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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.

Background Extensive research documents that female sex workers (FSWs) in Russia are very vulnerable to abuses from police, including police sexual coercion. However, despite qualitative data suggesting abusive policing practices are more likely for FSWs contending with substance abuse issues and risky sex work contexts, there is a paucity of quantitative study evaluating these associations specifically in terms of police sexual coercion. Such research is needed to guide structural interventions to improve health and safety for FSWs in Russia and globally. Objective The purpose of this study is to assess the prevalence of police sexual coercion among FSWs from two Russian cities, St. Petersburg and Orenburg, and to determine whether riskier sex work behaviors and contexts and substance use behaviors, including both IDU and risky alcohol use, are associated with increased risk for sexual coercion from police. Method FSWs in St. Petersburg and Orenburg were recruited via time-location and convenience sampling and completed structured surveys on demographics (age, education), sex work risks (e.g., violence during sex work) and substance use. Logistic regression analyses assessed associations of substance use and risky sex work with police sexual coercion, adjusting for demographics. Results Participants ( N =896) were aged 15 and older (94% were 20+ years). Most (69%) reported past year binge alcohol use, and 48% reported IDU the day before. Half (56%) reported 4+ clients per day. Rape during sex work ever was reported by 64%. Police sexual coercion in the past 12 months was reported by 38%. In the multivariate model, both current IDU (AOR=2.09, CI=1.45–3.02) and past year binge alcohol use (AOR=1.46, CI=1.03–2.07) were associated with police sexual coercion, as was selling sex on the street (not in venues) (AOR=7.81, CI=4.53–13.48) and rape during sex work (AOR=2.04, CI=1.43–2.92). Conclusion Current findings document the substantial role police sexual violence plays in the lives of FSWs in Russia. These findings also highlight heightened vulnerability to such violence among self-managed and substance abusing FSWs in this context. Structural interventions addressing police violence against FSWs may be useful to improve the health and safety of this population.

We conducted a qualitative study of male sex work in St. Petersburg Russia with a focus on social vulnerabilities, HIV risk perception, and HIV-related behaviours. In-depth interviews were conducted with individuals knowledgeable about male sex work through their profession (n=8) and with male sex workers themselves (n=12). Male sex work involves a variety of exchanges including expensive vacations, negotiated monetary amounts, or simply access to food. Methods to find clients included the Internet, social venues (e.g. gay clubs and bars), and public places (e.g. parks). Use of the Internet greatly facilitated male sex work in a variety of ways. It was used by both individuals and agencies to find clients, and appeared to be increasing. Men often reported not being professionally connected to other male sex workers and limited disclosure about their work. Many were aware of the work-related risks to personal safety including violence and robbery by clients. Perceived risk for HIV was mostly abstract, and several exceptions to condom use with clients were noted. Alcohol use was reported as moderate but consumed frequently in association with work. These data suggest that the most salient risks for male sex workers include professional isolation, threats to personal safety, limited perceived HIV risk, and sub-optimal levels of condom use.

Injection drug users in Tirana, Albania and St. Petersburg, Russia were recruited into a study assessing HIV-related behaviors and HIV serostatus using Respondent Driven Sampling (RDS), a peer-driven recruitment sampling strategy that results in a probability sample. (Salganik M, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Method. 2004;34:193-239). This paper presents a comparison of RDS implementation, findings on network and recruitment characteristics, and lessons learned. Initiated with 13 to 15 seeds, approximately 200 IDUs were recruited within 8 weeks. Information resulting from RDS indicates that social network patterns from the two studies differ greatly. Female IDUs in Tirana had smaller network sizes than male IDUs, unlike in St. Petersburg where female IDUs had larger network sizes than male IDUs. Recruitment patterns in each country also differed by demographic categories. Recruitment analyses indicate that IDUs form socially distinct groups by sex in Tirana, whereas there was a greater degree of gender mixing patterns in St. Petersburg. RDS proved to be an effective means of surveying these hard-to-reach populations.

Objectives To ascertain HIV prevalence among people who inject drug (injection drug users (IDUs)) in the Russian Federation and identify explanations for the disparity in different cities. Design Cross-sectional survey with serological testing for HIV and hepatitis C virus prevalent infections. Setting 8 Russian cities—Irkutsk, Omsk, Chelyabinsk, Yekaterinburg, Naberezhnye Chelny, Voronezh, Orel and St Petersburg. Participants In 2007–2009 active IDUs were recruited by respondent-driven sampling with a target sample size of 300 or more in each city. Main outcome measures Participants were administered a questionnaire covering sociodemographics, injection risk and protective behaviours, sexual behaviours, HIV knowledge, experiences with drug treatment and harm reduction programmes and social networks. Participants were tested for HIV and hepatitis C by enzyme immunoassay. Data were analysed to identify individual-level, network-level and city-level characteristics significantly associated with HIV prevalence. Factors significant at p≤0.1 were entered into a hierarchical regression model to control for multicollinearity. Results A total of 2596 active IDUs were recruited, interviewed and tested for HIV and hepatitis C virus infection. HIV prevalence ranged from 3% (in Voronezh) to 64% (in Yekaterinburg). Although individual-level and network-level variables explain some of the difference in prevalence across the eight cities, the over-riding variable that seems to account for most of the variance is the emergence of commercial, as opposed to homemade, heroin as the predominant form of opioid injected. Conclusions The expansion of commercial heroin markets to many Russian cities may have served as a trigger for an expanding HIV epidemic among IDUs in that country.