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Rapid Assessment and Response on HIV/AIDS Among Especially Vulnerable Young People in Serbia

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Rapid Assessment and Response on HIV/AIDS Among Especially Vulnerable Young People in Serbia Rapid Assessment and Response on HIV/AIDS among Especially Vulnerable Young People in Serbia Report prepared by Prof. dr Viktorija Cucic Canadian Agence International canadienne de Development développement Agency International Canada Rapid Assessment and Response on HIV/AIDS among Especially Vulnerable Young People in Serbia Report prepared by Prof. dr Viktorija Cucic Canadian Agence International canadienne de Development développement Agency International Canada RAR projekat u Republici Srbiji Published by: UNICEF Belgrade For publisher: Jean-Michel Delmotte, Head of UNICEF Office Report prepared by: Prof. dr Viktorija Cucic Proof reading: Benedict Clibborn Design: Konstantin Petrovic Cover photograph: Graffiti from Skopje, FYROM Layout: ELKO PRINT, Milos Milojevic; Printed by: RADUNIC Printing House, Belgrade Print run: 400 Published: November, 2002 The opinions expressed in this publication are those of the authors and do not necessarily reflect the policies or views of UNICEF. The designations employed in this publication and the presentation of the material do not imply on the part of UNICEF the expression of any opinion whatsoever concern- ing the legal status of the country or territory, or of its authorities, or the deliminations of its frontiers. UNICEF Belgrade Svetozara Markovica 58 11000 Belgrade, Yugoslavia Tel: (+381 11) 3602 100 Fax: (+381 11) 3602 199 E-mail: [email protected] RAR on HIV/AIDS among EVYP in Serbia CONTENT Project organisation . .4 Acknowledgments . .5 Abbreviations . .6 Executive Summary . .7 Introduction . .9 SITUATION ANALYSIS . .10 1. SERBIA AT THE TIME OF THE RAR PROJECT . .10 2. VULNERABLE GROUPS BEING STUDIED IN SERBIA . .11 3. DRUG ABUSE IN SERBIA . .13 4. SEX WORKERS - PROSTITUTION IN SERBIA . .17 5. MEN HAVING SEX WITH MEN - HOMOSEXUALITY IN SERBIA . .18 6. HIV/AIDS IN SERBIA . .19 RAR PROJECT . .22 1. AIMS AND OBJECTIVES OF THE RAR PROJECT . .22 2. RAR PROCESS . .22 3. METHODOLOGY . .24 4. SAMPLE . .26 5. ETHICAL CONSIDERATIONS . .29 6. DATA ANALYSIS . .30 7. FINDINGS . .30 8. DISCUSSION . .78 9. RECOMMENDATIONS . .80 BIBLIOGRAPHY . 83 ANNEXES . .84 A. WORKSHOP TRAINING . .84 B. QUESTIONNAIRES . .91 C. INTERVIEW STRUCTURE - HEALTH WORKERS . .108 D. INTERVIEW STRUCTURE - SCHOOL PRINCIPALS . .110 E. QUESTIONNAIRE FOR IDENTIFYING INTERVENTIONS . .111 F. INTERVIEW STRUCTURE - DECISION MAKERS . .113 G. EXAMMPLES OF MEGA GRIDS . .115 H. PHOTOGRAPHS . .145 3 RAR on HIV/AIDS among EVYP in Serbia PROJECT ORGANISATION TABLE A Organogram of RAR Project UNICEF Regional Coordinator UNICEF Local Coordinator National Coordinator National Team Local coordinator Local coordinator Local coordinator Local coordinator Beograd Kragujevac Nis Novi Sad Local team Local team Local team Local team UNICEF LOCAL FIELD TEAM BELGRADE: Regional Co-ordinator 1. Danijel Meskovic Ms. Elsie Wong 2. Sasa Nikolic 3. Boris Micovic Local Co-ordinator 4. Branislav Miskovic Dr Jelena Zajeganovic-Jakovljevic 5. Tatjana Stamatovic 6. Darko Cehic 7. Vladimir Veljkovic 8. Isein Fetoski NATIONAL TEAM 9. Andrej Ilankovic 1. Prof. Dr Viktorija Cucic 10. Milos Loncarevic Republic Coordinator 11. Dragan Protilupac 2. Prof. Dr Vesna Bjegovic, Local Field Coordinator for Belgrade LOCAL FIELD TEAM NIS: 1. Marko Stefanovic 3. Asoc. Prof. Dr Dragana Ignjatovic-Ristic, 2. Gordana Nikolic Local Field Coordinator for Kragujevac 3. Miodrag Djordjevic 4. Asoc. Prof. Dr Bojana Ilic 4. Lidija Djurdjic Local Field Coordinator for Nis 5. Marija Tasic 5. Vladan Beara Local Field Coordinator for Novi Sad LOCAL FIELD TEAM KRAGUJEVAC: 1. Andrea Markovic 2. Mirjana Rikanovic 3. Zoran Rastovic 4. Vesna Andrejevic 5. Mirjana Jovanovic 6. Sandra Nikolic Labovic LOCAL FIELD TEAM NOVI SAD: 1. Boris Popov 2. Slavoljub Zaric 3. Atila Kovac 4. Vlatko Salaj 4 RAR on HIV/AIDS among EVYP in Serbia ACKNOWLEDGMENTS The RAR Project was undoubtedly one of the most comprehensive research studies carried out in the field of HIV/AIDS in Serbia. For all of us working in the Project was a unique experience Instructions, directions, guidance and support that were conferred by UNICEF, by way of its officers Ms. Jane Gronow and Ms. Jelena Zajeganovic, were of particular impor- tance to us. We owe special thanks to Ms. Elsie Wong, RAR Regional Coordinator, for her gener- ous assistance, her patience and the length of time that she was willing to dedicate to this engagement. Without the help and co-operation given to us by the Ministry of Health of Serbia, the Ministry of Internal Affairs of Serbia and the Republic AIDS Committee, this project could not have been realised. We also owe a special thanks to the members of the National and Community Advisory Boards in Belgrade, Kragujevac, Nis and Novi Sad (see below) who shared their expert- ise and experience, both individually and from their institutions and organisations. Through this, they contributed to the success of the RAR project. Their crucial role can be also found in the implementation of the recommendations and interventions devel- oped from the research. The study was also bestowed exceptional significance by the National RAR Team mem- bers whose interest and commitment rendered our meetings substantial and useful. The driving force in the field was provided by the highly motivated Local RAR Teams who brought their determination and diligence to the whole study. Finally, we are indebted to all the young people in Serbia who let us turn their life sto- ries and problems into a study whose aim is to help youth. Without them and their con- sent to co-operate with us, this research would not have been realised. THE RAR TEAM National Advisory Board: Bjeloglav Dragisa, Brajevic-Lalovic Milanka, Dragicevic Dragana, Dujic Aleksandar, Grujic Mira, Ilic Dragan, Jaksic-Kandida Maja, Jovic Radovan, Kinta Rasma, Matovic-Miljanovic Sanja, Mihajlovic Ljiljana, Novakovic Mile, Protulipac Dragan, Petrovic Oliver, Petrovic Ranko, Ramah Aleksandar, Sedlecki Katarina, Senlis Eleonore, Fridman Vesna. Community Advisory Board - Belgrade: An|elic Sla|ana, Babic Ljiljana, Dimitrijevic, Milan, Djorelijevski Lambe, Koso Silvija, Miskovic Branislav, Micovic Boris, Paunic Mila, Petrovic Ranko, Rajin Gordana, Raketic Dijana, Salemovic Dubravka, Stankovic Zana, Curcic Jelena, Vujovic Sreten, Zakula Nevenka Community Advisory Board - Kragujevac: Bosnjakovic Radmilo, Cvetanovic Predrag, Evtov Dragana, Joksimovic Mirjana, Lukic Vladan, Marinkovic Dejan, Milojevic Igor, Pajevic Vesna, Popovic Nenad, Petrovic Radmilo, Radosavljevic Dragana, Rosic Mirko, Samardzic Goran, Savcic Gordana, Simonovic Branislav, Stevanovic Zarko, Zecevic Ana Community Advisory Board - Nis: Arsenijevic Verica, Boskovic Slobodanka, Gagovic Predrag, Jovanovic Bojan, Nikolic Violeta, Petkovic Branislav, Radovic Miodrag, Sretkovic Dusica, Spasic Miroslav, Stankovic Bojana, Stevanovic Nebojsa, Stojanovic Katica, Todorovic Ivana, Ciric Goran Community Advisory Board - Novi Sad: Bozic Rajna, Ber-Bozic Aleksandra, Bijanko Jasminka, Jovisevic Ostoja, Miladinovic Sonja, Miljanovic Predrag, Radulovic Natalija, Radulovic Vesna, Savic Vesna, Stanulovic-Kapor Nila, Stefanovic Danica, Rosic Snezana, Vuckovic Nikola 5 RAR on HIV/AIDS among EVYP in Serbia ABBREVIATIONS AIDS . .acquired immune deficiency syndrom CAB . .Community Advisory Board CIDA . .Canadian International Development Agency DDD . .Don't Do Drugs (NGO engaged in substance abuse prevention) DM . .German mark (German national currency in the time of the research) EVYP . .especially vulnerable young people FRY . .Federal Republic of Yugoslavia GDP . .gross domestic product HIV . .human immunodeficiency virus HR . .harm reduction IV . .intravenous IVDU . .intravenous drug users IPH . .Institute of Public Health JAZAS . .Yugoslav Association against AIDS KI . .key informant MSM . .men who have sex with men NGO . .non-governmental organisation NA . .not available / no answer OD . .overdose PLACE . .priorities for local AIDS control efforts PLWHA . .people living with HIV/AIDS RAR . .rapid assessment and response S.A.A. .same as above STI . .sexually transmitted infections STW . .sex trade workers UN . .United Nations UNAIDS . .Joint United Nations Programme on HIV/AIDS UNICEF . .United Nations Children's Fund US$ . .American dolar (American national currency) WHO . .World Health Organisation YDU . .Young drug users 6 RAR on HIV/AIDS among EVYP in Serbia EXECUTIVE SUMMARY The Rapid Assessment and Response on HIV/AIDS among Especially Vulnerable Young People Project (RAR) in Serbia is a part of a regional UNICEF project simultaneously implemented in five countries of South Eastern Europe. The objectives of the RAR for Serbia were derived from the main RAR objectives, which are the following: • to assess the extent and nature of HIV risk by exploring the context and characteristics of risk behavior, health and social consequences as well as present state of intervention targeting especially vulnerable young people (EVYP); • to increase awareness and support of local communities towards EVYP and to provide initial intervention activities; and, • to propose the general, as well as the specific, local framework for HIV/AIDS preventive action according to the key findings of the RAR. The RAR assessment activities were conducted in four cities: • Belgrade, Nis, Novi Sad and Kragujevac Cities were selected according to the following criteria: • the largest cities; • the presence of good infrastructure; • available sources for data collection; • the number of people living with HIV/AIDS (PLWHA); • the presence of a University;
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