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Professor Natalya Nizova

Provision of Assistance and Services in Reproductive Health for HIV-Positive Women Including IDUs in Ukraine. Professor Natalya Nizova AIHA Prevention of Mother-to-Child Transmission of HIV Project Manager in Ukraine Amsterdam, 13-15 November 2006.

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Professor Natalya Nizova

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  1. Provision of Assistance and Services in Reproductive Health for HIV-PositiveWomen Including IDUsin Ukraine Professor Natalya Nizova AIHA Prevention of Mother-to-Child Transmission of HIV Project Manager in Ukraine Amsterdam, 13-15 November 2006

  2. Total Number of IDUs Registered in Ukraine (Addiction Register Data) • Among new cases of HIV in Ukraine in 2005 – 60% IDUs about half of them being women of reproductive age. • Per 100 thou registered IDUs the annual turnover exceeds $ 350 million • Ukrainian MoH developed a draft concept of the state policy on alcohol and drugs • The addiction assistance system in Ukraine needs reformation – the IDU resocialisation system is being developed very slowly – just 6% of drug users after receiving inpatient treatment get rehabilitation services • (from materials of Parliamentary hearings, July 2005)

  3. HIV-+ women are discriminated and stigmatised both by the society and medical staff first of all because of the opinion that they are usually CSWs or IDUs. HIV+ status in half of cases was also a cause of abortion in some cases – as a result of pressure put by medical staff (POLICY project research, 2004) • Concept of the state programme Reproductive Health of the Nation for 2006-2015 is based on the WHO strategy “… enhancing …reproductive health (RH)… by organising more accessible and less costly primary medical and sanitary aid of high quality including services for protection of sexual and RH”. Priorities include: - ... provision of RH services by general practitioners and family doctors - improving the FP system in Ukraine - developing health protection mechanisms for socially unprotected population groups

  4. In 2003 in Ukraine women received services provided by:- 11 thou obstetricians and gynaecologists (4.7 per 10 thou of female population)- 416 obstetricians and gynaecologists for children and adolescents- 24.5 thou midwives (10.4 per 10 thou of female population)- 24.7 thou of paediatricians (3.6 per 10 thou of child population) • In 2003 the state and communal health sectors had: - 15,655 offices of medical assistants and midwives - 1,845 women’s health clinics and women’s health departments in polyclinics - 2,037 examination offices - 95 medical genetic counselling offices - 73 counselling centres on marriage and family issues - 3,258 children's polyclinics, health clinics, departments and offices - 907 offices for adolescents EFFECTIVENESS OF FP AND RH WORK WITH HIV+ WOMEN AND IDUs????

  5. MoH of Ukraine UNDESIRABLE PREGNANCY IN 92% OF CASES ENDS WITH ABORTION Pregnancy Outcomes in HIV+ Women (from presentation by N. Y. Zhilka, 2005)

  6. The harm reduction and prevention strategy for IDUs (in Ukraine) is now not implemented widely enough to ensure significant impact on the current/future epidemicsThe second-generation of HIV epidemiological surveillance is crucial for monitoring the trends of the epidemiological process. Expansion from “conventional” risk groups to “bridge” groups, etc.The need to integrate services for HIV+ women into reproductive health servicesPrerequisites for common problems relating to undesirable pregnancies in UkraineThe situation seems to be acute among HIV+ women some of whom have limited access to health servicesThe issue of needs for specific contraceptives for women receiving HAARV therapy will become increasingly important with the expansion of the ARV therapyRECOMMENDATION: Systemic offer of family planning services to HIV-positive women defined by antenatal testing during antenatal and postnatal periodDr. Clair Torn, Centre for Paediatric Epidemiology and Biostatistics of the Child Health Institute, University College, London (S.-Petersburg, 2006)

  7. Satellite Clinic: New Model of Decentralised Care Provision Odessa County Hospital • Goal: to provide more accessible and anonymous care and improve the quality of life PLWH • Services provided include • HIV tests, clinical services to family, laboratory tests, psychological social support and adherence support, primary medical services • Very close cooperation with Odessa County AIDS Centre including legal database exchange as well as cooperation with NGOs that provide “peer-to-peer” counselling, adherence support, etc. • Advantages of the clinic: • Better accessible territorial location in the city than the AIDS Centre • Visiting the clinic involves less stigmatisation than visiting the AIDS Centre • In 2006 it will become a place providing comprehensive care services (ARV will also be prescribed in the clinic)

  8. HPI PATH AIHA IEC: 15 Peer: 60 Caregivers trained: 228 MOH, Ministry for Family, Youth and Sport, Health Administrations Coordinating Committees VCT: 900 TOT (planned): 24 TOT: 35 VCT: 335 Pregnant women, mothers, families children Ob/Gyns Paediatricians NGOs Midwives Methodological Centres of PMTCT Excellence 100 30 EBM PMTCT: IEC materials (PATH, JSI, HPI) Training materials (PATH, WHO/USG/AIHA, HPI) JSI Research (PATH, JSI, HPI)

  9. Thank you!

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