ALARMING RATE EXCEEDS PREVIOUS ESTIMATES; PREVALENCE AMONG CERTAIN SUBGROUPS IS AMONG HIGHEST REPORTED IN WORLD

A study published in the November 1, 2007 issue of the journal AIDS reports that 37.4% of street youth between the ages of 15 and 19 years old surveyed in St. Petersburg, Russia are HIV-positive, placing street youth in Russia among the populations most at-risk for HIV around the world. The study, conducted by the health and human rights organization Doctors of the World-USA (DOW), the U.S. Centers for Disease Control and Prevention (CDC), and the City AIDS Center in St. Petersburg, Russia, found that factors such as injection drug use, unsafe sexual practices, homelessness, and orphanhood were prime drivers of HIV transmission in this group.

"These results underscore the urgent need to increase efforts focused on youth," said Tom Dougherty, DOW Executive Director. "Information on how HIV is transmitted is not enough - we must reach out to at-risk youth with programs that engage them and give them hope for a future."

Young people represent almost half of all HIV infections worldwide. The HIV epidemic in Russia, one of the fastest growing in the world, is most heavily concentrated among the young: 80% of new HIV infections occur among people 15 to 30 years old. Street youth - young people who live on the street some or all of the time - constitute a group particularly at risk. Abandoned, abused, or neglected, they often organize into groups as they negotiate survival, performing odd jobs and engaging in activities that place them at risk for HIV, including transactional sex and drug use. Experts estimate there are 1 to 3 million street youth in Russia, with an estimated 10-16,000 in St. Petersburg alone.

In addition to the extraordinarily high HIV prevalence among the 313 surveyed street youth in St. Petersburg, the study reveals rates within certain subgroups are among the highest reported in the world - 60% of orphaned street youth tested positive for HIV, as did nearly 80% of those who used injection drugs. The study found that high-risk behaviors are common among this population, despite a relatively high awareness of behaviors that transmit HIV.

Outreach, prevention, access to care, and crisis intervention services must be expanded. With local government and non-government partners, DOW has established a range of interventions to engage street youth, link them to treatment, care, and support, and prevent new infections. This low threshold model has shown encouraging results: 54% of all positive youth have remained active in the program to date, 38% are linked to ongoing health and psychosocial services, and 35% are linked to care at the St. Petersburg City AIDS Center. These follow-up rates are especially promising, considering street youth are a mobile population, often with no permanent address. Without school, steady employment, or stable family relationships, they are at high risk of being lost to follow-up.

Attention to the social, behavioral, and medical factors that contribute to this epidemic are an urgent priority. Without treatment and support, many of the HIV-infected youth will die between the ages of 20 and 30. Strengthening comprehensive services for street and at-risk youth, including drug rehabilitation, educational outreach, housing, vocational training, and family support programs, is vital to curbing high-risk behaviors and preventing further spread of HIV.

Public-private partnerships are key to addressing HIV and the range of issues that threaten the survival of street and at-risk youth. Comprehensive programs are essential to enable street youth to ensure their survival. With the support of private foundations (Ford Foundation, MAC AIDS Fund and others), corporations (Johnson & Johnson), the local government and the United States Agency for International Development, and in partnership with DOW, the Russian NGO Doctors to Children and multiple city agencies are providing comprehensive medical and social services to at-risk and street youth. These include drop-in centers and outreach programs, access to counseling, educational and vocational training, foster family programs, legal support, and health services. HIV prevention and education programs target street and at-risk children and youth and provide free testing, counseling and other care, and access to treatment. A new transitional housing facility for HIV-positive drug-involved youth will open in 2008. 8.

Collaborative efforts to address the underlying causes of HIV and other health issues not only help curb the impact of this deadly disease, but create a brighter future for street and at-risk youth.

For more information, visit our website: www.doctorsoftheworld.org