize business…» «My parents do not know that I am a SW, at school, where my child is studying, also nobody knows …» «It needs to be shown on TV, talked about by mass-media… people need to see that we are normal women and we have the same problems and needs as everyone else…» NOVOGRAD-VOLYNSKI «Police hunts us as homeless dogs. Nothing has changed…». «We always drink alcohol before going to work!» «Сидишь в баре, увидел тебя мент – и составляет протокол…» «Police «covers up» their own girls and hunts us all over the place …». «Police raids are usually once per quarter but most of them are at the end of the year…» COMPONENT 2
Quatations and problems: SWs KIEV Access to and accessibility of SRH and HIV services «My doctor in the clinic does not know what safe abortion means..» «When my sister was sick, all relatives were tested for TB…» «I am glad that everything in anonymous. They always smile and ask “how’s life?”, offer tea and coffee, and all services are free …» (about services in local NGO) «Very inconvenient that all doctors are located in different places (about public clinics) «I would very much like to receive information about contraceptives…» «I learned about condoms at school…» «My friend, who got involved in sex work before me, told me about condoms…» «I never received any information about abortion, learned about it only when it happened to me…» «Doctors never told me about safe abortions. They do not need my safe abortion…» «If a client insists on sex without condom, I usually tell him to go away… no one went away so far…» «I know colleagues who take additional 20-50%, sometimes 100%, for sex without a condom…» «I have regular clients with whom I sleep without a condom – they are all married, they pay more and I trust them…» «It is hard to get condoms at night, if I do not have one with me, I may have sex without it…» «I think that every woman has to have her own doctor – the one who knows her body, who knows how she delivered, what diseases she had, etc…» «If it is an organization that provides quality and anonymous services, I do not care if it is public, private or NGO…» Main barriers «Once I came to a clinic and told them that I am a sex worker – they refused to provide me services» «Access to the services was OK. However I had problems with quality of received services in public clinic: doctor prescribed me wrong treatment when I had bacterial vaginosis …» «If I am not from Kiev and would like to receive services in public clinic, I need to have a medical card – this can be done by paying 50 UAH. However, if I want to come to the clinic next time, I have to pay again…»
Reasons for not using the services: «Not enough time…» «I do not go because I do not want to skip the work…» «I need information about the existing services, so far I do not have it…» «Very little information on internet websites, social networks, forums. A lot of SWs actively use internet» (about access to SRH/HIV/STI services) «I need financial compensation to start taking care about my health and spending my time to go to doctors!» «I do not like judgmental attitude toward me» Services and specialists that are in demand: ObGyn; Venerologist-dermatologist; Psychologist; Infectionist Endocrinologist; Mammologist. RIVNE «Sometimes you need to travel around the city to do all necessary tests» «Never received any information. I gave girth to my daughter, then I had an abortion, and now I cannot have any more children». «I used drugs in the past. All my friends were also using drugs. Now I am off the drugs, I also do not drink and do not even smoke» «Once I went to a dentist in public clinic. At the registry I told my name and was waiting for my medical card in a hallway. I could hear haw nurses were whispering and talking about me. When I received my medical card I noticed a sign (in big letters) in red colour on it – AIDS, 4 years. I waited in a hallway for my appointment and when it was my turn, nurse announced out loud that person with AIDS is here. Can you imagine reaction of people around me?! The doctor treated me like a pig, not like a human. After this incident I decided that I will not leave this as it is and I went to the AIDS Center to my doctor and told him everything that happened in the dental clinic. After that this situation changed and I was treated normally in the dental clinic. However, since that time I never disclose my status to anyone...». NOVOGRAD-VOLYNSKI «Sometimes it is not up to me to have sex with or without a condom: sometimes condoms break or client can take it off without me noticing… «I need condoms for oral and anal sex». «If you look 15 years old or younger, no one will sell you condoms in the pharmacy». «Sometimes it happens that I work without condom – this is when client pays extra money or has problems with erection». «And why would you tell in the hospital that you are a sex worker? If you tell them, then everyone around will know, the whole city will be talking about you and pointing fingers at you». MSM КIEV «I do not understand why people use free services when there are private clinics with good quality and confidentiality. For me it is obvious that if it is free then it is of a poor quality» «It is important for me to know where to go for treatment if something happens. I do not want to be sick…» «I learned about condoms from my friends…» «My father talked with me about condoms when I was 13. I first tried to use it when I was 16». «Using of a condom for anal sex is a must. I will not sleep with a partner who refuses to Page 11 of 16
use condom. As for the oral sex without a condoms – it is OK with me.» «I think that there is nothing wrong if a client buys condoms himself. He better knows what fits him. I usually take care of lubricants and personal hygiene». «I accept oral sex without a condom as there is no evidence of HIV transmission through oral sex» «When partner asks me why you cannot have oral sex without a condom, I do not know what to answer. Indeed, why?». «I understand why clients bring drugs with them. After taking drugs I can agree for sex without a condom and without an extra pay». «A lot of my friends know that I am MSM-SW. Some take it OK, others stopped communicating with me. …» «I take care of my health – this is my comparative advantage from other TG-SWs…» Services and specialists that are in demand: Proctologist Dermatologist Psychologist, psychiatrist (for TG) Infectionist Endocrinologist Urologist DNIPROPETROVSK «I always hide my sexual orientation when receiving medical services» «When we go for testing with my partner we are not hiding our sexual orientation» ZHYTOMYR «Sometimes it is very hard to negotiate using a condom with a partner. The partners says “Aren’t you trusting me?” or “I will not have good erection”.…» «NGOs need to have more specific services – I do not want to run around the city disclosing my orientation to other doctors». «In medical institutions, if you do not have money – you do not receive decent services». COMPONENT 3
Quotations and Problems: SWs «Police officer hit me in the face and broke my telephone. He was threatening me…» «Security Service people were among our clients. The never paid in full on what we agreed at the beginning…» «I went to a client but when I got there the police was waiting for me. They took me to a police station, but my agency paid them money and they let me go…» «I had a very good friend for a long time. Then we got into fight because of the same client. She started to blackmail me, saying that she will tell my parents what I do for living…» When the status is disclosed «System administrator at my official work found out that I also work as sex worker (I am also an accountant). He found out on the internet where I post my adds and started to blackmail me…» «Teachers at school where my child is studying found out that I am a SW they wrote a letter to social services that I am a bad mother and that the child needs help…» DNIPROPETROVSK «Police forced me to sign blank protocol…» «Police arrested me in sauna… Took me to police station and started to demand money. They threatened me with a gun…» RIVNE «Police car stopped at the sidewalk where I was working, they told me to get in their car and that they will pay me for my services. At first they paid me but after sex they demanded their money back. I told them no. Then they started to threaten me – I got very
scared and gave them back all my money …» «Police arrested me without any witnesses and tried to make me sign the protocol. I refused. They started to threaten me and told me that they will lock me up for 3 days. I continued to refuse signing the protocol, spent couple of hours at the police station and they they told me to get out…» «I was standing on a street when a police car pooled over and they started to write a protocol. I refused to sign it. They started to threaten me, put handcuffs on me and put me in their car. They told me that they will drive me now to the nearest forest. Then one of them started the engine…. We were driving somewhere, not sure in what direction, but then they just stopped the car and told me to get out…» «Police took us to a police station where we set for a while. All that time 2 officers were deciding about who will write the protocol. Then I guess they decided that they do not need all this hassle and released us (incident with new Police) NOVOGRAD-VOLYNSKI «There is enough violence, both inside of the community and outside of it…» «My friend was beaten up, robbed and raped by 4 military soldiers. No one came for help, not even the neighbors, even though she was screaming so loud that the hole building could hear her» «Discrimination is everywhere: in family, among clients, inside of the community...» «Nobody thinks we are humans ! Police arrested us just because we are prostitutes». «Everybody treats us like trash. People have more sympathy for drug users than for prostitutes». «I was working with a truck driver in his car. Police grabbed me from the car and took me to police station where they took away all my documents and demanded free sex. When I refused they kicked me out without giving back my documents. Now I am living without my passport». MSM KIEV «There is a stereotype that police is after us. Not true – they are so intolerant that they simply do not look at our adds on the internet, instead they go aster SWs…» «One of my clients raped me and beat me up. Then he gave me extra 500 USD and left. Of course I did not go to police or anywhere else (TG-SW)…» DNIPROPETROVSK «We need to have a law that defines LGBT and prohibits its discrimination…» «If we want the voice of LGBT to be heard we must unite with our partners from the community…» «Work with staff in educational institutions and medical institutions is very important… but who will allow that? …» «We need more information and advertisement of the hotline, HIV services, and gayfriendly organizations…» «Services must be provided by specialists who are trained to work with MSM »… «Police threatened to disclose my sexual orientation to teachers in my college… physical violence in the police station, attack on me near a gay club – all of this resulted in my heavy depression and constant fears…» «We were walking with my boyfriend in the part and kissing. Police arrested us and forced us to give them free sex…» «Mass-media does not know how to correctly write about LBGT – a lot of times journalists forget about their ethics. …» ZHYTOMYR «10 years ago it was better. Now it is very hard. Radicals and nationalists constantly hunt us down and beat us. ..» «Nowhere to turn for legal support because of the absence of lawyers in local NGOs. Regular lawyers are usually homophobes » «We have been robbed. We wanted to file a case with police but they told us to back away or they will tell everyone about our relations (robbery happened during our romantic meeting) «Of course we are forced to pretend that we are straight. There is no one to protect us…» Page 13 of 16
«I cannot just walk down the street with my partner.» «Police would meet with as in the internet as clients, then beat us up and blackmail...» COMPONENT 4
Quotations and Problems: SWs KIEV «We need to change the procedure of writing the protocols and payment of fines » «Stop harassing our managers (pimps) and change legislation in a way that people who work with us do not get hurt …» «It is necessary to create a law that would protect rights of SWs …» «Before we go with legalization or even depenalization of sex work, we need to prepare our society for this, using, for example, a nationwide information campaign» DNIPROPETROVSK «We need to create new laws that would not only guarantee our rights on paper but would be implemented…» «It is important to change situation with writing of protocols during unlawful detentions and arrests…» «It is time to develop a law about social package for sex workers – then we can talk about payment of taxes…» NOVOGRAD-VOLYNSKI «What is the reason for going to police or court, if you do not have money to pay for a lawyer?». «It is one thing when you go to the court as a normal person. The other story is when you go there as a SW. You have to be prepared for stigma and discrimination » MSM KIEV «It is very important to legalize sex work. I am personally ready to work and pay taxes to the government. Clients can be very dangerous and we need protection (TG-SW). «It is important to make changes to the international classification of diseases where homosexuality is considered as a psychiatric disorder ». (TG) «I would love to work and live abroad but my passports does not allow me to travel outside of the country. In my passport I am different (TG-SW) «I am not ready to say to the world who I really am. So far I have 2 lives.» DNIPROPETROVSK «It is important to work with new Police. Some free courses on human rights would also be nice…» «We need more cases of coming out. We also need to involve and motivate young MSM…» ZHYTOMYR «It is impossible to integrate in our society – it is not tolerant, it is very aggressive and hostile». «Everybody wants to go to Kiev and not to be exposed at home. I also want to go. In my city we do not have any gay clubs. Internet is the only thing.
COMPONENT 5
Quotations and Problems: SWs «It is important to reform healthcare system» «We need to monitor the reform so it is for the people» «Police has to be limited in their rights to detain us all the time…» «Ukraine must follow the conventions it ratified. Police should know that conventions
that were ratified by Ukraine are mandatory for implementation …»
MSM «We need some nation-wide movements. And mass-media should also be sensitized on how they write about LGBT.» «We need to join up ! What can join us? – thematic parties, movie screenings, interest clubs, safe places to hang out. Recommendations for future interventions
Recommendations for future interventions Access to SRH and HIV services
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Collaboration of NGOs and community networks of key populations with youth friendly services (clinics) in order to increase knowledge of young KPs about the existing services and ensure uninterrupted and easy access to SRH/HIV services (training of medical staff from YFC on working with young key populations, preparation of peer-educators/trainers/volunteers from representatives of key populations)
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Include issues of SRH and HIV / STI prevention among young key populations in the system of primary healthcare (within the framework of current healthcare reform) as well as in the new National programme of HIV prevention for 2016-2020.
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Organize work of mobile clinics (in particular for work with SWs) in all regions of Ukraine that would ensure confidentiality of provided services.
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Creation of centres for integrated services (one-stop shop) on the basis of NGOs and community networks with involvement of counselling specialists and social workers, friendly doctors, psychologists, gynaecologists, dermatovenerologists, lawyer, etc. Such centres should also ensure anonymity and confidentiality, and account for specifics of each group of key populations.
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Development and implementation of training programmes on specifics of work with young key populations and formation of tolerant attitude towards SWs and MSM among medical staff and police.
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Ensure access of young key populations to condoms (male and female), lubricants, and PEP. Legal context and violence
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Improve (make easier) the system of medical examination for filing rape cases with law enforcement authorities.
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Prevention of violence and work with perpetrators, with clients of SWs.
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Allying examination procedure for TGs with relevant international norms.
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Work with Ombudsperson in the context of ensuring universal human rights (protection of human rights of young key populations).
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Initiate creation of specialized funds to support community networks of key populations. Page 15 of 16
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Information and education work with law enforcement representatives, medical workers, and representatives of mass-media on formation of tolerant attitude, prevention of violence and protection of rights of young key populations.
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Start dialogue with decision-makers and legal institutions to analyse existing legislation in the context of possible discrimination of key populations, and revise it according to best international practices.
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Create a network of “friendly journalists” that would objectively and without prejudice write about the needs of young key populations.
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Ensure gradual transition of funding for programmes targeting key populations from donors to state funds.
Participation and rights
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Conduction of informational campaigns: 1) for increasing level of tolerance of the society towards key populations, 2) for empowerment and education of young key populations in order to ensure their meaningful involvement into decision making processes.
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Involvement of representatives from key populations into the process of planning and implementation of information campaigns, development, implementation and monitoring of national and local programmes, in order to ensure that their needs are adequately reflected and addressed.
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Mobilization, capacity building and formation of active life position of representatives from young key populations in order to ensure their visibility and increase their skills in advocating for their rights.