IHRD - Drug-Related HIV Harm Reduction
for Sex Workers
Supported by IHRD
AIDS Information & Support Center
Kopli 32, 10412 Tallinn, ESTONIA
Tel/fax +372 6413165
tugikeskus@hotmail.com
2001-2002
Situation
During the past 3-4 years the number of i/v addicts has increased drastically
in Estonia. Although officially there are about 1000 i/v drug addicts registered,
their real number must be at least 10 times higher. They mostly use pure
heroin. I/v drug consumption starts at an early age (14-16) and it are practiced
very dangerously: needles are shared. The HIV epidemic among i/v drug addicts
in Ukraine, Russia and Belarus may also break out in Estonia. A clear indicator
of it is epidemic of hepatitis B and C among i/v drug users in Tallinn and
Narva.
By the 31 December 1999 there were 95 people who tested HIV-positive.
22 patients developed AIDS and 19 of them died. All HIV-positive persons,
more than half of them are homosexuals, acquired the infection through
the sexual mode of transmission. HIV epidemic among drug users in Russia,
Ukraine, Belarus, Lithuania and Latvia should put us on the alert.
In 1998 in Estonia two first cases of HIV infection among drug users
were diagnosed, but in the course of two years there is a high amount of
diagnosed cases of Hepatitis B and C among drug users especially in regions
of high unemployment (Tallinn, Narva, Kohtla-Järve).
In 1997 there was an epidemic of B and C hepatitis in Lasnamäe,
one district of Tallinn: more than 200 cases of Hepatitis were diagnosed.
This was a clear indicator of the ways of the spread of infection (i.e.
proof of the fact that needles are not being sterilized and are passed
around between drug users. The first polls conducted by the AIDS Prevention
Center in Narva proved that HIV is quite likely to spread among i/v drug
addicts.
The most endangered category of i/v drug addicts is 14-16 years old
youngsters
In August 2000 the epidemic of HIV among IDU-s in Estonia started: during
3 months 204 new cases were diagnosed, age 15-24, 94% of them in Narva,
and 20% of them women.
In Estonia is continuously high level of STD-s. High level of STD-s
increases the possibility for spreading of HIV in population. The level
of syphilis since 1992 year has increased 20 times.
Problem statement
The growth in prostitution could already be noticed in 1992 when the
first sex firms that offered call girls services started to rent property
for that purpose. Gradually increasing the phenomenon reached its peak in
1995-1995. Since 1996-1997 the number of these firms has declined considerably.
There have been changes both in age and in ethnic background Considerably
was growing the part of IDU-s - women and girls, involved in prostitution
(from 1% in 1996 to 18% in 1996-1999).
Today a considerable number of sex workers go to work abroad to Finland,
Sweden, Germany, and Spain etc. The changes can be put down to market economy
(higher competitiveness of bigger sex firms, satiation of the local market,
continual economic problems of non-Estonians etc.) as well as the present
legislation. During past 3-4 years the number of i/v addicts has increased
drastically in Estonia. Growing number of sex workers -IDU at last two years
put as at alert.
The first experience in work with sex workers we have from 1994. First
contacts with IDU-s were implemented at 1997, mostly man drug addicts.
Sex workers - drug addicts is quite new phenomena in our society and
the number of sex workers -IDU-s increased remarkably at the last two years.
The needs of sex workers - IDU-s are specific, comparatively with others
IDU-s, who are mostly man.
Previous activities during last six years in work with sex-workers shows,
that during last two years the number of IDU-s among sex-workers increased
dramatically from 1% in 1994 to 18% of IDU-s in period 1996-1999.
Experience of the work with IDU-s shows, that the sex workers IDU-s
contribute special activities and measures, including not only needle exchange,
but counseling about STD-s and safer sex.
Previous work shows, that it is better to provide services to sex workers
IDU-s separately from other IDU-s, who are mostly men and have different
habits.
Impact statement
Clarifying extending
of drug use among sex workers (kinds of drugs, ways of using, possibility
to implement prevention measures.
Covering with services
the greatest possible number of drug addicts involved in sex business.
Creation “peer-education”
system among target group.
Reducing the number
of STD-s and Hepatitis B and C among them.
Protection of human
rights of sex workers - IDU-s.
Approach
Education of staff of
the project for work using harm reduction methods.
Implementation of services
for sex workers: needle exchange, counseling, voluntary testing on HIV,
STD, Hepatitis B and C. Distribution of information materials, condoms,
etc.
Creation of “peer-education”
system among sex workers - IDU-s. Organization of outreach work.
Spreading of activities
undertaken from Tallinn to 6 another cities of Estonia (cities at risk).
Main goal of the project
To prevent the spreading HIV/AIDS infection among sex workers - drug
users and in the future to prevent spreading of infection from IDU mother
to child.
Aims of the project
To implement a harm
reduction methods among sex workers - drug addicts
To involve in the project
as many sex workers - IDU-s as possible by using the method of outreach
work
To reduce the number
of Hepatitis B and C and STD-s among sex workers - IDU-s as much as possible
with using safe injecting and safer sex practice
To prove that IDU-s
sex workers also have human rights and right for health
To change the stigma
concerning sex workers - drug addicts in society from “witch hunt” to tolerance
and assistance
Objectives
To clarify real situation
with sex workers - IDU-s
To educate the staff
of the AIDS Information & Support Center, to implement harm reduction
methodology in work practice of the staff of the project SEASTAR, concerning
HIV/STD prevention among sex workers
To make available for
sex workers - IDU-s counseling, needle exchange, safer sex practice education,
voluntary confidential testing, informative materials, sterile equipment
for injections and condoms
To spread positive experience
of this project from Tallinn to other cities with same problems - (Pärnu
- at summer time increasing number of sex workers and Narva - high level
of unemployment, high number of sex workers - IDU-s)
Measures
Education of personal
of the SEASTAR project (HIV/STD Prevention among sex workers), how to implement
harm reduction approaches in their work (four persons)
By trainers of project
staff we use the workers of needle exchange and methadone program personal
Providing outreach work
with aim to reach as much as possible sex workers - IDU-s
Implementation of next
kind of services for clients of project: needle exchange program, counseling
of medical doctor, psychiatrist, provide possibilities for sex workers -
IDU-s, who want to be “drug-free” to have access to detoxification treatment,
and for heroin users methadone maintenance treatment (who need it).
Distribution for sex
workers - IDU-s informational materials (about safer sex practice, safe injections,
prevention of Hepatitis B and C, prevention of STD-s), condoms, bleach,
sterile injection equipment.
Providing of voluntary
and confidential HIV/STD testing, pre- and post counseling
Recruiting of more active
sex workers - IDU-s to be “peer-educators” for others sex workers - drug
addicts in question of AIDS prevention
Providing survey for
sex workers - IDU-s in order to find out about existence of factors of risk
behavior, frequency and opportunities of avoidance (questionnaire)
To acquire former sex
worker - IDU-s for outreach work
Spreading the intervention
among sex workers - drug addicts in Tallinn, Pärnu and Narva since
that is a large amount of cases reported of Hepatitis B and C among IDU-s
and high level of prostitution there.
Providing psycho-social
support and advocacy of sex workers - drug addicts
Project staff
Project leader, medical doctor, two outreach workers (one of them nurse). Project leader - Irina Mironova, nurse. Her responsibilities
are outreach work, financial and administrative activities, fundraising,
supply the equipment, evaluation and reporting, Medical doctor - Toomas Vessin. He is responsible for medical
check-up, counseling, pre- and post test-counseling, treatment of STD-s,
collecting epidemiological data, analyses of epidemiological situation. nurse Lidia Rozuman -all kinds of medical procedures,
HIV tests, safer injection training’s in office, outreach work; distribution
of condoms, injection materials, leaflets and booklets, needle exchange Medical doctor Milvi Noode - she is responsible for medical check-up,
counseling, pre- and post test-counseling, treatment of STD-s, collecting
epidemiological data, analyses of epidemiological situation.
All personal have four years experience of educational and prevention
work with sex workers. During those years the staff created trustful relations
with sex workers population. AIDS Information and Support Center was achieve
the confidence and trust of sex workers, this fact is proved by 1300 visits
of sex workers during period of three years 1996-1999.
Our previous experience shows that the main difficulty is stigmatization
of such groups in society, like sex workers and IDU-s. So sex workers who
are at the same time the drug addicts are double stigmatized. Social support
of that targeted group faced with the ignorance and opposition of decision-makers,
and finally of all society.
One main measure for changing opinion of society is work with mass media.
We have a useful experience in organizing media campaigns and use this method
in future for creating tolerance and support.
For these efforts we build co-operation with National AIDS Prevention
Center and National Drug Prevention Program. We are the only NGO dealing
with problems of prostitutes.
With help of this project we were trying to prove to governmental structures
and decision-makers the importance and necessity of such kind of work. After
end of project results we hope to apply continuing financing from governmental
recourses. Very important side of this project is to take advocacy efforts
with aim to guarantee human and sexual rights of young women, involved
in sex business and drug use.
Evaluation of the project
Providing questionnaire for clients we hope mapping of existing situation
and clarify the needs and problems of sex workers - IDU-s.
We suppose monitor monthly data of distributed clean needles and syringes
and used one. Voluntary testing on Hepatitis B and C, HIV, some STD-s
(Syphilis and Gonorrhea) and medical analysis of results.
Interviews with sex workers - drug addicts for clarifying of they needs,
they assessment of services and behavior changes after counseling and training’s.
Number of trained sex workers - IDU-s who are able to be “peer-educators”.
Records of the project will be presented like report for IHRD.
Special report will be presented for the Ministry of Social Affairs
and National Health Protection Board.
Conclusions and evaluation of project will be reported through mass
media.
Experience of the project will be shared with other concerned organizations
(NGO and GO) through the existing network.