A 2006 survey of street youth at pre-mapped street youth locations in St. Petersburg, Russia, found extremely high HIV seroprevalence (37.4%) among 313 street youth aged 15-19 years of age, strongly associated with injection drug use, which was reported by 50.6% of participants. In response, multi-sectoral social support and prevention measures were instituted. In 2012, we conducted a follow-up survey of 15- to 19-year-old street youth using the same study procedures as in 2006. Of 311 participants, 45 (14.5%) reported injection drug use; 31 participants (10.0%, 95% confidence interval, 6.0%-16.2%) were HIV-seropositive. Predictors independently associated with HIV seropositivity included injection drug use (adjusted prevalence ratio 53.1) and transactional sex (adjusted prevalence ratio 1.3). None of the 178 participants aged 15-17 years were HIV-positive. Thirty of 31 (96.8%) HIV-seropositive individuals reported injection drug use. Street youth in St Petersburg had a 73% decrease in HIV seroprevalence from 2006 to 2012, primarily due to decreased initiation of injection drug use. This marked reduction in the HIV epidemic among street youth occurred after implementation of extensive support programs and socio-economic improvements.

BACKGROUND: Little is known about the extent to which HIV-infected street youth (living part or full time on the streets) exhibit behaviors associated with HIV transmission in their interactions with youth not living on the streets ("non-street youth"). We aimed to determine prevalences and predictors of such "bridging behaviors": inconsistent condom use and needle sharing between HIV-positive street youth and non-street youth. METHODS: A total of 171 street youth in 3 Ukrainian cites were identified as HIV infected after testing of eligible participants aged 15 to 24 years after random selection of venues. Using data from these youth, we calculated prevalence estimates of bridging behaviors and assessed predictors using logistic regression. RESULTS: Overall, two-thirds of HIV-infected street youth exhibited bridging behaviors; subgroups with high prevalences of bridging included females (78.3%) and those involved in transactional sex (84.2%). In multivariable analysis, inconsistent condom use with non-street youth was associated with being female (adjusted prevalence ratio [aPR], 1.2; 95% confidence interval [CI], 1.1-1.4), working (aPR, 1.2; 95% CI, 1.03-1.4), multiple partners (aPR, 1.4; 95% CI, 1.2-1.6), and "never" (aPR, 1.4; 95% CI, 1.1-1.6) or "sometimes" (aPR, 1.3; 95% CI, 1.02-1.8) versus "always" sleeping on the street. Needle sharing with non-street youth was associated with being male (aPR, 1.4; 95% CI, 1.02-2.0), orphaned (aPR, 2.3; 95% CI, 1.8-3.0), and 2 years or less living on the streets (aPR, 1.8; 95% CI, 1.5-2.1). CONCLUSIONS: Bridging behaviors between HIV-infected street youth and non-street youth are common. Addressing the comprehensive needs of street and other at-risk youth is a critical prevention strategy.

BACKGROUND: Ukraine developed Europe's most severe HIV epidemic due to widespread transmission among persons who inject drugs (PWID). Since 2004, prevention has focused on key populations; antiretroviral therapy (ART) coverage has increased. Recent data show increases in reported HIV cases through 2011, especially attributed to sexual transmission, but also signs of potential epidemic slowing. We conducted a data triangulation exercise to better analyze available data and inform program implementation. METHODS AND FINDINGS: We reviewed data for 2005 to 2012 from multiple sources, primarily national HIV case reporting and integrated biobehavioral surveillance (IBBS) studies among key populations. Annually reported HIV cases increased at a progressively slower rate through 2011 with recent increases only among older, more immunosuppressed individuals; cases decreased 2.7% in 2012. Among women <25 years of age, cases attributed to heterosexual transmission and HIV prevalence in antenatal screening declined after 2008. Reported cases among young PWID declined by three-fourths. In 2011, integrated biobehavioral surveillance demonstrated decreased HIV prevalence among young members of key populations compared with 2009. HIV infection among female sex workers (FSW) remains strongly associated with a personal history of injecting drug use (IDU). CONCLUSIONS: This analysis suggests that Ukraine's HIV epidemic has slowed, with decreasing reported cases and older cases predominating among those diagnosed. Recent decreases in cases and in prevalence support decreased incidence among young PWID and women. Trends among heterosexual men and men who have sex with men (MSM) are less clear; further study and enhanced MSM prevention are needed. FSW appear to have stable prevalence with risk strongly associated with IDU. Current trends suggest the Ukrainian epidemic can be contained with enhanced prevention among key populations and increased treatment access.