Street-based adolescents at high risk of HIV in Ukraine

Young women who sell sex in Bangui, Central African Republic: a neglected group highly vulnerable to HIV

BACKGROUND

The objectives of this study were to determine the association between the vulnerability factors linked to human immunodeficiency virus (HIV) and other sexually transmitted infection among the young women who sell sex (YWSS) group (15-24 years) and adult sex workers, engaged in consensual sex for money (AFSW).

METHODS

A cross-sectional study was conducted among AFSW involved in commercial sex transactions. Prevalence ratios (PR) analysis was carried out using log-binomial regression model.

RESULTS

The prevalence of HIV-1 was 29.4% among YWSS compared to 19.6% among female sex worker (PR = 1.43 [1.07-1.91]). Consistent condoms use last 3 months were very low at 22.3% and 41.2%, respectively (PR = 0.52 [0.37-0.74]), the low education level among YWSS versus AFSW (PR = 0.55 [0.40-0.76]); YWSS having been a victim of sexual violence in the last 12 months (PR = 2.00 [1.52-2.63]), were also more likely to be HIV positive.

CONCLUSIONS

The YWSS had a high prevalence of HIV, experienced other socioeconomic vulnerabilities and remain a key population for comprehensive HIV programs. To reach all YWSS, programs need to consider many outreach programs and address the shared determinants of HIV risk.

Exploratory qualitative study examining acceptability of strategies to improve access to substance use treatment and HIV prevention services for young adults on probation in Ukraine

OBJECTIVE

Adults <30 years' of age experience elevated HIV-rates in Ukraine. Young adults (YA) involved in the criminal justice system (CJS) are at an increased HIV-risk given elevated rates of substance use, engagement in high-risk sexual behaviour and insufficient healthcare access. The objective of this exploratory study was to investigate the acceptability of strategies to refer and link CJS-involved YA to HIV-prevention and substance use treatment services from CJS settings.

DESIGN

We conducted qualitative individual interviews with CJS-involved YA (18-24 years), and CJS stakeholders. Interviews were guided by the Social Ecological Model. Interviews with YA explored substance use and sexual behaviour, and acceptability of strategies to link YA to HIV-prevention and substance use treatment services from CJS. Stakeholder interviews explored system practices addressing HIV-prevention and substance use and addiction. Data were analysed using Inductive Thematic Analysis.

SETTING

Data were collected in three locales, prior to the 2022 Russian-Ukrainian conflict.

PARTICIPANTS

Thirty YA and 20 stakeholders.

RESULTS

Most YA were men, reported recent injection drug use and were M age=23 years. YA were receptive to linkage to HIV-prevention services from CJS; this was shaped by self-perceived HIV-risk and lack of access to HIV-prevention services. YA were less receptive to being referred to substance use treatment services, citing a lack of self-perceived need and mistrust in treatment efficacy. Stakeholders identified multilevel contextual factors shaping acceptability of HIV-prevention and substance use treatment from CJS (eg, stigma).

CONCLUSIONS

Findings should be reviewed as a historical record of the pre-conflict context. In that context, we identified strategies that may have been used to help curtail the transmission of HIV in a population most-at-risk, including CJS-involved YA. This study demonstrates that improving access to substance use treatment and HIV-prevention services via CJS linkage were acceptable if provided in the right conditions (eg, low or no-cost, confidential).

High risky behavior and HIV/AIDS knowledge amongst street children in Shiraz, Iran

Background: Street children around the world are accompanying a wide range of risky behaviors. The most common ones include risky sexual behavior, substance and alcohol abuse, and violence. This study aimed to assess risk behaviors and HIV knowledge of street children in Shiraz. Methods: A total of 329 street children (7-18 years of age who spend days or nights on streets with or without their family for earning money) were interviewed through 2014-2016 in Shiraz. Data were collected through a structured interview about high-risk behaviors and HIV/AIDS Knowledge based on a form and questionnaire. Street children were asked to identify HIV/AIDS mode of transmission. All correct answers were scored as one (1), and incorrect, "don't know" responses and no responses scored as zero. The data were analyzed by SPSS software 16 (SPSS, Inc. Chicago, USA) using the Independent t-test and chi-square test, and Pearson's correlation test. P value< 0.05 was considered as statistically significant Results: The mean ± SD age was 13.46±3.09. A total of 86.6% of them were boys. A total of 97.6% of them reported staying with their parents. Street children reported sleeping place as follow: with their parents (n=312, 94.8%), sharing accommodation with other kids (n=13, %4), sleeping in parks (n=2, 7%), and one with relatives. The frequency of smoking, alcohol drinking, and drug abuse were 35 (10.6%), 47 (14. 3%), and 6 (1.8%) respectively. A total of 43 (13.1%) street children reported sexual activity, among them 30 (9.1%) had sexual activity without a condom. Mean ± SD HIV/AIDS knowledge scoring of street children was, 4.1±3.9. Conclusion: Special programs should be implemented in order to reduce high-risk behavior among street children. Intervention should include increasing awareness about alcohol and drug abuse, HIV/AIDS knowledge, sexual and verbal abuse through an organized system with the help of peer education.

Outcomes of the "STEPS" HIV prevention training program for young males in the penitentiary institution, Ukraine

Purpose Ukraine has one of the fastest growing HIV epidemics globally. Due to their engagement in high-risk behaviors, adolescents and emerging adults involved with the penitentiary system are at a particularly high risk of HIV-acquisition. To address the epidemic, young males (aged 14 to 20 years) in penitentiary institutions across Ukraine participated in a ten-week, group-based HIV-prevention intervention (STEPS). The paper aims to discuss these issues. Design/methodology/approach The authors analyzed clinical and programmatic services data collected as part of an evaluation of the STEPS intervention. Paired t-tests and χ² were used to examine pre- and post-intervention differences in HV knowledge, attitudes, and risk behaviors and alcohol and other drug use knowledge. Findings In total, 105 male youths participated in the ten-session STEPS intervention. At baseline, males reported high frequencies of risk behaviors (e.g. unprotected sexual activity, injection drug use), moderate levels of HIV-related knowledge, and negative attitudes toward HIV and people living with HIV. At follow-up (immediately following the last STEPS session), participants' HIV-related knowledge substantially improved and participants tended to have more favorable attitudes toward HIV. Research limitations/implications Outcomes suggest that knowledge and attitudes about HIV among Ukrainian incarcerated youth can improve as a result of group-based HIV-prevention intervention. Originality/value In Ukraine, individuals involved with the criminal justice system are one of the populations most-at-risk for HIV; criminal justice-involved adolescents and young adults are disproportionately affected by the HIV epidemic. Research among this sub-population is limited. This study aims to address this gap by evaluating an on-going group-based HIV-prevention program designed to reduce adolescent risk of HIV.

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

INTRODUCTION

The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities.

METHODS

We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes.

RESULTS AND DISCUSSION

The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed.

CONCLUSIONS

Limited data available indicate uneven outcomes in paediatric services and some shared challenges for adolescent transition including retention in care and adherence. The impact of issues specific to low prevalence, concentrated epidemic settings are poorly understood to date. Outcome data are urgently needed to guide management strategies and advocate for service provision in these regions.

Paying for Sex by Young Men Who Live on the Streets in Dhaka City: Compounded Sexual Risk in a Vulnerable Migrant Community

PURPOSE

Dhaka City is home to thousands of migrants from Bangladesh's rural areas who often live in the streets. Prior studies examine street youth's practice of selling sex as a survival mechanism. We assess their less-studied practice of paying for sex and its association with sexual risk behaviors and outcomes.

METHODS

As part of the global Link Up project, trained interviewers recruited 447 young men who live on the streets, ages 15-24, from seven Dhaka City "hotspots" to participate in a survey about sexual health. Among those who ever had sex, we examined frequencies and conducted bivariate analyses of sociodemographic characteristics by paying for sex status. We then conducted bivariate and multivariate logistic regression analyses of paying for sex in the last 12 months and sexual health behaviors and outcomes.

RESULTS

Median participant age was 18 years. Among those who ever had sex (N = 321), 80% reported paying for sex in the last 12 months and 15% reported selling sex in the last 12 months. In multivariate analyses, those who paid for sex had significantly increased odds of reporting sexually transmitted infection-related symptoms in the last six months (adjusted odds ratio = 1.76, 95% confidence interval [CI] = 1.17-2.64) and engaging in unprotected last sex with a nonprimary partner (adjusted odds ratio = 2.19, CI = 1.58-3.03).

CONCLUSIONS

The adverse factors associated with paying for sex among young men who live on the streets in Dhaka City highlight the need for programs to educate on HIV/sexually transmitted infection prevention and promote condom use, STI screening/treatment, and HIV testing in this population.

Sexual abuse and risky sexual behaviors among young female hawkers in Burkina Faso: a mixed method study

BACKGROUND

Young street hawkers in Burkina Faso are increasingly exposed to workplace hazards such as physical and sexual abuse, and also unsafe sexual practices. The objectives of this study were to identify the socio-demographic status and work characteristics of young female hawkers, describe their sexual behavior and their experience with regards to sex-related violence at the workplace.

METHODS

The study used a mixed design combining qualitative and quantitative methods. It was carried out in two traffic stations in Burkina Faso namely Bittou customs station and Boromo bus station. Female hawkers aged 13 - 24 years were invited to participate in a questionnaire survey and local key informants were recruited to partake in an in-depth interview. The recruitment was based on their duties related to the hawkers.

RESULTS

The study included 264 participants in the survey and 16 interviewees. The survey showed that three quarter of participants had primary education or lower. About half of them had been sexually harassed, with clients, public members and co-hawkers as the most common source of assault. Most (68.6%) hawkers were sexually active; among them 43.7% had received money or gifts for sex. Positive factors associated with commercial sex include working in Boromo and age above 17, while negative factors include being Muslim and having female genital mutilation. The interviews confirmed the relationship between hawking and the socio-economic situation of participant's family, and pointed out societal factors that expose hawkers to risky sexual behaviors.

CONCLUSION

This study provides a better understanding of young female hawking activity in Boromo and Bittou. Implementing an empowerment program for female street vendors and their families, and an efficient surveillance system might help reduce these hazards.

Accessibility to sexual and reproductive health and rights education among marginalized youth in selected districts of Tanzania

Introduction

Access to information, education and services is central in the promotion of sexual and reproductive health and rights (SRHR) among young people. It enables young people make informed choices on sexuality matters, hence reduce teenage pregnancies and sexually transmitted infections (STIs). This study assessed accessibility of SRH rights’ information among marginalized young people in three municipalities of Iringa, Ilala and Kinondoni in Tanzania.

Methods

A cross-sectional study design using mixed methods was conducted in 2013 in three selected districts of Tanzania. We randomly selected 398 young people including those with disabilities to partake in quantitative survey while 48 community members were purposely selected for qualitative part. Quantitative data analysis was done using descriptive statistics and chi square test with the assistance of the Statistical Package for Social Science(SPSS) version 20, while qualitative data was thematically analyzed.

Results

There were 396 (99%) participants (144 Males and 251 females), with a mean age of 20.1years. The majority were out of school female, cohabiting and had completed secondary education. Overall, 317 (79.6%) had SRH rights knowledge. The leading sources of SRH rights information were peer educators (36.7%) and radio (22.8%). Awareness regarding laws and policies related to SRH right was 55.1%. However, young people living with HIV and school truants had more access to SRHR education and services than the other youth groups(χ2 30.69, p< 0.0001). The qualitative study revealed that parents and teachers perceived themselves to be incompetent in providing SRH information to their youngsters despite of being mostly trusted.

Conclusion

Access to SRH rights information is high but decreases when it is disaggregated across different age groups. There is a need for diversified approach for reaching specific groups of young people depending on their needs and circumstances

A pressing need to respond to the needs and sexual and reproductive health problems of adolescent girls living with HIV in low- and middle-income countries

INTRODUCTION

This commentary provides the rationale and makes a call for greater investment and effort to meet the sexual and reproductive health (SRH) problems of adolescent girls living with HIV in low- and middle-income countries (LMIC).

DISCUSSION

Adolescent girls in LMIC are at a greater risk of acquiring HIV infection than their male peers. They also face a number of other serious SRH problems--early pregnancy, pregnancy- and childbirth-related complications, unsafe abortions, sexual abuse and intimate partner violence and sexually transmitted infections. While many LMIC have made notable progress in preventing HIV in children and adults and in improving the access of these population groups to HIV treatment and care, adolescents in general and adolescent girls in particular have not received the same effort and investment.

CONCLUSIONS

Much more needs to be done to implement proven approaches to prevent new HIV infections in adolescent girls in LMIC and to meet the needs of those living with HIV.

Global Epidemiology of HIV Among Women and Girls Who Use or Inject Drugs: Current Knowledge and Limitations of Existing Data

BACKGROUND

Women and girls who use and inject drugs are a critical population at risk of HIV. In this article, we review data on the epidemiology of drug use and injection among women globally and HIV prevalence among women and girls who use and inject drugs.

RESULTS

Women and girls comprise one-third of people who use and inject drugs globally. There is substantial variation in HIV prevalence in this population, between and within countries. There is a pronounced lack of data examining HIV risk among particularly vulnerable subpopulations of women who use and inject drugs, including women who have sex with women, transgender women, racial and ethnic minority women, and young women. Women who use and inject drugs experience stigma and discrimination that affect access to services, and high levels of sexual risk exposures.

CONCLUSIONS

There are significant gaps in our understanding of the epidemiology of drug use and injecting among women and girls and HIV risk and prevalence in this population. Women are frequently underrepresented in studies of drug use and HIV risk and prevalence among people who inject drugs, limiting our understanding of possible sex differences in this population. Most research originates from developed countries and may not be generalizable to other settings. A great deal of work is needed to improve understanding of HIV among particularly vulnerable subpopulations, such as transgender women who use drugs. Better data are critical to efforts to advocate for the needs of women and girls who use and inject drugs.

Tailored combination prevention packages and PrEP for young key populations

INTRODUCTION

Young key populations, defined in this article as men who have sex with men, transgender persons, people who sell sex and people who inject drugs, are at particularly high risk for HIV. Due to the often marginalized and sometimes criminalized status of young people who identify as members of key populations, there is a need for HIV prevention packages that account for the unique and challenging circumstances they face. Pre-exposure prophylaxis (PrEP) is likely to become an important element of combination prevention for many young key populations.

OBJECTIVE

In this paper, we discuss important challenges to HIV prevention among young key populations, identify key components of a tailored combination prevention package for this population and examine the role of PrEP in these prevention packages.

METHODS

We conducted a comprehensive review of the evidence to date on prevention strategies, challenges to prevention and combination prevention packages for young key populations. We focused specifically on the role of PrEP in these prevention packages and on young people under the age of 24, and 18 in particular.

RESULTS AND DISCUSSION

Combination prevention packages that include effective, acceptable and scalable behavioural, structural and biologic interventions are needed for all key populations to prevent new HIV infections. Interventions in these packages should meaningfully involve beneficiaries in the design and implementation of the intervention, and take into account the context in which the intervention is being delivered to thoughtfully address issues of stigma and discrimination. These interventions will likely be most effective if implemented in conjunction with strategies to facilitate an enabling environment, including increasing access to HIV testing and health services for PrEP and other prevention strategies, decriminalizing key populations' practices, increasing access to prevention and care, reducing stigma and discrimination, and fostering community empowerment. PrEP could offer a highly effective, time-limited primary prevention for young key populations if it is implemented in combination with other programs to increase access to health services and encourage the reliable use of PrEP while at risk of HIV exposure.

CONCLUSIONS

Reductions in HIV incidence will only be achieved through the implementation of combinations of interventions that include biomedical and behavioural interventions, as well as components that address social, economic and other structural factors that influence HIV prevention and transmission.

Providing comprehensive health services for young key populations: needs, barriers and gaps

INTRODUCTION

Adolescence is a time of physical, emotional and social transitions that have implications for health. In addition to being at high risk for HIV, young key populations (YKP) may experience other health problems attributable to high-risk behaviour or their developmental stage, or a combination of both.

METHODS

We reviewed the needs, barriers and gaps for other non-HIV health services for YKP. We searched PubMed and Google Scholar for articles that provided specific age-related data on sexual and reproductive health; mental health; violence; and substance use problems for adolescent, youth or young sex workers, men who have sex with men, transgender people, and people who inject drugs.

RESULTS

YKP experience more unprotected sex, sexually transmitted infections including HIV, unintended pregnancy, violence, mental health disorders and substance use compared to older members of key populations and youth among the general population. YKP experience significant barriers to accessing care; coverage of services is low, largely because of stigma and discrimination experienced at both the health system and policy levels.

DISCUSSION

YKP require comprehensive, integrated services that respond to their specific developmental needs, including health, educational and social services within the context of a human rights-based approach. The recent WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations are an important first step for a more comprehensive approach to HIV programming for YKP, but there are limited data on the effective delivery of combined interventions for YKP. Significant investments in research and implementation will be required to ensure adequate provision and coverage of services for YKP. In addition, greater commitments to harm reduction and rights-based approaches are needed to address structural barriers to access to care.

Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support

Access to youth friendly health services is vital for ensuring sexual and reproductive health (SRH) and well-being of adolescents. This study is a descriptive review of the effectiveness of initiatives to improve adolescent access to and utilization of sexual and reproductive health services (SRHS) in low- and middle-income countries. We examined four SRHS intervention types: (1) facility based, (2) out-of-facility based, (3) interventions to reach marginalized or vulnerable populations, (4) interventions to generate demand and/or community acceptance. Outcomes assessed across the four questions included uptake of SRHS or sexual and reproductive health commodities and sexual and reproductive health biologic outcomes. There is limited evidence to support the effectiveness of initiatives that simply provide adolescent friendliness training for health workers. Data are most ample (10 initiatives demonstrating weak but positive effects and one randomized controlled trial demonstrating strong positive results on some outcome measures) for approaches that use a combination of health worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media. We found a paucity of evidence on out-of-facility-based strategies, except for those delivered through mixed-use youth centers that demonstrated that SRHS in these centers are neither well used nor effective at improving SRH outcomes. There was an absence of studies or evaluations examining outcomes among vulnerable or marginalized adolescents. Findings from 17 of 21 initiatives assessing demand-generation activities demonstrated at least some association with adolescent SRHS use. Of 15 studies on parental and other community gatekeepers' approval of SRHS for adolescents, which assessed SRHS/commodity uptake and/or biologic outcomes, 11 showed positive results. Packages of interventions that train health workers, improve facility adolescent friendliness, and endeavor to generate demand through multiple channels are ready for large-scale implementation. However, further evaluation of these initiatives is needed to clarify mechanisms and impact, especially of specific program components. Quality research is needed to determine effective means to deliver services outside the facilities, to reach marginalized or vulnerable adolescents, and to determine effective approaches to increase community acceptance of adolescent SRHS.

Gender differences between predictors of HIV status among PWID in Ukraine

BACKGROUND

The HIV epidemic in Ukraine is among the largest in Europe. While traditionally the epidemic has spread through injection risk behavior, sexual transmission is becoming more common. Previous research has found that women in Ukraine have higher rates of HIV and engage in more HIV risk behavior than men. This study extended that work by identifying risk factors that differentially predict men and women's HIV status among people who inject drugs (PWID) in Ukraine.

METHODS

From July 2010 to July 2013, 2480 sexually active PWID with unknown HIV status were recruited from three cities in Ukraine through street outreach. The average age was 31 years old.

RESULTS

Women, who made up twenty-eight percent of the sample, had higher safe sex self-efficacy (p<.01) and HIV knowledge (p<.001) than men, but scored higher on both the risky injection (p<.001) and risky sex (p<.001) composite scores than men. Risky sex behaviors were associated with women's HIV status more than men's. We also report results identifying predictors of risky injection and sex behaviors.

CONCLUSIONS

Gender-specific interventions could address problem of HIV risk among women who inject drugs in a country with a growing HIV epidemic. Our findings suggest specific ways in which intervention efforts might focus on groups and individuals who are at the highest risk of contracting HIV (or who are already HIV positive) to halt the spread of HIV in Ukraine.

Knowledge, attitude and behavioral intention to act regarding HIV infection and prevention in immigrants from the Former Soviet Union in Germany: a comparative study with the native population

In Germany, immigrants from Former Soviet Union (FSU) countries represent one of the largest immigrant groups. Some FSU countries face the highest HIV prevalence in the region of Eastern Europe and Central Asia. However, the HIV knowledge, attitude and behavioral intent have not been investigated in FSU immigrants compared to the native population yet. A cross-sectional anonymous survey among 1,205 FSU immigrants and 435 native Germans (aged 18-65 years) in Bavaria. Data analysis from the participating 435 (36 %) immigrants and 334 (76.8 %) natives showed that the immigrants were less knowledgeable (p < .001) about HIV transmission (median score 8 vs. 9, ranged from 0 to 10) and HIV prevention (4 vs. 5, ranged from 0 to 6) than the native Germans, especially with regard to HIV transmission during anal (67 vs. 79.1 %; OR = 1.86 [1.32-2.62]) and oral (49.7 vs. 61.8 %; OR = 1.63 [1.21-2.20]) intercourse and showed a high misconception rate. Age and education were associated with knowledge about sexual HIV transmission; male gender, age and education with HIV prevention by single-use of needles/syringes. In case of a suspected HIV contraction, fewer immigrants would request a test; in case of a confirmed HIV diagnosis fewer would use a condom or inform their sexual partner(s). This first comparative study indicates an urgent need for HIV/AIDS education among FSU immigrants.

The Age of Initiation of Drug Use and Sexual Behavior May Influence Subsequent HIV Risk Behavior: A Systematic Review

Researchers examining injection drug users (IDUs) in drug treatment have been trying for decades to determine the optimal way to intervene to prevent the transmission and spread of human immunodeficiency virus (HIV) in this population. Although efficacious HIV risk reduction interventions are widely available, questions remain about what specific factors are most related to HIV risk behavior and defined as unprotected sexual activity and/or high risk drug use. This review involved an evaluation of the research literature in order to better understand the association between drug use and sexual behavior debut on HIV risk behavior. Findings suggest that drug use debut and sexual behavior debut may be related to subsequent HIV risk behavior. Evidence to date implies that intervening at an earlier age to assist youth to avoid or delay these high risk behaviors may be an additional means of reducing subsequent HIV risk.

HIV Prevention and Rehabilitation Models for Women Who Inject Drugs in Russia and Ukraine

Women who inject drugs require gender-specific approaches to drug rehabilitation, modification of risk behaviors, and psychosocial adaptation. Improved outcomes have been demonstrated when the specific needs of women's subpopulations have been addressed. Special services for women include prenatal care, child care, women-only programs, supplemental workshops on women-focused topics, mental health services, and comprehensive programs that include several of the above components. To address the special needs of women injecting drug user (IDU) subpopulations, such as HIV-positive pregnant women and women with young children, recently released female prisoners, and street-involved girls and young women, HealthRight International and its local partners in Russia and Ukraine have developed innovative service models. This paper presents each of these models and discusses their effectiveness and implementation challenges specific to local contexts in Russia and Ukraine.

Review of HIV vulnerability and condom use in central and eastern Europe

The epidemiological trend of increasing HIV incidence rates due to sexual transmission in central and eastern Europe has been documented. The current review analysed research articles that report on a wide spectrum of vulnerable populations from this world region. Studies of injection drug users, commercial sex workers, men who have sex with men, adolescents and young adults all reported inconsistent condom use. However, these patterns varied across populations and geographic areas. Populations in former Soviet countries - the most affected by HIV - also often appeared to have lower condom use rates. Intensified, comprehensive and locally tailored measures to curb sexual HIV transmission are urgently needed. Social development programs need to incorporate HIV prevention.