IHRD - Drug-Related HIV Harm Reduction for Sex Workers
2001 Year Report
Organization and project information
AIDS Information & Support Center
Project “HIV PREVENTION AMONG SEX WORKERS - INTRAVENOUS DRUG
USERS”
Name and title of individual submitting report: Irina Mironova
Project address: Kopli 32
City: Tallinn
Country: ESTONIA Postal
code: 10412
Phone: +372 6413165
Fax: +372 6413165
E-mail: tugikeskus@hotmail.com
Staff and volunteers in this sex worker harm reduction project
5 How many people (including current and new staff,
both part-time and full-time) were paid with this OSI / IHRD funding to
work with this sex worker harm reduction project in the six-month period
(approx.) August 2001-January 2002? (indicate the total number of people
funded)
8 How many people volunteered (gave their time and
effort but were not paid) to work with this sex worker harm reduction project
in the six-month period (approx.) August 2001-January 2002? (indicate
the total number of volunteers)
Sex workers reached by your harm reduction project
How many first-time contacts with individuals engaged in sex work
did your project make?
during all of 2001? (please indicate the total number of people
who were reached at least once
with any form of outreach or services)
During 1 year of the project approximately 822 first-time contacts with
CSW in 8 cities Tallinn, Narva, Parnu (summer months), Sillamäe, Kohtla-Järve,
Jõhvi, Ahtme, Kiviõli.
What are the demographic characteristics of this entire population
of sex workers reached by your organization? (indicate actual numbers or
estimated percentages out of 100% for each grouping; otherwise indicate “NA”
for ‘information not available’)
The sex workers IDUs we working with are mostly female sex workers, it
is just few cases of male sex workers, it looks that they use previously
amphetamines and ecstasy From the previous projects we now that in sex
business works nearly 83% Russian-language speaking girls and women. The
26,5% of girls was less then 18 years old. Usually they are 18-24 years old
- 46,4%, from 24 to 30 years old - 16% and 11,1% older then 30 years.
45% of sex-workers are from capital, 53% from other places in Estonia
and only 2% from other countries. Only 9% do not use alcohol at all, 42%
use every week, 19% - every month, and 30% answered that not very often. 90%
of sex workers smoking.
On the question about drug use were answered 321 sex-worker and the results
are very alarmed - 28% of the girls use drugs. From those, who use (89
sex-workers): smoke - 57%, injects - 45% and use tablets - 45%. (recourse:
questionnaire for 382 sex workers - “SEASTAR” project 1996-1999).
But from the working with drug users sex workers we find that the
part of the adolescent girls are quite bigger, especially if we talk about
this girls, who don’t work in usual locations (bars, clubs, saunas etc),
but sell sex for earning money for drugs. In last year the part of Estonian
speaking IDU-s was growing, same process was happened among sex workers IDU-s.
60% work mostly on the streets or highways
30% work mostly in bars, clubs, hotels or brothels
10% work mostly in other locations (such as escorts)
70% work alone (without friends or protection)
30% work under the control of a pimp, bodyguard or mafia
35% are under the age of 18 years
65% are over the age of 18 years
100% are from the local area (from within 500 kilometers)
0% is immigrants or migrants from other places
What are the health and drug-related risks of all these sex workers
reached by your organization during the past six months? (indicate
actual numbers if you know them or estimated percentages out of 100%; otherwise
indicate “NA” for ‘information not available’)
40% of sex workers who report physical violence against them in the past
year
35% of sex workers who have, or have had, a sexually transmitted infection
in the past year
5-10% of sex workers who know and report that they are HIV-positive.
50% who drink alcohol every day
50% who use any kind of drug every day (what kind?
30% using heroin or opiate)
35% who inject drugs every day (what kind? 90% using heroin
or opiate)
10% who report a history of drug overdose or health problems related
to injecting
30% of all sex workers who now report consistent safer sex, including
condom use
30% of all sex workers who now report some safer sex practices
5-10% of all sex workers who now report consistent safer injecting practices
30% of all sex workers who now report some safer injecting practices
Other health and drug-related risks:
Problems with police, problems with owners of sex agencies, unwanted
pregnancy, abortions; HIV, Hepatitis B and C infected children
From the SEASTAR Project data we now that the knowledge of safer sex is
insufficient: 6% of the respondents do not use condoms at all, and 26%
do not use condoms all the time.
30% was sexually abused in the childhood (under 16 years of age). 40%
of sex business employees fall victim to violence and sexual abuse when working.
Totally nearly 35 % of the girls, consulted and examined medically during
their first visits were discovered minimum one sexually transmitted disease.
Nearly 45% of sex-workers were diagnosed candida and gardnerella.
The corresponding figures among multiply visitors were decreased considerably,
especially when the girls come regularly.
Totally nearly 8-9 % of the girls, consulted and examined medically during
the multiply visits are discovered minimum one sexually transmitted disease.
18 % of sex-workers were diagnosed candida and gardnerella.
The reason why multiply visitors are still discovered to have so many
diseases is that very often they get infected when not working or because
they fall victim of sexual violence when working
Through the contacts with sex workers IDUs we have now quite clear picture
about kinds of drug use, the “brothels” sex workers IDU-s use mostly amphetamines,
also inject heroin, take tablets, smoke marihuana and other group, working
in occasional places, old houses, street, use mostly heroin.
The first group works in saunas, sex clubs, hotels, massage saloons,
striptease clubs and use drugs to keep themselves in “working” conditions,
the others work in apartments, old, ruined houses, streets, drug users
gathering places, cars, toilets etc. and use received payment for immediate
acquisition of the drugs.
During 1996-1999 years fortunately we don’t find the HIV positive sex
workers, but during last 1,5-year situation changed, now we diagnosed more
then ten women who are HIV positive drug users and sell sex for drugs. More
of that, some man, which were founded infected through the HIV/STD testing
in our center for general public (not drug addicts themselves) give us information,
that they are sure that they were infected by prostitutes.
Unfortunately the group of sex workers IDU-s from bars, clubs, saunas,
brothels is affected by their clients, who ask unprotected sex and are
ready to pay 2-3 times more for that. Because in those cases sex workers
don’t need to pay this “additional” money for pimps, guards, and other
mediators - the girls very often agreed to serve clients without condoms.
Other groups of young girls, who sell themselves for drugs or for money
to apply drugs is affected by immediate need earn money and buy drugs. Some
of them don’t use condoms at all, motivation to buy condoms is very weak,
and it looks that for that group extremely important to guarantee free condoms
and lubricants.
Sex workers served by your project
532 How many individuals engaged in sex work were
served by your project during all of 2001? (please indicate the
total number of people reached more than once with any form of follow-up
outreach, harm reduction or services)
During 1 year of the project 532 CSW were reached more then
once (Two or more times multiply visits individuals. In 6 month report
we
interpreted the question as number of all visits, not persons, so the
figure 648 was
the total number of visits.
In what locations did your organization provide outreach and services?
(check all that apply)
X streets, highways and other outside spaces
X bars, clubs, hotels, brothels or other commercial establishments
X clinics, drop-in centers or other health care or social
service settings
__ schools, courts, job training centers or other public places
X private houses
X by direct telephone outreach, such as through a hotline
or outreach to escorts
X by indirect outreach, such as media, printed material,
working with militia,
or working with sex worker bodyguards or pimps.
What types of outreach and services did your organization provide?
(check all that apply)
X one-time information and referrals
X legal counseling / advocacy
X follow-up one-to-one counseling / education
__ professional training
__ group counseling / education
X syringe exchange
safer sex education other types of outreach and services
(please describe):
How many individuals were reached by your project with syringe exchange?
822 total number of sex workers who participated in syringe
exchange through this
project during the past
six months
822 commercial sex workers in 8 cities (approximately 320 in the first
6 months) Tallinn, Parnu (summer months),Narva, Sillamäe, Kohtla-Järve,
Jõhvi, Ahtme, Kiviõli. were participated in syringe/needle
exchange during 1 year.
31020 syringes, 33542 needles total number of needles/syringes distributed
to sex workers through this project during the past six months
In Tallinn, Parnu (summer months), Narva, Sillamäe, Kohtla-Järve,
Jõhvi, Ahtme, Kiviõli 31020 (16000 in first 6 month) syringes,
33542 needles (17000 in first 6 month) were distributed to sex workers
IDU-s in 1 year.
How many individuals were assisted by referrals?
15 total number of sex workers who were referred to other places for
medical
and social services
12 approximate number who succeeded in accessing and using those referrals
What would you say are the greatest outreach, harm reduction and service
needs for your clients? (please add any comments that you think might
be helpful for potential funders)
Testing and treatment of STD, HIV; gynecological services; drop-in center
services; legal advice; rehabilitation services for drug users (methadone
detoxification, methadone maintenance)
Organization and project development
Have you had any successes in building organizational capacity as
a result of this sex worker harm reduction funding? (please check
any of the following categories and provide any examples of successes and
further needs)
___ new or expanded needs assessments and population descriptions
___ new or more developed programs for HIV harm reduction
among sex workers
X new linkages and referral relationships
with other service providers
X new or expanded fundraising
X further experience in program and financial
management
X new or expanded project evaluation
X new staff training and capacity
Examples of successes and further needs:
Needs:
Cooperation of two projects (Harm Reduction for sex workers IDU-s and
grant for support HIV+ People drug users) helps organize groups of support
for HIV+ women
IDU-s
Successes:
As result of harm reduction projects promotion City Government of Tallinn
and Ministry of Social Affaires gave additional financial resources for
needle exchange in Eastern part of Estonia, which is mostly affected by
epidemic of HIV.
It’s allowed us to open 6 additional needle exchange sites for IDU-s
in region (May 2001). The staff of opened sites is trained for needle exchange
and counseling of IDU-s and CSW particularly. Local commercial sex workers
now have possibility to visit these new sites in Narva (additional mobile
unit), Sillamäe, Kohtla-Järve, Jõhvi, Ahtme, Kiviõli.
With help of our coordinators and IHRD we constantly have a possibility
to train our staff and volunteers:
Training in Bratislava - 2 persons
Seminar in Vienna - 1 person
Training seminar in Odessa - 2 people
We also provide trainings for people, who start to work in 6 new sites
in Narva (Mai 2001)
We received partly financing for creation on the base of center Drop-in
center for sex workers - the other part applied from Finnish Embassy in Tallinn.
We can in future use those rooms in additional hours like drop-in for sex
workers group, who are IDU-s but works in brothels and clubs and for peer
education activities.
Biggest success is the first signs of acceptance of harm reduction ideology
by government and policy makers. As result of this, first time through
HIV/AIDS era the state gave finances for needle exchange program, what
include particularly services for commercial sex workers too.
During last period some governmental institutions, as Ministry of Justice
and Health Department were interested in our activities in field of sex
work and trafficking.
Our neighbors in Baltic region, especially in Finland and Sweden began
to put more attention for serious situation with HIV, drug use in our country
and try to support some our activities.