Partnership to implement street youth HIV prevalence survey

PURPOSE/BACKGROUND: This study assessed HIV seroprevalence among 313 street youth in St. Petersburg and described social, sexual and behavioral characteristics associated with HIV infection. Survey was conducted during March-May 2006 in St. Petersburg, Russia.

PARTNERSHIP MODEL: Doctors of the World (DOW) sought assistance confirming HIV test results of its 2005 HIV convenience sample of 55 street youth (31% positivity). DOW received assistance from US Centers for Disease Control and Prevention (CDC) to conduct a systematic, unbiased survey of HIV seroprevalence among St. Petersburg street youth; incorporated Russian NGO service provider partners in site selection, survey staffing. St. Petersburg City AIDS Center facilitated compliance with requirements, interagency cooperation, and clinical, virologic, and immunologic assessments for youth with positive rapid HIV tests. DOW co-designed, co-implemented, and co-staffed survey, provided follow-up services.

DESIGN/METHODS: A cross-sectional assessment was conducted which included city-wide mapping of 41 street youth locations, random selection of 22 study sites, rapid HIV testing for all consenting 15-19 year old street youth at these sites, and interviewer-administered survey.

RESULS/OUTCOME: Of 313 participants, 117 (37.4%) were HIV-infected. Subgroups with seroprevalences >60% included: double orphans (64.3%), those with no place to live (68.1%), those previously diagnosed with a sexually transmitted infection (70.5%), those currently sharing needles (86.4%), and those currently using injection drugs (78.6%), stadol (82.3%), heroin (78.1%), inhalants (60.5%). Characteristics independently associated with HIV infection included: injection drug use, sharing needles, being a double or single orphan, having no place to live, and being diagnosed with a sexually transmitted infection. Most HIV-infected street youth were sexually active (96.6%), had multiple partners (65.0%), used condoms inconsistently (80.3%).

Results justify programmatic response (prevention, treatment, support). DOW, with survey partners, is beginning to implement this response, developing a replicable model.

RECOMMENDATIONS: Partners' strengths improved results and impact in all areas with no significant challenges: 1. Improved study design, project implementation, accuracy of results. 2. Strengthened documentation of need for improved prevention, treatment, and support programs and policies among high-risk youth via knowledge of HIV prevalence and related behavioral risk characteristics. 3. Created constituency among survey partners for service and policy initiatives.