CONSULTATION REPORT HEALTH, RIGHTS ANDAccess WELL-BEING to and availability of A Practical ToolSRH for HIV and and HIVSexual services and Reproductive for Health Programmes with Young Key Populations Youngin Eastern Key Europe Populations and Central Asia Focus group discussions among young key populations GEORGIA International Planned Parenthood Federation - 1 - TABLE OF CONTENTS ACKNOWLEDGEMENTS 4 SERVICES 73 ABBREVIATIONS 6 HIV PREVENTION 76 DEFINITIONS OF KEY POPULATIONS 7 4.1.1 Condoms and lubricant 76 GLOSSARY OF OTHER TERMS 8 4.1.2 Pre-exposure prophylaxis (PrEP) 78 4.1.3 Post-exposure prophylaxis (PEP) 80 HOW TO USE THIS TOOL 9 4.1.4 Risk reduction and sexuality-related communication 80 INTRODUCTION AND BACKGROUND 11 4.1.5 STI prevention, screening and management 81 HARM REDUCTION 85 4.2.1 Needle and syringe programmes (NSP) 86 YOUNG KEY POPULATIONS AND HIV RISK 14 4.2.2 Opioid substitution therapy (OST) 89 THE EASTERN EUROPEAN 4.2.3 Overdose management 90 AND CENTRAL ASIAN CONTEXT 15 4.2.4 Addressing harmful drug and alcohol use 91 SEXUAL AND REPRODUCTIVE 4.2.5 Further considerations 92 HIV TESTING SERVICES (HTS) 93 HEALTH AND RIGHTS 17 4.3.1 Approaches to delivering HTS 94 1.3.1 Human rights as the basis for sexual and reproductive rights 17 SRHR SERVICES 96 1.3.2 What are sexual and reproductive 4.4.1 Contraceptive choices and counselling 98 health and rights? 17 4.4.2 Prevention and screening 1.3.3 Why do sexual and reproductive of HPV-related cancers 100 health and rights matter? 18 4.4.3 Safe abortion services 101 4.4.4 Prevention of perinatal transmission of HIV 102 PRINCIPLES FOR PROGRAMMING 4.4.5 Prenatal, newborn and infant care 103 WITH YOUNG KEY POPULATIONS 20 4.4.6 Gender-affirming services 105 RESOURCES 22 HIV TREATMENT AND CARE 106 4.5.1 Pre-ART care 106 COMMUNITY EMPOWERMENT, 4.5.2 Antiretroviral therapy 107 4.5.3 Viral load monitoring 107 PARTICIPATION AND RIGHTS 23 4.5.4 Adherence and retention 107 COMMUNITY EMPOWERMENT 4.5.5 Prevention, screening and management AND CAPACITY DEVELOPMENT 24 of common co-infections 109 2.1.1 Community empowerment 24 OTHER CARE AND SUPPORT SERVICES 111 2.1.2 Capacity development 30 4.6.1 Clinical care following violence 111 PARTICIPATION, RIGHTS 4.6.2 Mental health 112 4.6.3 Social services 113 AND SOCIAL INCLUSION 35 RESOURCES 114 INFORMATION AND EDUCATION FOR AN ENABLING ENVIRONMENT 38 SERVICE DELIVERY 119 COMPREHENSIVE SEXUALITY EDUCATION (CSE) 40 ACCESS TO SERVICES FOR YOUNG RESOURCES 44 KEY POPULATIONS 121 SERVICE COORDINATION 127 LEGAL CONTEXT, STIGMA, SERVICE INTEGRATION 132 DISCRIMINATION AND VIOLENCE 46 SERVICE DECENTRALIZATION 135 THE LEGAL AND POLICY ENVIRONMENT 47 COMMUNITY AND PEER OUTREACH LEGAL REFORM 41 AND SUPPORT 138 3.2.1 Parental consent 54 RESOURCES 144 ADDRESSING STIGMA AND DISCRIMINATION 57 ADDRESSING VIOLENCE 59 3.4.1 Types of violence 59 ANNEX. FOCUS GROUP DISCUSSIONS WITH YOUNG 3.4.2 Perpetrators 60 KEY POPULATIONS TO DOCUMENT ACCESS 3.4.3 Interventions to address violence 61 AND BARRIERS TO SRHR AND HIV SERVICES 145 SENSITIZING LAW ENFORCEMENT AND SERVICE-PROVIDERS 66 3.5.1 Sensitizing law enforcement 66 3.5.2 Sensitizing service-providers to work with young key populations 68 RESOURCES 71 - 2 - HEALTH, RIGHTS & WELL-BEING - Programming Tool for YKPs in EECA Region - 3 - ACKNOWLEDGEMENTS This tool was developed by the United Nations Marjeta Dervishi, Eurasian Coalition on Male Health (ECOM) Djurica Stankov, Population Fund Eastern Europe and Central National AIDS Programme, Albania Volha Lukashkova, AS - Centre for the Empowerment Youth of Asia Regional Office (UNFPA EECARO) and the Victoria Dochitcu, UNFPA, Belarus People Living with HIV and AIDS, Serbia International Planned Parenthood Federation UNFPA, Republic of Moldova John Macauley, Dragana Stojanovic, European Network Regional Office (IPPF EN), Kerim Dževlan, United Nations Development Programme (UNDP), Serbian Association for Sexual and Reproductive with the UNFPA Country Offices and IPPF Member Association XY, Bosnia and Herzegovina Istanbul Regional Hub Health and Rights (SRH), Serbia Associations from eight countries - Albania, Nermina Fakovic, Venera Maitieva, Ketevan Stvilia, Bosnia and Herzegovina, Georgia, Kyrgyzstan, Ministry of Health, the former Yugoslav Republic Ministry of Health, Kyrgyzstan Global Fund HIV Programme, PIU, National Centre Serbia, Tajikistan, the former Yugoslav Republic of Macedonia Tijana Medvedec, for Disease Control and Public Health, Georgia of Macedonia, and Ukraine - in partnership with Ahmadzoda Farzoma, Association XY, Bosnia and Herzegovina Zarina Tajibaeva, country-level government teams from government, Tajik Family Planning Alliance, Tajikistan Oleksandr Minko, NGO “Anti Spid”, Tajikistan local-government representatives, community Dzmitry Filippau, Community member, Ukraine Nesrine Talbi, members from young key populations and service- menZDRAV Foundation, Ukraine Karlygash Mizanova, IPPF European Network providers. Regional key-populations networks, Elena Fiskova, NGO “Legalife”, Ukraine UNFPA Eastern Europe and Central Asia Regional Dorina Tocaj, UNFPA Albania international partners and other experts also Beka Gadabadze, Office Molmol Toitukova, contributed, including those who gathered for two Community member, Georgia Peter Mladenov, National AIDS Centre, Kyrgyzstan regional consultations in Tbilisi, Georgia (November Saltanat Gamir kyzy, Y-PEER, Bulgaria Nino Tsereteli, 2015) and Kyiv, Ukraine (November 2016). Community member, Kyrgyzstan Svitlana Moroz, NGO Tanadgoma, Georgia Rumena Gjerdovska, Eurasian Women’s Network on AIDS (EWNA), Maia Tsereteli, The time and expertise of all the participants HERA - Health Education and Research Ukraine National Centre for Disease Control and Public and contributors, and of the organizations Association, the former Yugoslav Republic of Erlan Orsekov, Health, Georgia that contributed case examples, are gratefully Macedonia NGO Kyrgyz Indigo, Kyrgyzstan Elena Tsukerman, acknowledged. Bogdan Globa, Emina Osmanovic, NGO “Legalife”, Ukraine Tochka Opory, Ukraine Ministry of Civil Affairs , Bosnia and Herzegovina Roxana Vasi, Olesya Aksyonova, Arkadiy Grigoryev, Yana Panfilova, SWAN (Sex Workers’ Rights Advocacy Network), Community member, Tajikistan EHRN (Eurasian Harm Reduction Network) Union of Adolescents and Youth Teenergizer, Hungary Akmal Aminjonov, Kiromiddin Gulov, Ukraine Milka Vasilijevic, NGO “Equal Opportunities”, Tajikistan NGO “Equal Opportunities”, Tajikistan Snežana Pantić Aksentijević, Serbian Association for Sexual and Reproductive Elena Anoprienko, Brunilda Hylviu, Ministry of Health, Serbia Health and Rights (SRH), Serbia Centre for Medical, Psychological Support and Albanian Centre for Population and Pinar Percinel, Gokhan Yildrimkaya, Social Rehabilitation of Adolescents and Youth, Development, Albania UNFPA Eastern Europe and Central Asia Regional UNFPA Eastern Europe and Central Asia Regional Ukraine Natalia Isaeva, Office Office Adisa Bajramovic, NGO “Legalife”, Ukraine Andrey Poshtaruk, UNFPA Ukraine Yuri Yoursky, Association XY, Bosnia and Herzegovina Zoran Jordanov, Marija Rakovic, UNFPA Serbia Eurasian Coalition on Male Health (ECOM) Arian Boci, NGO EGAL (Equality for Gays and Lesbians), Gennady Roshchupkin, Alexander Yurchenko, NGO Stop AIDS, Albania the former Yugoslav Republic of Macedonia Eurasian Coalition on Male Health (ECOM) menZDRAV Foundation, Ukraine Elizabeta Bozinoska, Firuz Karimov, Salokhiddin Saibov, Irina Zharuk, HERA - Health Education and Research UNFPA Tajikistan Tajik Family Planning Alliance, Tajikistan Alliance for Public Health, Ukraine Association, the former Yugoslav Republic of Masrur Karimov, Dilshod Saidburkhonov, Macedonia UNFPA Tajikistan Republican AIDS Centre, Tajikistan Fatima Cengic, Andriy Klepikov, Tetiana Slobodian, UNFPA Bosnia and Herzegovina Alliance for Public Health, Ukraine Women Health and Family Planning, Ukraine COORDINATING GROUP Galina Chirkina, Marina Kornilova, Uroš Smiljanić, James Baer, Coordinating Editor Reproductive Health Alliance, Kyrgyzstan Alliance for Public Health, Ukraine Serbian Association for Sexual and Reproductive Jennifer Butler, UNFPA Eastern Europe and Dalila Davidhi, Magda Kostava, Health and Rights (SRH), Serbia Central Asia Regional Office Community member, Albania Association HERA XXI (Health Education Rights Cholpona Egeshova, UNFPA, Kyrgyzstan Alternative), Georgia Daniel Kalajdjieski, UNFPA, the former Yugoslav Ivan Lavrentjev, Republic of Macedonia Lena Luyckfasseel, IPPF European Network Daniel McCartney, IPPF Natalia Zakareishvili, UNFPA, Georgia Ilya Zhukov, UNFPA Headquarters - 4 - HEALTH, RIGHTS & WELL-BEING - Programming Tool for YKPs in EECA Region - 5 - ABBREVIATIONS DEFINITIONS OF KEY POPULATIONS ARV antiretroviral LGBTI lesbian, gay, bisexual, transgender Young people are those aged 10-24 years, as defined Young transgender people is an umbrella term for all and intersex by the UNAIDS Interagency Working Group on Key young people whose internal sense of their gender (their CRC Convention on the Rights Populations.1 Within this age range, children are below gender identity) is different from the sex they were of the Child MSM man who has sex with men/men the age of 18 years, unless, under the law applicable to assigned at birth. Someone born female who identifies the child, majority is attained earlier. Adolescents are as male is a transgender man/boy. A transgender who have sex with men those aged 10–19 years. woman/girl is someone born male who identifies as CSE comprehensive sexuality