Sex Workers (SW)

Home , Bila Tserkva, Kropyvnytskyi, Vasylkiv

MAIN RESULTS OF BIO-BEHAVIORAL SURVEILLANCE AMONG KEY POPULATIONS MAIN RESULTS OF BIO-BEHAVIORAL SURVEILLANCE AMONG KEY POPULATIONS

KYIV – 2018 2

Authors: Yana Sazonova Tetyana Salyuk ICF “Alliance for Public Health”

Design and lay-out: Larysa Sukhomlinova

Translation: Olesya Khmel

Drafting and publishing of this report became possible with the technical support of the project “Engaging Local Indigenous Organizations in Developing HIV/AIDS Monitoring and Evaluation Capacity in Ukraine” (METIDA), implemented by the ICF «Alliance of Public Health», funded by the U.S. Centers for Diseases Control and Prevention (CDC) under the President’s Emergency Plan for AIDS Relief (PEPFAR).

This publication is supported by the Cooperation Agreement No. 2GGH000840 with the U.S. CDC. The authors are solely responsible for the content of this publication and does not always reflect the official position of the U.S. Centers for Disease Control and Prevention (CDC). 3

BRIEF DESCRIPTION OF THE SURVEY METHODOLOGY

The aim of this survey is to monitor the behavioral and epidemiological indicators’ prevalence among key populations for HIV-infection TARGET GROUPS OF THE SURVEY:

 People who inject drugs (PWID);  Men who have sex with men (MSM);  Sex workers (SW)

The survey is cross-sectional on its design. RDS was the main recruiting method for PWID and MSM in all survey cities. A group of Sex workers used RDS and TLS methods for different surveys cities.

The size of implemented sampling is the following: for PWID – 10,076 respondents, for SW – 5,043 respondents, for MSM – 5,972 respondents.

SURVEY GEOGRAPHY

Survey among PWID (30 cities): Vinnytsa, Dnipro, Kryvyi Rih, Donetsk, Zhytomyr, Zaporizhia, Melitopol, Ivano-Frankivsk, Kyiv, Bila Tserkva, Vasylkiv, Fastiv, Kropyvnytskyi, Severodonetsk, Lutsk, Lviv, Mykolaiv, Odessa, Poltava, Rivne, Sevastopol, Sumy, Ternopil, Uzhhorod, Kharkiv, Kherson, Khmelnytskyi, Cherkassy, Chernivtsi, Chernihiv. Survey among MSM (27 cities): Vinnytsa, Dnipro, Donetsk, Mariupol, Zhytomyr, Zaporizhia, Ivano-Frankivsk, Kyiv, Bila Tserkva, Kropyvnytskyi, Lutsk, Lviv, Mykolaiv, Odessa, Poltava, Rivne, Sevastopol, Simferopol, Sumy, Ternopil, Uzhhorod, Kharkiv, Kherson, Khmelnytskyi, Cherkassy, Chernivtsi, Chernihiv. Survey among SW (25 cities): Vinnytsa, Dnipro, Mariupol, Zhytomyr, Zaporizhia, Ivano-Frankivsk, Kyiv, Bila Tserkva, Kropyvnytskyi, Lutsk, Lviv, Mykolaiv, Odessa, Poltava, Rivne, Simferopol, Sumy, Ternopil, Uzhhorod, Kharkiv, Kherson, Khmelnytskyi, Cherkassy, Chernivtsi, Chernihiv. The survey algorithm included structured interview, rapid tests for HIV and hepatitis C detection, laboratory testing for early HIV infection verification and determination of viral load levels for HIV-positive participants. Data collection duration: direct data collection lasted from November 2017 to March 2018.

BASIC DEFINITIONS: Bio-behavioral surveillance – behavioral and biological research, related in time and place to the same respondent. RDS (Respondent Driven Sampling) – sample guided and realized by the respondents. TLS (Time Location Sampling) – a kind of cluster sampling aimed at forming geographical list of spots frequented by representatives of the target group. MAIN RESULTS OF BIO-BEHAVIORAL 4 SURVEILLANCE AMONG KEY POPULATIONS

PEOPLE WHO INJECT DRUGS (PWID)

SOCIO-DEMOGRAPHIC PROFILE PEOPLE WHO INJECT DRUGS (PWID) 5

INJECTION BEHAVIOR PRACTICES

Consistently high indicators on clean injecting equipment for drug use have been recorded since 2011. The indicators on use of sharing dishes/equipment for drugs preparing or distribution or their purchase in an already acquired syringe have exceeded 50%. However, over the years, these indicators have a steady trend to decrease.

100 96 97 97 97

70 64 60 55 58 51 50 48 39 40

30 28 31 20 8 10 6 6 6

0 2011 (n=9,069)2013 (n=9,502) 2015 (n=9,405)2017 (n=10,076)

Used sterile injecting equipment the last time they injected Used sharing syringe/needle during the last 30 days Got/purchased drugs in an already acquired syringe and didn’t see how this syringe was filled in Used sharing dishes for preparing and/or distribution of drug substance

Figure. 1. Dynamics of the main indicators on injection behavior among PWID, 2011 – 2017.

OVERDOSE

28 Among those who indicated availability of such cases:  24,5 years – the average age of the first episode of overdose;  2,7 times – the average number of overdose cases; 5  1,5 times – the average number of overdose cases during the last 12 months. OVERDOSE OVERDOSE CASE CASES DURING DURING THE LAST THE LIFETIME 12 MONTHS

Figure. 2. The prevalence of overdose cases among PWID throughout the life and during the last 12 months, 2017. MAIN RESULTS OF BIO-BEHAVIORAL 6 SURVEILLANCE AMONG KEY POPULATIONS

SEXUAL BEHAVIOR PRACTICES

2011 2013 2015 2017 Using a condom during the last sexual contact with a partner*, % 48 54 48 44 Type of a partner you had the last sexual contact with*, %: regular/permanent – 71 75 73 casual – 26 23 25 commercial (who was provided with money or other economic benefits for sex) – 2 1 2 commercial (who provided money or other economic benefits for sex) – 1 1 0 Using a condom over the last 90 days, %: Indicated the existence of a permanent sex partner (-s) 77 76 63 65 Always used a condom with a permanent sex partner (-s)** 27 29 26 23 Indicated the existence of a casual sex partner (-s) 33 34 30 26 Always used a condom with a casual sex partner (-s)*** 53 56 47 50 Indicated the existence of a commercial sex partner (-s), 3 4 3 3 who was provided with money or other economic benefit for sex Among men 3 4 4 4 Always used a condom with a commercial sex partner (-s), 53 63 63 62 who was provided with money or other economic benefit for sex§ Among men 63 63 67 62 Indicated the existence of a commercial sex partner (-s), 3 2 2 1 who provided money or other economic benefit for sex Among women 9 6 7 3 Always used a condom with a commercial sex partner (-s), 58 62 53 20 who provided money or other economic benefit for sex§§ Among women 60 44 54 46

* Among those who had sex during the last 30 days: 2011 n=7,042, 2013 n=8,074, 2015 n=6,808, 2017 n=6,733; ** Among those, who indicated the presence of a permanent sex partner over the last 90 days: 2011 n=6,221, 2013 n=6,048, 2015 n=5,893, 2017 n=6,462; *** Among those, who indicated the presence of a casual sex partner over the last 90 days: 2011 n=2,592 2013 n=2,280, 2015 n=2,815, 2017 n=2,608; § Among those, who indicated the presence of a commercial sex partner that was provided with money or other economic benefit for sex over the last 90 days: 2011 n=219, 2013 n=165, 2015 n=301, 2017 n=317; §§ Among those, who indicated the presence of a commercial sex partner that provide money or other economic benefit for sex over the last 90 days: 2011 n=217, 2013 n=314, 2015 n=152, 2017 n=86. PEOPLE WHO INJECT DRUGS (PWID) 7

PREVALENCE OF HIV

The HIV prevalence among people who inject drugs (PWID) is 22,6%. HIV prevalence among representatives of the younger group (up to 25 years old) is 5,0%, while in group aged 25 and older – 23,9%.

22 22 23 20

7 6 5 4

2011 (N=9,069) 2013 (N=9,502) 2015 (N=9,405)2017 (N=10,076)

HIV prevalence among PWD in general HIV prevalence among PWID aged up to 25

Figure. 3. HIV prevalence among PWID in general, and among those aged up to 25, 2011–2017.

Chernihiv

Lutsk Sumy Rivne Kyiv Zhytomyr Lviv Kyiv region Kharkiv Poltava Ternopil Severodonetsk Khmelnytskyi Cherkassy Vinnytsa Ivano- Uzhhorod Frankivsk Dnipro Donetsk Chernivtsi Kropyvnytskyi

Zaporizhia

Mykolaiv HIV prevalence,% Odessa 0 - 10 Kherson 10 - 20 20 - 30 30 - 40 40 - 42

Sevastopol Figure. 4. HIV prevalence among PWID in the survey cities

* HIV prevalence among PWID in non-regional level towns included into the survey sampling:  40,3% (95% CІ: 35,9–44,8) – in Kryvyi Rih (Dnipropetrovsk region);  6,4% (95% CІ: 3,5–9,3) – in Melitopol (Zaporizhian region). ** HIV prevalence presented on Luganks region map, corresponds to the indicator recorded in Severodonetsk City. *** HIV prevalence in Kyiv region is presented as an aggregated indicator of three cities, in which the survey was conducted:  40,4% (95% CІ: 34,7–46,2) – in Bila Tserkva (Kyiv region);  25,3% (95% CІ: 19,6–31,1) – in Fastiv (Kyiv region);  11,2% (95% CІ: 7,8–14,6) – in Vasylkiv (Kyiv region). MAIN RESULTS OF BIO-BEHAVIORAL 8 SURVEILLANCE AMONG KEY POPULATIONS

PREVALENCE OF HEPATITIS С

The prevalence of hepatitis C among people who inject drugs is 63,9%. Hepatitis C prevalence among representatives of the younger group (up to 25 years old) is 29,8%, while in the group of PWID aged 25 and older – 66,3%.

Chernihiv

Lutsk Sumy Rivne Kyiv Zhytomyr Lviv Kyiv region Kharkiv Poltava Ternopil Severodonetsk Khmelnytskyi Cherkassy Vinnytsa Ivano- Uzhhorod Frankivsk Dnipro Donetsk Chernivtsi Kropyvnytskyi

Zaporizhia Prevalence of Hepatitis C Mykolaiv

20.0 - 40.0 Odessa 40.0 - 60.0 Kherson 60.0 - 80.0 80.0 - 86.5

Figure. 5. The prevalence of Hepatitis C among PWID in the survey cities Sevastopol

* The prevalence of Hepatitis C among PWID in non-regional level towns included into the survey sampling:  72,9% (95% CІ: 68,0–77,7) – in Kryvyi Rih (Dnipropetrovsk region);  65,2% (95% CІ: 59,0–71,6) – in Melitopol (Zaporizhian region). ** The prevalence of Hepatitis C presented on Lugansk region map corresponds to the indicator reported in Severodonetsk City. *** The prevalence of Hepatitis C in Kyiv region is presented as an aggregated indicator of three cities, in which the survey was conducted:  91,9% (95% CІ: 89,3–94,5) – in Bila Tserkva (Kyiv region);  56,0% (95% CІ: 48,7–63,3) – in Fastiv (Kyiv region);  43,4% (95% CІ: 36,8–50,0) – in Vasylkiv (Kyiv region). THE HIV TREATMENT CASCADE

78422

58% 52% 38% 28%

Estimated KNOW THEIR REGISTERED RECEIVE ART VIRALLY number HIV POSITIVE AT HCF SUPPRESSED of PWID PLHV STATUS

Figure. 6. The HIV Treatment Cascade among PWID, 2017 р. (It is calculated among PWID, who received an HIV positive test result, n=2,261) MEN WHO HAVE SEX WITH MEN (MSM) 9

MEN WHO HAVE SEX WITH MEN (MSM)

SOCIO-DEMOGRAPHIC PROFILE

AGE GROUPS, %: SEXUAL ORIENTATION, %:

40% < 25 years old 64% homosexual 34% 25–34 years old 34% bisexual 17% 35–44 years old 1% heterosexual 9% 45 years and older 1% not yet determined

MARITAL STATUS: AVERAGE AGE, YEARS

never been married in a registered marriage with a woman 29

AVERAGE MONTHLY 81% 13% 5% 1% INCOME, UAH.

5,979

divorced widower

LIVE WITH…:

39% 16% 5% 40%

parents/relatives partner-woman

partner-man Live alone MAIN RESULTS OF BIO-BEHAVIORAL 10 SURVEILLANCE AMONG KEY POPULATIONS

SEXUAL BEHAVIOR PRACTICES

2011 2013 2016 2018 Condom use during the last anal sex with partner-male, %* 71 72 71 78 Type of a partner you had the last sexual contact with, %*: regular/permanent 51 53 52 55 casual 46 42 43 41 commercial (who was provided with money or other economic benefits for sex) 1 2 1 1 commercial (who provided money or other economic benefits for sex) 2 2 2 2 group sex – 1 2 1 Condom use over the last 30 days, %: Indicated the presence of a permanent sex partner (-s) 60 57 57 54 Used a condom during the last sexual contact with a permanent sex partner (-s)** 62 63 67 71 Indicated the presence of a casual sex partner (-s) 54 58 50 45 Used a condom during the last sexual contact with a casual sex partner (-s)*** 80 83 88 87 Indicated the presence of a commercial sex partner (-s), who was provided 3 5 3 3 with money or other economic benefit for sex Used a condom during the last sex with a commercial sex partner (-s), 86 93 89 83 who was provided with money or other economic benefit for sex§ Indicated the presence of a commercial sex partner (-s), who provided 4 5 5 4 money or other economic benefit for sex Used a condom during the last sex with a commercial sex partner (-s), 78 76 80 71 who provided money or other benefit for sex§§ Had sexual contacts with a woman, % 58 54 61 54 Used a condom during the last sexual contact with a woman 65 66 62 67 (among those who have such contacts over the last 6 months), %§§§

* Among those, who had anal sex over the last 6 months: 2011 n=5,618, 2013 n=7,847, 2015 n=4,109, 2018 n=5,410; ** Among those, who indicated the presence of a permanent sex partner over the last 30 days: 2011 n=3,549, 2013 n=4,728, 2015 n=2,499, 2018 n=3,189; *** Among those, who indicated the presence of the casual sex partner over the last 30 days: 2011 n=3,216, 2013 n=4,579, 2015 n=2,184, 2018 n=2,620; § Amon those, who indicated the presence of a commercial sex partner who was provided with money or other economic benefit for sex over the last 30 days: 2011 n=162, 2013 n=371, 2015 n=146, 2018 n=148; §§ Among those, who indicated the presence of a commercial sex partner who provided money or other economic benefits for sex over the last 30 days: 2011 n=315, 2013 n=463, 2015 n=287, 2018 n=239; §§§ Among those, who indicated the availability of sexual contacts with a woman over the last 6 months: 2011 n=1,538, 2013 n=4,303, 2015 n=1,080, 2018 n=1,429. MEN WHO HAVE SEX WITH MEN (MSM) 11

USE OF ALCOHOL AND DRUGS

Never During the last 30 days Less than once a month, During the last year (but not for the last 30 days) At least once for the last month Never or too long ago 0,4 8 0,3 7 45

99 85 29

26 USED USED THE FREQUENCY OF BEING NON INJECTING INJECTING IN A STATE OF STRONG DRUGS, % DRUGS, % ALCOHOLIC SPITTING

Figure. 7. The frequency of alcohol use and prevalence of drugs use among MSM, %

WILLINGNESS TO USE PRE-EXPOSUREWILLINGNESS TOWARDS PROPHYLAXIS PREP, % (PREP) 93

HIVNEGATIVE*ELIGIBLE DEMONSTRATED INDICATOR HAVE ALREADY ACCORDING TO RSIK WILLINGNESS OF PREP USED PREP DURING BEHAVIOR CRITERIA** TO USE PREP*** READINESS**** LAST 12 MONTHS

Figure. 8. Net weight of those, who want to take PrEP and correspond to prescription criteria (HIV-negative and have risky sexual behavior)

* Received negative HIV test result within IBBS. ** Eligible according to risk behavior criteria: have unsafe sex and/or have sex with more than one partner for the last 30 days, or/and have HIV-positive sex partner. *** It was indicated in the framework of the survey, that they want to take PrEP and agree for all conditions of its prescription and monitoring of use. **** Indicator of PrEP Readiness: the proportion of MSM with HIV-negative, eligible according to risk behavior criteria and demonstrated willingness to use PrEP. MAIN RESULTS OF BIO-BEHAVIORAL 12 SURVEILLANCE AMONG KEY POPULATIONS

Sevastopol 36 Chernihiv 34 Kropyvnytsky 28 Rivne 26 Ternopil 26 Donetsk 25 Mykolayiv 24 Vinnytsia 24 Mariupol 21 Odessa 20 Chernivtsi 19 Lutsk 19 Dnipro 19 Kyiv 18 Cherkassy 18 Poltava 18 Uzhhorod 17 Ivano-Frankivsk 17 Zaporizhia 17 Lviv 15 Bila Tserkva 14 Kherson 12 Sumy 11 Simferopol 9 Zhytomyr 7 Kharkiv 6 Khmelnytskyi 2

Figure. 9. Indicator of willingness towards PrEP by survey cities, % MEN WHO HAVE SEX WITH MEN (MSM) 13

PREVALENCE OF HIV

The HIV prevalence among men who have sex with men (MSM) is 7,5%. Prevalence of HIV among representatives of the younger group (up to 25 years old) is 6,7%, while in a group of MSM aged 25 and older – 8,0%.

Chernihiv

Lutsk Rivne Sumy Kyiv Zhytomyr Lviv Bila Tserkva Kharkiv Poltava Ternopil Khmelnytskyi Cherkassy Vinnytsa Ivano- Uzhhorod Frankivsk Dnipro Donetsk Chernivtsi Kropyvnytskyi

Zaporizhia

Prevalence Mykolaiv of HIV infection, % Odessa 0.0 - 2.0 Kherson 2.0 - 5.0 5.0 - 10.0 10.0 - 15.0 Simferopol 15.0 - 22.8

Sevastopol Figure. 10. The HIV prevalence among MSM in the survey cities

* Indicators of HIV prevalence among MSM in non-regional level cities included into the survey sampling:  8,8% (95% CІ: 5,0–12,6) – in Mariupol (Donetsk region);  1,2% (95% CІ: 0,1–2,3) – Bila Tserkva (Kyiv region).

THE HIV TREATMENT CASCADE

13553

59% 56% 46% 35%

ESTIMATED KNOW THEIR REGISTERED RECEIVE VIRALLY NUMBER HIVPOSITIVE AT HCF ART SUPPRESSED OF MSMPLHV STATUS

Figure. 11. The HIV Treatment Cascade among MSM, 2017–2018. (Calculated among MSM, who received HIV-positive test result, n=312) MAIN RESULTS OF BIO-BEHAVIORAL 14 SURVEILLANCE AMONG KEY POPULATIONS

SEX WORKERS (SW)

SOCIO-DEMOGRAPHIC PROFILE

AGE GROUPS, % SEX, %: 24% < 25 years old 97% female 51% 25–34 years old 2,9% male 22% 35–44 years old 0,1% transgender people 4% 45 years and older

MARITAL STATUS: AVERAGE AGE, YEARS

Not married/not Officially married married and don’t have a sex 30 partner to live with

AVERAGE MONTHLY 64% 17% 20% INCOME, UAH

Officially not married/not 12,410 married but live with a sex partner WAYS OF SEX WORKERS’ CLIENTS SEARCHING, %: 33% 24% 18% 16% 5% 4%

web-based on a street, in entertainment through in a hotel/motel in sauna highway, etc. facilities intermediaries (pimp, other sex workers, clients) SEX WORKERS 15

SEXUAL BEHAVIOR PRACTICES

2011 2013 2016 2018

Used a condom during sexual contacts with clients, %: last sexual contact 92 97 94 94 always during oral sex for the last 30 days 58 68 77 63 always during vaginal sex for the last 30 days 74 85 89 90 always during anal sex for the last 30 days 68 71 83 86 Number and clients’ profile who were provided with sexual services for the last 30 days, % : Median number of regular clients – – 4 3 Median number of casual clients – – 20 10 Age characteristics of clients who were provide with sexual services: teens (up to 19 years old) 3 3 8 3 young men/women (19–24 years old) 38 40 49 27 young men/women (25–34 years old) 82 86 89 70 men/women of middle age (35–49 years old) 86 90 90 88 men/women (50 years and older) 38 43 43 41 Social and professional groups of clients, who were provided with sexual services: military servants 26 31 59 38 students 19 29 36 20 truck divers 33 44 39 33 seamen 10 17 16 13 taxi drivers 40 45 51 39 0ther transport workers 30 30 32 17 policemen 32 41 46 24 representatives of a criminal organization or an organized group – 30 33 21 businessmen 71 77 73 64 Representatives of key population, who were provided with sexual services: People who inject drugs 15 21 12 12 Bisexuals and/or homosexuals 10 – 5 11 MAIN RESULTS OF BIO-BEHAVIORAL 16 SURVEILLANCE AMONG KEY POPULATIONS

THE USE OF DRUGS

Non-injecting drug use Injecting drug use 5 1 10 Yes, I used drugs during 5 the last 30 days Yes, I used drugs during the last 12 months (but not the last 30 days) Yes, I used drugs more than 12 months ago I never used drugs and even didn’t taste it

Refusal to answer

Figure. 12. The prevalence of injecting and non-injecting drug use

50 37 Cherkassy 26 32 Kropyvnytskyi 14 14 Zaporizhia 15 14 Bila Tserkva 27 13 Dnipro 12 12 Kerson 16 11 Lutsk 44 10 Mariupol 23 10 Poltava 17 10 Kyiv 26 6 Rivne 9 4 Odessa 10 2 Vinnytsia 11 2 Sumy 6 1 Kharkiv 2 1 Khmelnytskyi 17 1 Chernihiv 11 1 Lviv 2 1 Chernivtsi 8 0 Simferopol 18 0 Zhytomyr 27 0 Uzhhorod 4 0 Ivano-Frankivsk 2 0 Mykolayiv 6 0 Ternopil

Used injecting drugs during the last 12 months Used non-injecting drugs during the last 12 months

Figure. 13. The prevalence of injecting and non-injecting drug use in the survey cities, % SEX WORKERS 17

NONINJECTING USE, % INJECTING USE,%

54 58

20 17 10 4

MARIJUANA AMPHETAMINES METHADON OPIUM METHADON AMPHETAMINES “FEN” EXTRACT “FEN” Figure. 14. Top 3 of the most commonly used non-injecting and injecting drugs among sex workers (among those, who used drugs at least during the last 12 months)

PREVALENCE OF HIV

Used injecting drugs for the last 30 days Didn’t use injecting drugs for the last 30 days Total

12 8 3 5

PREVALENCE OF HIV INFECTION PREVALENCE OF HEPATITIS C

Figure. 15. The Prevalence of HIV infection and Hepatitis C among sex workers depending on the current practice of injecting drug use MAIN RESULTS OF BIO-BEHAVIORAL 18 SURVEILLANCE AMONG KEY POPULATIONS

The HIV prevalence among Sex workers is 5,2%. Prevalence of HIV among representatives of the younger group (up to 25 years old) is 1,3%, while in a group of Sex workers aged 25 and older – 6,4%

Chernihiv

Lutsk Rivne Sumy Kyiv Zhytomyr Lviv Bila Tserkva Kharkiv Poltava Ternopil Khmelnytskyi Cherkassy Vinnytsa Ivano- Uzhhorod Frankivsk Dnipro Donetsk Chernivtsi Kropyvnytskyi

Zaporizhia

Prevalence Mykolaiv of HIV infection, % Odessa Kherson

Simferopol

Figure. 16. The HIV prevalence among sex workers in the survey cities

* Indicators of HIV prevalence among MSM in non-regional level cities included into the survey sampling:  18,1% (95% CІ: 13,3–23,9) – in Mariupol (Donetsk region);  12,8% (95% CІ: 6,4–19,2) – in Bila Tserkva (Kyiv region).

THE HIV TREATMENT CASCADE

4184

53% 46%

29%

Estimated KNOW THEIR REGISTERED RECEIVE AR T number HIVSPOSITIVE STATUS AT HCF of SWsSPLHV Figure. 17. The HIV Treatment Cascade among Sex workers, 2017–2018 рр. (Calculated among SW, who received HIV-positive test result, n=232) HIV INCIDENCE AMONG KEY POPULATIONS 19

This section presents the laboratory analysis resuts of dry blood specimens collected in 2013 for the detection of early infections.

Incidence is a probability of occurrence of a given medical condition in a definite population within a specified period of time. In this case HIV incidence among key populations (SW, MSM, PWID) is calculated for the year preceding the survey.

Aggregated indicators of HIV incidence in key populations, 2013

HIV prevalence % Incidence % Group (95% CІ) (95% CІ) Sex workers 5.58 (4.92, 6.32) 0.44 (0.09, 0.79) Men who have sex with men 4.17 (3.70, 4.73) 0.91 (0.54, 1.29) People who inject dugs 17.89 (16.81, 19.04) 0.74 (0.33, 1.14)

* CІ – confidence interval

Figure. 18. HIV incidence among SW in the survey cities, 2013.

9.1% 6.0%

1.4% 1.2% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% I I I K K K K R V V LVI KYIV SUMY RIVNE LUTS DESSA DNIPRO O KHARKI POLTAV A LUGANS KHERSO N DONETS TERNOPI L VINNYTS A MYKOLAIV ZHYTOMY APORIZHIA CHERNIHIV UZHHORO D CHERKASSY EVASTOPOL IMFEROPOL CHERNIVTS Z S S BILA TSERKVA KHMELNYTSKY KROPYVNYTSKY IVANOSFRANKIVS

MSM 7.1% 5.4% 3.8% 2.0% 1.6% 1.3% 1.1% 0.9% 0.7% 0.7% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% K K K V A V KYIV LVI SUMY RIVN E LUTS DESSA DNIPRO O KHARKI POLTAVA KHERSO N DONETS LUGANS TERNOPIL VINNYTS A MYKOLAIV ZHYTOMYR APORIZHIA CHERNIHI V CHERKASSY UZHHOROD IMFEROPOL CHERNIVTSI Z S SEVASTOPOL BILA TSERKV KHMELNYTSKY I KROPYVNYTSKY I IVANOSFRANKIVSK

PWID

5.4% 3.5% 2.7% 2.3% 1.8% 1.8% 1.5% 1.1% 0.9% 0.9% 0.8% 0.8% 0.6% 0.6% 0.5% 0.4% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% K K K V A V LVI KYIV SUMY RIVN E LUTS DESSA FASTIV DNIPRO O

KHARKI VASYLKIV POLTAVA KHERSO N DONETS LUGANS TERNOPIL VINNYTS A MYKOLAIV ZHYTOMYR APORIZHIA CHERNIHI V UZHHOROD CHERKASSY IMFEROPOL CHERNIVTSI Z S SEVASTOPOL BILA TSERKV KHMELNYTSKY I KROPYVNYTSKY I IVANOSFRANKIVSK

9.1% 6.0% SW

9.1% 1.4% 1.2% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 6.0% I I K K K K R V V KYIV 1.4% 1.2% MAINLVI RESULTS OF BIO-BEHAVIORAL SUMY RIVNE LUTS DESSA 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% DNIPRO O KHARKI POLTAV A DONETS LUGANS KHERSO N TERNOPI L I I VINNYTS A MYKOLAIV K K K K R V V ZHYTOMY APORIZHIA

SURVEILLANCE AMONG KEY POPULATIONSCHERNIHIV UZHHORO D CHERKASSY EVASTOPOL IMFEROPOL 20 CHERNIVTS Z S S KYIV LVI BILA TSERKVA KHMELNYTSKY SUMY RIVNE LUTS DESSA KROPYVNYTSKY I DNIPRO O KHARKI IVANOSFRANKIVS POLTAV A DONETS LUGANS KHERSO N TERNOPI L VINNYTS A MYKOLAIV ZHYTOMY APORIZHIA CHERNIHIV UZHHORO D CHERKASSY EVASTOPOL IMFEROPOL CHERNIVTS Z S S

Figure. 19BILA TSERKVA . Incidence among MSM in the survey cities, 2013. KHMELNYTSKY KROPYVNYTSKY I IVANOSFRANKIVS

MSM 7.1% 5.4% 3.8% MSM 7.1% 2.0% 1.6% 1.3% 1.1% 0.9% 0.7% 0.7% 5.4% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 3.8% I I K K K V A V 2.0% 1.6% KYIV 1.3% 1.1% 0.9% 0.7% LVI

0.7% SUMY RIVN E LUTS DESSA 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% DNIPRO O KHARKI POLTAVA DONETS KHERSO N LUGANS TERNOPIL VINNYTS A MYKOLAIV K K K V A V ZHYTOMYR APORIZHIA CHERNIHI V CHERKASSY UZHHOROD IMFEROPOL CHERNIVTSI Z SEVASTOPOL S KYIV LVI BILA TSERKV KHMELNYTSKY SUMY RIVN E LUTS DESSA KROPYVNYTSKY DNIPRO O KHARKI IVANOSFRANKIVSK POLTAVA KHERSO N DONETS LUGANS TERNOPIL VINNYTS A MYKOLAIV ZHYTOMYR APORIZHIA CHERNIHI V CHERKASSY UZHHOROD

IMFEROPOL CHERNIVTSI Z SEVASTOPOL S BILA TSERKV KHMELNYTSKY I KROPYVNYTSKY I IVANOSFRANKIVSK Figure. 20. Incidence among PWID in the survey cities, 2013. PWID

5.4% PWID 3.5% 2.7% 2.3% 1.8% 1.8% 1.5% 1.1% 0.9% 0.9% 0.8% 0.8% 0.6% 0.6% 5.4% 0.5% 0.4% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 3.5% K K K V A 2.7% 2.3% V 1.8% 1.8% 1.5% LVI 1.1% 0.9% 0.9% 0.8% 0.8% KYIV SUMY 0.6% 0.6% 0.5% RIVN E 0.4% LUTS DESSA FASTIV 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% DNIPRO O

KHARKI VASYLKIV POLTAVA KHERSO N DONETS LUGANS TERNOPIL VINNYTS A I I MYKOLAIV K K K V A V ZHYTOMYR APORIZHIA CHERNIHI V UZHHOROD CHERKASSY IMFEROPOL CHERNIVTSI Z S SEVASTOPOL LVI KYIV BILA TSERKV KHMELNYTSKY I SUMY RIVN E LUTS DESSA KROPYVNYTSKY I FASTIV DNIPRO O

KHARKI IVANOSFRANKIVSK VASYLKIV POLTAVA KHERSO N LUGANS DONETS TERNOPIL VINNYTS A MYKOLAIV ZHYTOMYR APORIZHIA CHERNIHI V UZHHOROD CHERKASSY

IMFEROPOL CHERNIVTSI Z S SEVASTOPOL BILA TSERKV KHMELNYTSKY KROPYVNYTSKY IVANOSFRANKIVSK