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This is a study on perceptions of child abuse and interventions in cases of abuse in the Family and Childhood Support Centres in Saint Petersburg, Russia. It raises the following questions: what is the divergence between the level of abuse experienced by a child and that recognized by adults? What are the conditions for recognition of the child as a victim of abuse by social workers? What interventions will the family and the child receive when the child recognized as a victim? To answer these questions, we conducted qualitative interviews with children and parents along with the social workers supporting them. The study confirms that children face abuse much more often than is recognized by adults. The child is more likely to be recognized as a victim if the parent reported the abuse, the abuse led to physical injury, or if it happened in the family. The child may be recognized as a victim if the child’s entry point into the system is through runaway or delinquent behaviour. However, in these cases, the child would more likely be treated as deviant than victimized. The child is less likely to be recognized as a victim in cases of corporal punishment within the family or abuse outside of the family (i.e., school bullying). Intervention into a case of abuse is usually focused on the mother of the child and involves enhanced supervision and social control of both the mother and the child.

Child sexual exploitation (CSE) is a major risk factor for acquiring human immunodeficiency virus/sexually transmitted infections (HIV/STI), violence and other health concerns, yet few studies have examined these associations in Russia until now. This study examines the prevalence of CSE (those entering the sex trade as a minor) among women in the sex trade in Russia and how exposures and behaviors related to violence and HIV/STI structural risks differ from those who entered the sex trade as an adult. Women in the sex trade (N = 896) in St. Petersburg and Orenburg, Russia were recruited via time-location sampling and completed structured surveys. Adjusted logistic regression analyses assessed associations between CSE victimization and HIV risk-related exposures. Of the 654 participants who provided their age at first sexual exploitation, 11% reported CSE prior to age 18. Those who reported CSE were more likely to be organized by others and to be prohibited from leaving a room or house and from using condoms, three-quarters experienced rape when trading sex, a third were involved in pornography before age 18 and they had less education if they entered the sex trade as a minor. In adjusted analyses, those entering the sex trade as a minor were significantly more likely than those entering the sex trade as an adult to report drug use prior to age 18 (AOR = 5.75, 95% CI = 2.53&ndash, 13.09) to have &ge, 5 clients/day (past 12 months, AOR = 3.55, 95% CI = 1.56&ndash, 8.08), to report receiving police assistance (AOR: 3.10, 95% CI = 1.26&ndash, 7.54), and to have fewer experiences of police extortion (AOR = 0.35, 95% CI = 0.10&ndash, 1.24). They were four times more likely to participate in pornography before the age of 18 (AOR = 4.08, 95% CI = 1.32, 12.60) and three times more likely to have been sexually abused as child (AOR = 2.93, 95% CI = 1.27, 7.54). Overall, entry as a minor was related to greater risk for victimization and an inability to protect oneself from STI/HIV.

© 2015 Elsevier Ltd. Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1-31) and 20% in Canada (95% UI 3-39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25-42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8-36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33-46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.